Anatomic Study of the Dorsalis Pedis Artery, First Metatarsal Artery, and Second Metatarsal Bone for Mandibular Reconstruction

Category: Bunion Introduction/Purpose: The scarf osteotomy has gained in popularity for the treatment of a symptomatic hallux valgus deformity due to its inherent stability, versatility of correction and early mobilization. We have reported parallel-shaped modified scarf osteotomy(PSMSO) with good functional outcomes and no complication as stress fracture or troughing. However, we encountered second transfer metatarsalgia after the osteotomy. The scarf osteotomy can be shortened, but there was no specific amount of shortening that will produce transfer metatarsalgia in limitation of our literature review. In this study, we measured the shortening of first metatarsal length and investigated the relation of first metatarsal length and second transfer metatarsalgia after PSMSO for hallux valgus deformity. Methods: We retrospectively reviewed 168 consecutive PSMSOs performed in 124 patients with hallux valgus deformity between March 2009 and August 2015. Concomitant other pathologies of foot or previous second metatarsalgia were excluded. After excluding 45 cases, 123 cases in 88 patients were included. For clinical assessment, VAS, the AOFAS Hallux Metatarsophalangeal-Interphalangeal (AOFAS Hallux MTP-IP) Scale were obtained. The hallux valgus angle (HVA), the intermetatarsal angle (IMA), the distal metatarsal articular angle (DMAA), the first metatarsal length measured by a modified Davies and Saxby’s method and the protrusion of second metatarsal relative to first metatarsal using the Maestro’s method were assessed on standard weight bearing radiographs of the foot. For evaluation of the development of second transfer metatarsalgia, callosity or tenderness beneath the second metatarsal head was investigated. After identifying the lesion, we divided two groups with and without second transfer metatarsalgia and compared the variables after propensity score matching. Results: Mean follow-up period was 20.6±7.8 (12-66) months. The mean VAS and AOFAS Hallux MTP-IP score improved significantly (p<0.001). Significant corrections in the HVA, IMA and DMAA were obtained and the mean shortening of the first metatarsal length and the mean relative lengthening of second metatarsal protrusion were -3.1±2.5 mm and +2.5±2.8 mm at last follow-up (p<0.001, p<0.001). Eleven (8.9%, 11/123) cases developed second transfer metatarsalgia after PSMSO. After propensity score matching considered baseline characteristics, 9 cases with second transfer metatarsalgia were compared to 31 cases without it. The group with transfer metatarsalgia showed significant shortening in first metatarsal length and lengthening of second metatarsal protrusion relative to first metatarsal compared to those without the transfer lesion (-4.8±3.8 vs -2.0±2.1, p=0.013, +4.2±1.6 vs +1.9±2.1, p=0.005). Conclusion: Transfer metatarsalgia is one of numerous possible complications after scarf osteotomy. To avoid complications, we suggest that shortening of first metatarsal bone length should be minimized within -2 mm and second metatarsal protrusion relative to first metatarsal kept within +1.9 mm with considering the metatarsal parabola. If the shortening of first metatarsal was done over -4.8 mm, the additional procedure for second metatarsal may be considered.

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Avascular Necrosis of the First Metatarsal: A Case of Second Metatarsal Bone Transport with External Fixation

The Journal of Foot & Ankle Surgery ◽

10.1053/j.jfas.2019.04.008 ◽

2021 ◽

Author(s):

Bradley M. Lamm ◽

Kyle R. Moore ◽

Matthew Hentges ◽

Lanster R. Martin ◽

Jordan J. Ernst

Keyword(s):

External Fixation ◽

Avascular Necrosis ◽

Bone Transport ◽

Metatarsal Bone ◽

First Metatarsal ◽

Second Metatarsal

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Correlation of Different Methods of Measuring Pronation of the First Metatarsal on Weightbearing CT Scans

Foot & Ankle International ◽

10.1177/10711007211003090 ◽

2021 ◽

pp. 107110072110030

Author(s):

Matthew S. Conti ◽

Tamanna J. Patel ◽

Kristin C. Caolo ◽

Joseph M. Amadio ◽

Mark C. Miller ◽

...

Keyword(s):

Hallux Valgus ◽

Computer Aided Design ◽

Foot And Ankle ◽

Level Of Evidence ◽

3 Dimensional ◽

3D Cad ◽

First Metatarsal ◽

Hallux Valgus Deformity ◽

Second Metatarsal ◽

Α Angle

Background: There is no consensus in the foot and ankle literature regarding how to measure pronation of the first metatarsal in patients with hallux valgus. The primary purpose of this study was to compare 2 previously published methods for measuring pronation of the first metatarsal and a novel 3-dimensional measurement of pronation to determine if different measurements of pronation are associated with each other. Methods: Thirty patients who underwent a modified Lapidus procedure for their hallux valgus deformity were included in this study. Pronation of the first metatarsal was measured on weightbearing computed tomography (WBCT) scans using the α angle with reference to the floor, a 3-dimensional computer-aided design (3D CAD) calculation with reference to the second metatarsal, and a novel method, called the triplanar angle of pronation (TAP), that included references to both the floor (floor TAP) and base of the second metatarsal (second TAP). Pearson’s correlation coefficients were used to determine if the 3 calculated angles of pronation correlated to each other. Results: Preoperative and postoperative α angle and 3D CAD had no correlation with each other ( r = 0.094, P = .626 and r = 0.076, P = .694, respectively). Preoperative and postoperative second TAP and 3D CAD also had no correlation ( r = 0.095, P = .624 and r = 0.320, P = .09, respectively). However, preoperative and postoperative floor TAP and α angle were found to have moderate correlations ( r = 0.595, P = .001 and r = 0.501, P = .005, respectively). Conclusion: The calculation of first metatarsal pronation is affected by the reference and technique used, and further work is needed to establish a consistent measurement for the foot and ankle community. Level of Evidence: Level III, retrospective cohort study.

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Geometric Data of Hallux Valgus Feet

Foot & Ankle International ◽

10.1177/107110079601700907 ◽

1996 ◽

Vol 17 (9) ◽

pp. 548-554 ◽

Cited By ~ 19

Author(s):

Kenneth S. Lamur ◽

Anton Huson ◽

Chris J. Snijders ◽

Rob Stoeckart

Keyword(s):

Hallux Valgus ◽

Least Squares Method ◽

Metatarsal Bone ◽

Flexor Hallucis Longus ◽

Independent Variables ◽

First Metatarsal ◽

Linear Dependency ◽

Geometric Data ◽

Longus Muscle ◽

Stepwise Procedure

The aim of this study is to find basic quantitative geometric data that may contribute to the understanding of the etiology of hallux valgus. Embalmed specimens with existing hallux valgus (N = 39) were dissected; 28 variables were measured with a Vernier caliper gauge and toe goniometer. Correlations between pairs of independent variables were calculated. Linear dependency of the hallux angle, varus angle, and the width of the forefoot on a number of independent variables was analyzed by multiple linear regression. A least squares method and a stepwise procedure were used. The distance from the tendon of the flexor hallucis longus muscle to the head of the first metatarsal bone explains more than other variables the variation in hallux angle and width of the forefoot. A widened forefoot is significantly correlated with both hallux and varus angles. The interrelation of the predictor parameters illustrates the complicated hallux valgus phenomenon.

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The effects of gait speed on plantar pressure variables in individuals with normal foot posture and flatfoot

Acta of Bioengineering and Biomechanics ◽

10.37190/abb-01652-2020-02 ◽

2020 ◽

Vol 22 (3) ◽

Author(s):

Muge Kirmizi ◽

Yesim S. Sengul ◽

Salih Angin

Keyword(s):

Plantar Pressure ◽

Gait Speed ◽

Maximum Force ◽

First Metatarsal ◽

Fast Speed ◽

Pressure Sensitive ◽

Plantar Pressure Distribution ◽

Second Metatarsal ◽

Foot Posture ◽

All Speeds

Purpose: It is not known how gait speed affects plantar pressure characteristics in flatfoot. The aim of this work was to investigate the effects of gait speed on plantar pressure variables in flatfoot by comparing it to normal foot posture. Methods: Thirty individuals with flatfoot and 30 individuals with normal foot posture were recruited. Plantar pressure variables were obtained by a pressure-sensitive mat at self-selected slow, normal, and fast speeds. All assessments were performed on the dominant foot, and three satisfactory steps were obtained for each gait speed condition. The order of gait speeds was randomized. Results: In the flatfoot group, the contact area was higher in the midfoot, third metatarsal, and hallux at all speeds, also in the second metatarsal at slow and normal speeds than the normal foot posture group (p < 0.05). The maximum force was higher in the midfoot and hallux at all speeds in the flatfoot group (p < 0.05). Also, the maximum force was lower in the first metatarsal at normal and fast speeds, and in the lateral heel at fast speed (p < 0.05). In the flatfoot group, the peak pressure was found to be higher in the hallux at slow speed, but to be lower in the first metatarsal at fast speed (p < 0.05). Further, plantar pressure distribution was affected by gait speed in both feet. Conclusions: Analysis of plantar pressure variables should be performed at different gait speeds.

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HV Patients Show Greater Pronation of the First Metatarsal than Normals

Foot & Ankle Orthopaedics ◽

10.1177/2473011417s000030 ◽

2017 ◽

Vol 2 (3) ◽

pp. 2473011417S0000

Author(s):

Bradley Campbell ◽

Stephen Conti

Keyword(s):

Regression Analysis ◽

Hallux Valgus ◽

Three Dimensional ◽

Basic Sciences ◽

Weak Correlation ◽

Intermetatarsal Angle ◽

First Metatarsal ◽

Second Metatarsal ◽

Three Dimensional Models ◽

Standard Radiographs

Category: Basic Sciences/Biologics, Bunion, Midfoot/Forefoot Introduction/Purpose: The progression of the hallux valgus (HV) deformity demonstrates dorsiflexion and abduction; concomitant pronation has not received adequate documentation and the extent of pronation in the pathology is unknown even though correction of the deformity may need to address all three angles. To overcome the inability of standard radiographs to capture pronation, we have developed a means to assess the three dimensional deformity using CT scans. Our goal was to document the extent of pronation/supination both of the first phalanx with respect to the first metatarsal and of the first metatarsal with respect to the second metatarsal. Furthermore, we wanted to regress pronation against the intermetatarsal (IMA) angle of hallux valgus patients. Methods: Three-dimensional models were reconstructed from loaded and unloaded CT files of patients (10 HV, 10 normal). The orientations of specific bones, in anatomic directions, were determined by selecting landmarks on the surface of the phalanx and of the first and second metatarsals. The resulting calculations output a set of angles to determine the pronation/supination of the first metatarsal relative to the second and of the first phalanx relative to the first metatarsal. A regression analysis was conducted to extrapolate any relationship between adduction and pronation (known intermetatarsal and pronation). Results: The average pronation of the first metatarsal relative to the second metatarsal was 19.8 ± 7.1 and 28.3 ± 10.8 in the normal and HV groups respectively (p < 0.05). The influence of weightbearing demonstrated pronation angle differences that were greater in the normal group than in the HV group for both the IM pronation and the HV pronation (p < 0.05) (Figure 1). The differences in HV angles and IM angles between normal and HV patients were 22° and 7° respectively. The regression analysis of the pronation and intermetatarsal angle was not found to be significant, with a weak correlation (r2 = 0.26). Conclusion: The pronation of the first metatarsal relative to the second metatarsal between normal and HV patients is significantly different. While the first metatarsal had measurable pronation in patients with hallux valgus but that value was not predicted by the IMA. The findings of this study indicate pronation should be considered in any surgical technique that seeks to restore native configurations.

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Three-Dimensional Analysis of the First Metatarsal Bone in Minimally Invasive Distal Linear Metatarsal Osteotomy for Hallux Valgus

Foot & Ankle International ◽

10.1177/1071100719875222 ◽

2019 ◽

Vol 41 (1) ◽

pp. 84-93 ◽

Cited By ~ 1

Author(s):

Hiroyuki Seki ◽

Satoshi Oki ◽

Yasunori Suda ◽

Kenichiro Takeshima ◽

Tetsuro Kokubo ◽

...

Keyword(s):

Minimally Invasive ◽

Hallux Valgus ◽

Morphological Changes ◽

Case Series ◽

Metatarsal Bone ◽

Ct Scans ◽

Metatarsal Osteotomy ◽

Level Of Evidence ◽

3 Dimensional ◽

First Metatarsal

Background: Modified Bösch osteotomy (distal linear metatarsal osteotomy [DLMO]) is one of the minimally invasive correctional surgeries for hallux valgus. The 3-dimensional correctional angles and distances of the first metatarsal bone in DLMO have not been clarified. The purpose of this study was to analyze the 3-dimensional postoperative morphological changes of the first metatarsal bone in DLMO. Methods: Twenty patients (30 feet) who underwent DLMO were enrolled. Preoperative plain radiographs and computed tomography (CT) scans of the feet were examined. Postoperative radiographs and CT scans were also obtained after bone union. The surface data of the pre- and postoperative first metatarsals were reconstructed from the CT data. The positions of the distal ends of the first metatarsals described with respect to the proximal ends were calculated using CT surface-matching technique. Results: The distal end of the first metatarsal after DLMO was significantly supinated (10.2 ± 6.0 degrees, P < .001), adducted (6.0 ± 11.8 degrees, P = .004), dorsiflexed (11.1 ± 10.9, P < .001), shortened (7.4 ± 2.5 mm, P < .001), elevated (2.3 ± 3.1 mm, P = .001), and laterally shifted (8.2 ± 3.0 mm, P < .001) compared to the preoperative metatarsal distal end. Supination correction demonstrated a significant correlation with adduction correction ( r = 0.659, P < .001) on correlation analyses between these parameters. Conclusion: The 3-dimensional corrections of the first metatarsal bone after DLMO were evaluated. Pronation and abduction were successfully corrected. Furthermore, adduction correction might be an important factor affecting correction of pronation. Level of Evidence: Level IV, retrospective case series.

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The intersesamoidal ridge of the first metatarsal bone: anatomical basics and clinical considerations

Surgical and Radiologic Anatomy ◽

10.1007/s00276-003-0107-0 ◽

2003 ◽

Vol 25 (2) ◽

pp. 127-131 ◽

Cited By ~ 4

Author(s):

E. Brenner

Keyword(s):

Metatarsal Bone ◽

First Metatarsal ◽

Clinical Considerations

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Comparison of Postoperative Height Changes of the Second Metatarsal Among 3 Osteotomy Methods for Hallux Valgus Deformity Correction

Foot & Ankle International ◽

10.1177/1071100716666566 ◽

2016 ◽

Vol 38 (1) ◽

pp. 20-26 ◽

Cited By ~ 5

Author(s):

Jun Young Choi ◽

Yu Min Suh ◽

Ji Woong Yeom ◽

Jin Soo Suh

Keyword(s):

Hallux Valgus ◽

Deformity Correction ◽

Metatarsal Head ◽

Valgus Deformity ◽

Metatarsal Osteotomy ◽

Level Of Evidence ◽

First Metatarsal ◽

Scarf Osteotomy ◽

Hallux Valgus Deformity ◽

Second Metatarsal

Background: We aimed to compare the postoperative height of the second metatarsal head relative to the first metatarsal head using axial radiographs among 3 different commonly used osteotomy techniques: proximal chevron metatarsal osteotomy (PCMO), scarf osteotomy, and distal chevron metatarsal osteotomy (DCMO). Methods: We retrospectively reviewed the radiographs and clinical findings of the patients with painful callosities under the second metatarsal head, complicated by hallux valgus, who underwent isolated PCMO, scarf osteotomy, or DCMO from February 2005 to January 2015. Each osteotomy was performed with 20 degrees of plantar ward obliquity. Along with lateral translation and rotation of the distal fragment to correct the deformity, lowering of the first metatarsal head was made by virtue of the oblique metatarsal osteotomy. Results: Significant postoperative change in the second metatarsal height was observed on axial radiographs in all groups; this value was greatest in the PCMO group (vs scarf: P = .013; vs DCMO: P = .008) but did not significantly differ between the scarf and DCMO groups ( P = .785). The power for second metatarsal height correction was significantly greater in the PCMO group (vs scarf: P = .0005; vs DCMO: P = .0005) but did not significantly differ between the scarf and DCMO groups ( P = .832). Conclusions: Among the 3 osteotomy techniques commonly used to correct hallux valgus deformity, we observed that PCMO yielded the most effective height change of the second metatarsal head. Level of Evidence: Level III, retrospective comparative series.

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