The Association of Crista Volume With Sesamoid Position as Measured From 3D Reconstructions of Weightbearing CT Scans

2021 ◽  
pp. 107110072110613
Author(s):  
Audrey J. Clarke ◽  
Stephen F. Conti ◽  
Matthew Conti ◽  
Amr A. Fadle ◽  
Scott J. Ellis ◽  
...  
Keyword(s):  
Hallux Valgus ◽  
Articular Surface ◽  
Normal Subjects ◽  
Metatarsal Head ◽  
Strongly Correlated ◽  
3D Reconstructions ◽  
3 Dimensional ◽  
First Metatarsal ◽  
The Mean ◽  
Weightbearing Ct

Background: Malposition of the sesamoids relative to the first metatarsal head may relate to intersesamoid crista underdevelopment or erosion. Using 3-dimensional models created from weightbearing CT (WBCT) scans, the current work examined crista volume and its relationship to first metatarsal pronation and sesamoid station. Methods: Thirty-eight hallux valgus (HV) patients and 10 normal subjects underwent weightbearing or simulated WBCT imaging. The crista was outlined by the inferior articular surface, and a line was drawn to connect the lowest point of each sulcus on either side of the intersesamoidal crista throughout the length of the crista. The volume was calculated. Sesamoid station and first metatarsal pronation were calculated from the 3D reconstructions. The mean crista volumes between HV and normal patients were statistically compared, as were the crista volume and pronation angle between sesamoid stations. Results: The mean crista volume in HV patients was 80.10 ± 35 mm3 and in normal subjects was 150.64 ± 24 mm3, which differed significantly between the 2 groups ( P < .001). Mean crista volumes were found to be statistically significantly different between the sesamoid stations ( P < .001) with decreasing crista volumes significantly and strongly correlated with increasing sesamoid station ( r = −0.80, P < .001). There was no difference in the mean pronation angle between the 4 sesamoid stations ( P = .37). The pronation angle was not associated with crista volume ( P = .52). Conclusion: HV patients have lower mean crista volume than normal patients. Crista volume is correlated with sesamoid station. Pronation of the first metatarsal was not associated with crista volume. Clinical Relevance: Crista volume may offer an additional determinant for the severity of hallux valgus.

scholarly journals Effect on Foot Width With Triplanar Tarsometatarsal Arthrodesis for Hallux Valgus

2020 ◽  
Vol 5 (3) ◽  
pp. 247301142093480
Author(s):  
Justin Vaida ◽  
Justin J. Ray ◽  
Taylor L. Shackleford ◽  
William T. DeCarbo ◽  
Daniel J. Hatch ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Functional Outcome ◽  
Hallux Valgus ◽  
Metatarsal Head ◽  
Level Of Evidence ◽  
3 Dimensional ◽  
First Metatarsal ◽  
Institutional Review ◽  
Retrospective Comparative Study ◽  
Width Reduction

Background: Foot width reduction is a desirable cosmetic and functional outcome for patients with hallux valgus. Triplanar first tarsometatarsal (TMT) arthrodesis could achieve this goal by 3-dimensional correction of the deformity. The aim of this study was to evaluate changes in bony and soft tissue width in patients undergoing triplanar first TMT arthrodesis. Methods: After receiving Institutional Review Board approval, charts were retrospectively reviewed for patients undergoing triplanar first TMT arthrodesis for hallux valgus at 4 institutions between 2016 and 2019. Patients who underwent concomitant first metatarsal head osteotomies (eg, Silver or Chevron) or fifth metatarsal osteotomies were excluded. Preoperative and postoperative anteroposterior weightbearing radiographs were compared to evaluate for changes in bony and soft tissue width. One hundred forty-eight feet from 144 patients (48.1 ± 15.7 years, 92.5% female) met inclusion criteria. Results: Preoperative osseous foot width was 96.2 mm, compared to 85.8 mm postoperatively ( P < .001). Preoperative soft tissue width was 106.6 mm, compared to 99.3 mm postoperatively ( P < .001). Postoperatively, patients had an average 10.4 ± 4.0 mm reduction (10.8% reduction) in osseous width and average 7.3 ± 4.0 mm reduction (6.8% reduction) in soft tissue width. Conclusions: Triplanar first TMT arthrodesis reduced both osseous and soft tissue foot width, providing a desirable cosmetic and functional outcome for patients with hallux valgus. Future studies are needed to determine if patient satisfaction and outcome measures correlate with reductions in foot width. Level of evidence: Level III, retrospective comparative study

Metatarsophalangeal and Intermetatarsal Angle: Different Values and Interpretation of Postoperative Results Dependent on the Technique of Measurement

1998 ◽  
Vol 19 (8) ◽  
pp. 532-536 ◽  
Author(s):  
Wolfgang Schneider ◽  
Karl Knahr
Keyword(s):  
Articular Surface ◽  
Metatarsal Head ◽  
Postoperative Evaluation ◽  
Postoperative Results ◽  
Intermetatarsal Angle ◽  
Mean Values ◽  
First Metatarsal ◽  
The Mean ◽  
Postoperative Improvement ◽  
Type Of Surgery

For measurement of the first metatarsophalangeal angle and intermetatarsal angle I-II, five different methods for drawing the axis of the first metatarsal have been published. This study aimed to evaluate differences in the resulting angles that depend on the method of drawing this axis. Using pre- and postoperative radiographs of 20 patients who had surgery on the hallux (chevron procedure), highly significant differences were found: mean values for the preoperative metatarsophalangeal angle ranged from 27.3° to 31.9° the mean postoperative values were calculated at 8.6° to 20.3°. The preoperative mean of intermetatarsal angle I-II showed values from 13.0° to 17.6° the postoperative mean ranged from 5.2° to 16.7°. These differences-especially in the postoperative evaluation-resulted in a postoperative improvement between 11.6° and 20.8° for the metatarsophalangeal angle and between 0.9° and 10.0° for the intermetatarsal angle. These wide differences seem to be unacceptable for angles as a criterion of success in surgery on the hallux. The reason for these discrepancies can be found in the different relations of the points of reference to the anatomical outline of the metatarsal and the site of osteotomy. As a consequence of this study, defining the axis of the first metatarsal as a line connecting the center of the articular surface of the metatarsal head and the center of the proximal articulation can be recommended as the most appropriate method. The resulting angles are independent of the type of surgery performed on the hallux.

scholarly journals The Shape of the First Metatarsal Head and its Association with its Pronation Angle and the Presence of Sesamoid-Metatarsal Joint Osteoarthritis

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0037
Author(s):  
Yoshimasa Ono ◽  
Satoshi Yamaguchi ◽  
Seiji Kimura
Keyword(s):  
Hallux Valgus ◽  
Weight Bearing ◽  
Qualitative Evaluation ◽  
Metatarsal Head ◽  
First Metatarsal ◽  
Lateral Edge ◽  
Ankle Surgery ◽  
History Of ◽  
Joint Deformation ◽  
The Mean

Category: Bunion Introduction/Purpose: The rounded shape of the first metatarsal head’s lateral edge on the dorsoplantar radiograph of the foot is used as a qualitative evaluation of the first metatarsal pronation in hallux valgus feet. However, the relationship between the rounded shape and the metatarsal pronation angle of the first metatarsal has not been examined in detail. Furthermore, hallux valgus often accompanies osteoarthritis in the sesamoid-metatarsal joint. Deformation of the metatarsal head by osteophytes on the lateral edge of the lateral sesamoid facet may affect the rounded shape. The purpose of this study was to evaluate the associations of the shape of the first metatarsal head with (1) the presence of osteoarthritis in the sesamoid-metatarsal joint and (2) the pronation angle of the first metatarsal head. Methods: Patients were prospectively recruited between December 2016 and March 2017. Patients with a history of previous foot and ankle surgery or destruction of the head due to rheumatoid arthritis were excluded. A total of 121 patients, with the mean age of 61 years, underwent weight-bearing dorsoplantar, lateral, and first metatarsal axial radiographs. The shape of the first metatarsal head’s lateral edge was classified as either rounded, intermediate, or angular in shape in the dorsoplantar view. The presence of osteoarthritis in the sesamoid-metatarsal joint and the pronation angle of the first metatarsal head were assessed in the first metatarsal axial view. Other variables that could affect the first metatarsal shape, including the lateral first metatarsal inclination angle, were also assessed. Univariate and multivariate analyses were performed to determine the associations of the rounded shape of the first metatarsal with the pronation angle and sesamoid-metatarsal joint osteoarthritis. Results: Of 121 feet, 31, 41, and 49 feet had rounded, intermediate, and angular metatarsal heads, respectively. Sesamoid- metatarsal joint osteoarthritis was evident in 49 (40%) feet. The mean hallux valgus and first metatarsal pronation angle was 23° and 9°, respectively. The prevalence of sesamoid-metatarsal osteoarthritis was significantly higher (24 (77%), 11 (27%), and 14 (29%) for rounded, intermediate, and angular, respectively, P < .001) in feet with a rounded metatarsal head. Furthermore, the metatarsal pronation angle was significantly larger (14°, 8°, and 4° for rounded, intermediate, and angular, respectively, P < .001). These associations were also significant in the multiple regression analysis. Conclusion: A rounded metatarsal head was associated with a higher prevalence of osteoarthritis within the sesamoid-metatarsal joint, as well as a larger first metatarsal head pronation angle. A negative round sign can be used as a simple indicator of an effective correction to the first metatarsal pronation angle during hallux valgus surgery. However, in feet with sesamoid-metatarsal osteoarthritis, surgeons will need to be cautious as overcorrection may occur.

scholarly journals Effectiveness of the Plantar Aponeurosis Release for Limitation of the First Metatarsophalangeal Joint Extension after Hallux Valgus Surgery

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0001
Author(s):  
Hongjoon Choi ◽  
Daewook Kim ◽  
Yeong Hun Kang ◽  
Jong Ho Park
Keyword(s):  
Hallux Valgus ◽  
Metatarsophalangeal Joint ◽  
Metatarsal Head ◽  
Knee Extension ◽  
First Metatarsophalangeal Joint ◽  
Plantar Aponeurosis ◽  
First Metatarsal ◽  
Metatarsal Angle ◽  
Additional Procedure ◽  
The Mean

Category: Midfoot/Forefoot Introduction/Purpose: Even though stiffness of the first metatarsophalangeal joint (1MTP) is not a common complication, reduced dorsiflexion range of motion at the 1MTP after surgery for hallux valgus was reported as a complication. However, few clinical studies have investigated this issue and no clinical resolution has been reached thus far. We hypothesized that tightness of the gastrocnemius-plantar aponeurosis complex is one of the factors that limits the extension of 1MTP after hallux valgus surgery. Thus, an additional procedure of the plantar aponeurosis release during hallux valgus surgery may improve the range of extension at 1MTP. The purpose of this study was to test the efficacy of plantar aponeurosis release in improving the range of extension when a limitation is detected after hallux valgus surgery. Methods: Thirteen patients (17 feet) with limited 1MTP extension after hallux valgus surgery, underwent an additional procedure of plantar aponeurosis release. The inclusion criterion was limitation of 1MTP extension showed more than 15 degrees difference between knee extension and flexion position, measured after completing all procedures of the hallux valgus surgery. The passive range of 1MTP extension was evaluated by a goniometer while the first metatarsal head was supported with a palm, assuming a weightbearing position with knee extension and flexion, after completing all procedures of the hallux valgus surgery (Barouk test). A silfverskiold test was performed in all cases preoperatively. The weightbearing dorsoplantar and lateral radiographs of the foot were performed to measure the hallux valgus angle, intermetatarsal angle, distal metatarsal articular angle, and the talo-first metatarsal angle. Results: The mean range of 1MTP extension significantly improved from 2.53 degrees to 40.88 degrees in the knee extension position (p<0.0000). The mean range of the 1MTP extension also improved from 18.24 degrees to 43.24 degrees in the knee flexion position. The silfverskiold test was positive in 12 cases. In all patients, congruence of 1MTP was corrected. There were no surgery-related complications such as plantar aponeurosis rupture or nerve injury. Conclusion: Our study supports tightness of the gastrocnemius-plantar aponeurosis complex is one of the factors that limit the extension of 1MTP after hallux valgus surgery. Hence, plantar aponeurosis release can be considered as an effective additional procedure to improve the range of 1MTP extension when a limitation is presented after hallux valgus surgery.

scholarly journals Anatomical Risk Factors Associated with Rapid Progression of Hallux Valgus Deformity

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0034
Author(s):  
Shinohara Masashi ◽  
Yamaguchi Satoshi ◽  
Ono Yoshimasa
Keyword(s):  
Risk Factors ◽  
Hallux Valgus ◽  
Treatment Decision ◽  
Metatarsal Head ◽  
Rapid Progression ◽  
First Metatarsal ◽  
Hallux Valgus Deformity ◽  
Radiographic Measurements ◽  
The Future ◽  
The Mean

Category: Bunion; Other Introduction/Purpose: Hallux valgus (HV) deformity generally progresses gradually over the long term. However, the deformity progresses rapidly in some patients. Information on the future progression of the deformity helps treatment decision-making of both surgeons and patients. However, few studies have reported the natural progression of HV deformity. The purposes of this study were to clarify 1) the incidence and 2) anatomical risk factors of the rapid progression of HV deformity. Methods: Patients who visited the foot and ankle clinic of our hospital between 2013 and 2019 were retrospectively analyzed. Inclusion criteria were patients who underwent repeated foot radiographs with an interval of >=2 years. Exclusion criteria were patients <18 years old, history of first ray surgery, deformity or destruction of the first metatarsal head, and unable to stand plantigrade. The increase in HV angle between the baseline and the last follow-up was calculated. Then, patients were dichotomized into two groups: those with an increase in HV angle >=5°(Group P) and those with an increase of <5°(Group S). Radiographic measurements, including HV angle, Hardy’s sesamoid position, distal metatarsal articular angle, rounded metatarsal head, first metatarsal protrusion distance, were performed on the dorsoplantar and lateral foot radiographs at the baseline. The association between the baseline radiographic measurements and progression of HV deformity was assessed using the univariate and multivariate analyses. Results: A total of 268 feet of 268 patients (217 women and 51 men, mean age 61 years) were analyzed. The mean HV angle was 28°, and the mean interval between radiography was 49 months. Forty-five (17%) and 223 (83%) feet were categorized into groups P and S, respectively. The baseline Hardy’s sesamoid position was independently associated with the future progression of the deformity: 6/115 (5%) feet with normal sesamoid (grade <4) were in group P. On the other hand, 39/183 (21%) feet with laterally deviated sesamoid (grade>=4), 39 were in group P (p<0.001). The HV angle at baseline was not associated with the deformity progression (p=0.09). Other measurements, such as rounded metatarsal head, were also not associated with the progression. Conclusion: The rapid progression of HV deformity occurred in 1 out of 6 patients. Furthermore, the lateral deviation of the sesamoid on the dorsoplantar radiograph of the foot may be the risk factor of the rapid progression. For patients with mild deformity but deviated sesamoid, early corrective surgery may be justified to prevent the rapid progression of HV deformity.

scholarly journals Crista Volume Measured from 3D Reconstructions of Weightbearing CT Scans Shows a Relationship to Sesamoid Station

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0017
Author(s):  
Stephen F. Conti ◽  
Audrey Clarke ◽  
Matthew S. Conti ◽  
Scott J. Ellis ◽  
Mark C. Miller ◽  
...  
Keyword(s):  
Statistical Significance ◽  
Three Dimensional ◽  
Normal Subjects ◽  
T Test ◽  
3D Reconstructions ◽  
Reliable Technique ◽  
Plantar Surface ◽  
First Metatarsal ◽  
The Mean ◽  
Relationship Of

Category: Bunion Introduction/Purpose: The progression of hallux valgus (HV) deformities results in dislocation of the sesamoids from their position (station) under the plantar surface of the distal first metatarsal. With this dislocation, the crista separating the two sesamoids erodes as the contact of the medial sesamoid with the crista applies pressure with weightbearing. Recently, three dimensional (3D) reconstructions of the metatarsals and first phalanx have demonstrated a means to find a consistently quantify first metatarsal pronation. These same reconstructions can also produce a reliable technique to compute the volumes of the bones involved. The purpose of the current investigation is to examine the relationship of the volume of the crista to pronation and to sesamoid station. Methods: Eleven HV patients and five normal subjects with weightbearing or weightbearing equivalent CT (WBCT) imaging were randomly selected from the senior author’s patients. Pronation was quantified on WBCT scans using 3D reconstructions as described by Campbell et al. (FAI 2018). Crista volume was determined using a line drawn to connect the nadir of each sulcus on either side of the intersesamoidal crista in each slice of the WBCT image (Figure 1). Sesamoid station was also quantified on WBCT scans using the established four point categorization. A linear regression was performed to determine if the volume of the crista was associated with the pronation angle. The sesamoid station was simplified into two categories - mild medial sesamoid subluxation (less than 50% of the medial sesamoid was lateral to the nadir of the crista) and severe medial sesamoid subluxation - and crista volume between these two groups was compared using a t-test. Results: The regression of crista volume against first metatarsal pronation angle did not show statistical significance (P=0.94, r2=0.03). The mean crista volume in the mild medial sesamoid subluxation group was 156(+-47, range 72 - 231)mm3. The mean crista volume in severe medial sesamoid subluxation was 95 (SD 39, range 35 - 160) mm3. The t-test using simplified sesamoid station to compare crista volumes found that the mean crista volume in the mild medial sesamoid subluxation group was statistically significantly greater the than the mean crista volume in the severe sesamoid subluxation group (P=0.01). Conclusion: In HV, it has been hypothesized that the medial sesamoid erodes the crista resulting in arthritis. This is often overlooked as a source of pain in these patients. Our study found that pronation of the first metatarsal was not correlated with crista volume suggesting that pronation does not affect erosion of the crista. Instead, our results are the first to demonstrate that medial sesamoid subluxation as determined from sesamoid station results in erosion of the crista. This supports the hypothesis that sesamoid subluxation, arthritis, and crista erosion are important components of the HV deformity.

Relationship of Dome Height of the First Metatarsal Head with Hallux Valgus Angle and Metatarsophalangeal Alignment

2020 ◽  
Vol 110 (6) ◽  
Author(s):  
Esin Derin Cicek ◽  
Feyza Akan Begoglu ◽  
Ilknur Aktas ◽  
Feyza Unlu Ozkan
Keyword(s):  
Hallux Valgus ◽  
Articular Surface ◽  
Metatarsal Head ◽  
Standing Position ◽  
Dome Height ◽  
Hallux Valgus Angle ◽  
Radiographic Images ◽  
First Metatarsal ◽  
Valgus Angle ◽  
Study Results

Objectives Hallux valgus (HV) is a progressive foot deformity in which the first metatarsophalangeal (MTP) joint is affected. The relationship between the dome height of the first metatarsal head and the HV deformity has not been studied previously. This study aimed to investigate a possible relation of the dome height of the first metatarsal head with articular alignment and the hallux valgus angle (HVA), which is frequently used to evaluate HV. Methods A total of 129 feet of 68 patients were included in the study. Anteroposterior digital radiographic images of the foot taken in a weightbearing, standing position were used to assess the HVA, dome height, and shape of the first metatarsal head and the alignment of the MTP joint. The dome height of the first metatarsal head is the vertical distance from the base to the highest point of the articular surface doming. The alignment was categorized into three groups: aligned, deviated, and subluxated. Patients were assigned into three groups based on the HVA: Normal, Mild HV and Moderate HV. Results A statistically significant, positive correlation was found between the HVA and the dome height of the first metatarsal head (r = 0.293, P = 0.001 and P &lt; 0.05). The dome height was significantly lower in the patients with a normal HVA than those with a high HVA (P1 = 0.042, P2 = 0.039 and P &lt; 0.05, respectively). The dome height of the first metatarsal head was found significantly higher in feet with subluxation, compared to feet aligned and deviated (P1 = 0.001; P2 = 0.0089 and P &lt; 0.05, respectively). Conclusions Our study results suggest that HV deformity may be related to an increased dome height and the measurement of the dome height of the first metatarsal head might be used to evaluate an anatomic tendency toward HV development.

The Radiographic Morphology of Foot Deformities in Patients with Fibrodysplasia Ossificans Progressiva

2005 ◽  
Vol 26 (11) ◽  
pp. 937-941 ◽  
Author(s):  
Richard J. Harrison ◽  
J. David Pitcher ◽  
Mark S. Mizel ◽  
H. Thomas Temple ◽  
Sean P. Scully
Keyword(s):  
Hallux Valgus ◽  
Proximal Phalanx ◽  
Metatarsal Head ◽  
Length Ratio ◽  
Fibrodysplasia Ossificans Progressiva ◽  
Foot Deformities ◽  
First Metatarsal ◽  
First Ray ◽  
The Mean ◽  
And Gender

Background: The most consistent deformities that allow early diagnosis of fibrodysplasia ossificans progressiva are the presence of bilateral short first rays and hallux valgus. The purpose of this study was to describe the radiographic features observed in the feet of patients with fibrodysplasia ossificans progressiva. Methods: The radiographs of 26 feet (15 patients with fibrodysplasia ossificans progressiva) were reviewed to evaluate the radiographic changes that occur in the first ray. Variables analyzed were the hallux valgus (HV) angle, the distal metatarsal articular (DMA) angle, the proximal phalangeal articular (PPA) angle, the intermetatarsal (IM) angle, ratio of the lengths of the first and second metatarsal lengths (MT1:MT2), and the first and second ray length ratio. The length ratios were then subtracted from similar ratios in radiographs of age- and gender-matched normal patients previously reported. Results: The proximal phalanx was consistently shortened but morphologically dissimilar from subject to subject. Asymmetry was noted in some patients with bilateral radiographs. The mean HV angle was 28 degrees, and the mean IM angle was 10 degrees. The mean DMA angle was 33 degrees, and the mean PPA angle was 14 degrees. The MT1:MT2 ratio was 0.89, and the mean first ray to second ray length ratio was 0.87. The mean of the differences in the MT1:MT2 and first and second ray length ratios in patients with fibrodysplasia ossificans progressiva compared to the normal controls were 0.05 and 0.01, respectively. Fusion occurred between the abnormal tibial epiphysis of the proximal phalanx and metatarsal head with advancing age, and 68% of the metatarsal heads were fused with the abnormal proximal phalangeal epiphysis. Conclusions: Foot pathology in patients with fibrodysplasia ossificans progressiva is variable but consistently involves an abnormality of the tibial aspect of the proximal phalangeal epiphysis of the hallux. This results in the clinical observation of hallux valgus in these patients. The first metatarsal is consistently shortened, and fusion between the epiphysis of the abnormal proximal phalanx and the shortened first metatarsal head occurs with advancing age.

scholarly journals Mobility Changes in the First TMT Joint after Proximal First Metatarsal Osteotomy for Hallux Valgus Evaluated by Weightbearing CT and a 3D Analysis System

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0002
Author(s):  
Tadashi Kimura ◽  
Makoto Kubota ◽  
Hidekazu Hattori ◽  
Kazuhiko Minagawa ◽  
Naoki Suzuki ◽  
...  
Keyword(s):  
Hallux Valgus ◽  
Three Dimensional ◽  
Metatarsal Osteotomy ◽  
First Metatarsal ◽  
Valgus Angle ◽  
Medial Cuneiform ◽  
First Ray ◽  
The Mean ◽  
Weightbearing Ct

Category: Bunion Introduction/Purpose: In a previous study, we found that feet with hallux valgus show significantly greater three-dimensional mobility than normal feet in all joints of the first ray. Displacement was particularly pronounced in the first TMT joints, indicating that this is the primary cause of first ray hypermobility. We developed a plate used specifically for proximal first metatarsal osteotomy to perform three-dimensional correction of hallux valgus and associated deformities. In this study, we evaluated changes in mobility of the first TMT joints after surgery in 3D using weightbearing CT. Methods: The subjects were 5 feet of 5 female patients with hallux valgus (mean age 56 years, mean hallux valgus angle 38°). We performed non-weightbearing and weightbearing (using a load equivalent to body weight) CT scans before surgery using an original loading device (Fig a). We reconstructed 3D models from captured images by segmentation and defined axial coordinate system (Fig b). Next, we measured the three-dimensional displacement of the first metatarsal bone relative to the medial cuneiform bone under weightbearing conditions. At 1 to 1.5 years after proximal metatarsal osteotomy for all patients, we performed a follow-up CT scans using the same method and compared preoperative and postoperative displacement. Student’s t- test was performed to statistically compare data and statistical significance was set at p < 0.05. Results: Postoperatively (when performing a follow up CT), the mean hallux valgus angle improved from 38° to 10° and the mean first-second metatarsal angle improved from 23° to 7°. The mean score on the Japanese Society for Surgery of the Foot hallux scale improved from 62 points to 97 points. Displacement of the first metatarsal bone relative to the medial cuneiform bone between non-weightbearing and weightbearing conditions decreased significantly in all directions, from 4.2° ± 1.8° to 1.6° ± 1.1° of dorsiflexion (p = 0.02), 4.9° ± 1.8° to 0.7° ± 0.9° of inversion (p = 0.001), and 4.4° ± 1.9° to 1.7° ± 0.8° of adduction (p = 0.01). Conclusion: Displacement of the first TMT joints under weightbearing conditions decreased after our surgery. This indicates that the surgery corrected hallux valgus and associated pes planus and produced favorable functional outcomes by improving the shape of the foot and hypermobility of the first ray through correction of the orientation and tension of surrounding tendons and ligaments and the plantar aponeurosis. In the future, we plan to further examine the pathology and treatment of hallux valgus with a focus on postoperative changes in soft tissue orientation.

The Hallux Metatarsophalangeal Capsule: An Anatomic Study With Respect to Percutaneous Hallux Valgus Correction

2021 ◽  
pp. 107110072110272
Author(s):  
Kenneth M. Chin ◽  
Nicholas S. Richardson ◽  
John T. Campbell ◽  
Clifford L. Jeng ◽  
Matthew W. Christian ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Hallux Valgus ◽  
Metatarsal Head ◽  
Cadaveric Study ◽  
Anatomic Study ◽  
Orthopedic Surgeons ◽  
Popular Knowledge ◽  
Fresh Frozen ◽  
The Mean ◽  
Anatomic Relationship

Background: Minimally invasive surgery for the treatment of hallux valgus deformities has become increasingly popular. Knowledge of the location of the hallux metatarsophalangeal (MTP) proximal capsular origin on the metatarsal neck is essential for surgeons in planning and executing extracapsular corrective osteotomies. A cadaveric study was undertaken to further study this anatomic relationship. Methods: Ten nonpaired fresh-frozen frozen cadaveric specimens were used for this study. Careful dissection was performed, and the capsular origin of the hallux MTP joint was measured from the central portion of the metatarsal head in the medial, lateral, dorsal, plantarmedial, and plantarlateral dimensions. Results: The ten specimens had a mean age of 77 years, with 5 female and 5 male. The mean distances from the central hallux metatarsal head to the MTP capsular origin were 15.2 mm dorsally, 8.4 mm medially, 9.6 mm laterally, 19.3 mm plantarmedially, and 21.0 mm plantarlaterally. Conclusion: The MTP capsular origin at the hallux metatarsal varies at different anatomic positions. Knowledge of this capsular anatomy is critical for orthopedic surgeons when planning and performing minimally invasive distal metatarsal osteotomies for the correction of hallux valgus. Type of Study: Cadaveric Study.

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