High Prevalence of Degenerative Changes at the Metatarsal Head Sesamoid Articulation Found During Hallux Valgus Correction Surgery

2020 ◽  
pp. 193864002091213
Author(s):  
Justin Tsai ◽  
Joseph N. Daniel ◽  
Elizabeth L. McDonald ◽  
David I. Pedowitz ◽  
Ryan G. Rogero ◽  
...  
Keyword(s):  
Hallux Valgus ◽  
Case Series ◽  
Metatarsal Head ◽  
Positive Influence ◽  
Degenerative Changes ◽  
High Prevalence ◽  
Correction Surgery ◽  
Standard Radiographs ◽  
Preoperative Deformity ◽  
Arthritic Changes

Background. Despite the absence of complications and a restoration of normal hallux alignment, some patients have suboptimal outcomes from hallux valgus correction surgery. One risk factor for persistent pain may be the presence of arthritic changes at the metatarsal head articulation with the sesamoids, an area not easily assessed with standard radiographs unless dedicated sesamoid views are obtained. In this study, we prospectively evaluated the metatarsal head for degenerative changes during hallux valgus correction surgery and identified preoperative risk factors associated with these changes. Methods. We prospectively evaluated 200 feet in 196 patients who underwent hallux valgus surgery intraoperatively for the pattern and severity of arthritic changes at the metatarsal head. Mann-Whitney U testing was implemented to compare differences in arthritic scores between preoperative deformity groups. The Spearman correlation test was used to determine the association between age and preoperative deformity with the severity of degenerative changes. Results. More than half of all feet assessed had severe arthritic changes at the plantar medial aspect of the metatarsal head and 40% of feet at the plantar lateral aspect. Age and intermetatarsal angle were found to be positively correlated with arthritis in this area. Conclusion. Our prospective study has demonstrated the high prevalence of arthritic changes at the metatarsal head sesamoid articulation and the positive influence of age and severity of deformity on metatarsal head arthritic changes seen during hallux valgus correction surgery. Furthermore, these arthritic changes were found to have no significant influence on preoperative functional and pain levels. Levels of Evidence: Level IV: Case series

scholarly journals High Prevalence of Degenerative Changes at the Metatarsal Head Sesamoid Articulation Found During Hallux Valgus Correction Surgery

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0007
Author(s):  
Justin Tsai ◽  
Joseph N. Daniel ◽  
Elizabeth McDonald ◽  
Ryan Rogero ◽  
Kristen Nicholson ◽  
...  
Keyword(s):  
Hallux Valgus ◽  
Articular Surface ◽  
Metatarsal Head ◽  
Degenerative Changes ◽  
Suboptimal Outcome ◽  
High Prevalence ◽  
Exposed Bone ◽  
Correction Surgery ◽  
Preoperative Deformity ◽  
Arthritic Changes

Category: Bunion Introduction/Purpose: Despite absence of complications and a restoration of normal hallux alignment, some patients have suboptimal outcomes from hallux valgus correction surgery. One risk factor for persistent pain may be the presence of arthritic changes at the metatarsal head articulation with the sesamoids, an area not easily assessed with standard preoperative radiographs. In this study, we prospectively evaluated the metatarsal head for degenerative changes during hallux valgus correction surgery and identified preoperative risk factors associated with these changes. Methods: We prospectively evaluated 200 feet in 196 patients who underwent hallux valgus surgery intraoperatively for the pattern and severity of arthritic changes at the metatarsal head. Intraoperatively, the first metatarsophalangeal and sesamoid metatarsal joint were assessed for arthritic changes. The articular surface of the metatarsal head was divided into zones 1-6 (Figure 1). Cartilage loss in each zone was graded from 0-2 based on a novel grading system, with a score of 0 representing the absence of arthritis. A score of 1 indicated fissures without exposed bone, and a score of 2 represented degenerative changes to the level of exposed bone. Mann-Whitney U testing was implemented to compare differences in arthritic scores between preoperative deformity groups. Spearman’s correlation test was used to determine the association between age and preoperative deformity with the severity of degenerative changes. Results: One-hundred two out of 200 feet (51%) assessed had severe arthritic changes at the plantar medial aspect of the metatarsal head, and 40% (80/200) at the plantar lateral aspect. The mean preoperative hallux valgus and intermetatarsal angles were 29.6 ± 8.5 (range, 9.8-55.3) and 14.2 ± 3.3 (range, 6.6-25.9), respectively. Those presenting with an intermetatarsal angle (IMA) >/= 14 degrees had a significantly higher level of arthritis when compared to those presenting with an IMA < 14 degrees (p < 0.001). No difference in arthritis scores was found for HVA. Age was found to have a strong and significant (p < 0.001) correlation with zone 5, zone 6, total plantar zone, and total arthritis scores. Conclusion: The high prevalence of arthritic changes at the metatarsal head articulation with the sesamoids may be partially responsible for suboptimal outcome following hallux valgus correction surgery. Since these changes were associated with greater age and preoperative deformity, operating earlier in the pathology of hallux valgus may be of benefit.

scholarly journals Influence of First Metatarsophalangeal Joint Degenerative Changes on Functional Outcomes Following Hallux Valgus Correction

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0017
Author(s):  
Daniel Corr ◽  
Ryan G. Rogero ◽  
Andrew Fisher ◽  
Joseph T. O’Neil ◽  
Daniel J. Fuchs ◽  
...  
Keyword(s):  
Hallux Valgus ◽  
Functional Outcomes ◽  
Proximal Phalanx ◽  
Metatarsal Head ◽  
Degenerative Changes ◽  
Foot And Ankle ◽  
First Metatarsophalangeal Joint ◽  
Pain Scores ◽  
Exposed Bone ◽  
Arthritic Changes

Category: Bunion; Midfoot/Forefoot Introduction/Purpose: Previous studies have documented the prevalence of 1st metatarsophalangeal (MTP) joint arthritis in the setting of hallux valgus, with the articulation between the metatarsal head and the sesamoids being particularly vulnerable. However, little is known as to whether such degenerative changes of the metatarsal head-sesamoid articulation have any influence on postoperative functional and pain scores following hallux valgus correction. The purpose of this study is to determine the influence of degenerative changes of the 1st metatarsal head on outcomes at 2 years postoperatively. Methods: Patients underwent correction of a hallux valgus deformity from 2016-2017 by a single fellowship trained foot and ankle surgeon. Degenerative changes were classified by dividing the articular surface of the metatarsal head into 6 zones: zones 1 through 4 represented the surface articulating with the base of the proximal phalanx, while zones 5 and 6 represented the plantar aspect. Cartilage loss in each zone was graded from 0-2, with 0 representing the absence of arthritis, 1 indicating fissures without exposed bone, and 2 representing degenerative changes with exposed bone. Scoring was performed via direct visualization during the procedure. At 2 years postoperatively, patients were contacted to complete the Foot and Ankle Ability Measure (FAAM) Activities of Daily Living (ADL) and Sports subscales and Visual Analog Scale (VAS) for pain. Spearman’s correlations and one-way analysis of variance (ANOVA) were performed to determine if degree of arthritis had any influence on outcomes. Results: One hundred and forty-one patients (87.9% female) with both intraoperative arthritic grading and 2-year functional outcomes were included. At a mean of 25.4 (range, 23.0-34.8) months postoperatively, patients reported a mean (+- standard deviation) FAAM-ADL of 88.9 +- 17.3, FAAM-Sport of 77.3 +- 26.0, and VAS pain of 20.8 +- 27.1. Arthritis in zone 2 (r=0.20, p= 0.027) was found to be positively correlated with FAAM-Sport scores. ANOVA revealed those with a total arthritis grade of 0 or 2 or more in zones 1-4 had a significantly greater reduction in VAS pain scores (means of -35.1 and -37.7, respectively) than those with a grade of 1 (mean: -14.3) (p=0.008). Conclusion: Patients demonstrated a significant influence of arthritis on 2-year functional outcomes following HV correction, with higher levels of degenerative changes in zone 2 generally associated with better functional outcomes. Patients with more severe arthritic changes in zones 1-4 and those whose arthritic changes were localized solely to zones 5 and 6 demonstrated greater pain relief than those with mild degenerative changes. While these findings were unexpected, it demonstrates that those with more pronounced arthritis may benefit more from surgical correction of HV. Furthermore, surgeon intraoperative evaluation of arthritis may allow for improved counseling of patients regarding expected postoperative functional improvement.

Loss of Correction After Chevron Osteotomy for Hallux Valgus as a Function of Preoperative Deformity

2018 ◽  
Vol 40 (3) ◽  
pp. 287-296 ◽  
Author(s):  
Gerhard Kaufmann ◽  
Stefanie Sinz ◽  
Johannes M. Giesinger ◽  
Matthias Braito ◽  
Rainer Biedermann ◽  
...  
Keyword(s):  
Hallux Valgus ◽  
Case Series ◽  
X Rays ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Loss Of Correction ◽  
Chevron Osteotomy ◽  
Significant Correction ◽  
Preoperative Deformity

Background: Recurrence is relatively common after surgical correction of hallux valgus. Multiple factors are discussed that could have an influence in the loss of correction. The aim of this study was to determine preoperative radiological factors with an influence on loss of correction after distal chevron osteotomy for hallux valgus. Methods: Five hundred twenty-four patients who underwent the correction of a hallux valgus by means of distal chevron osteotomy at our institution between 2002 and 2012 were included. We assessed weightbearing x-rays at 4 time points: preoperatively, postoperatively, and after 6 weeks and 3 months. We investigated the intermetatarsal angle (IMA), the hallux valgus angle (HVA), the distal metatarsal articular angle (DMAA), joint congruity, and the position of the sesamoids. Results: At all points of the survey, significant correction of the IMA and HVA was detected. The IMA improved from 12.9 (± 2.8) to 4.5 (± 2.4) degrees and the HVA from 27.5 (± 6.9) to 9.1 (± 5.3) degrees. Loss of correction was found in both HVA and IMA during follow-up with a mean of 4.5 and 1.9 degrees, respectively. Loss of correction showed a linear correlation with preoperative IMA and HVA, and a correlation between preoperative DMAA and sesamoid position. Conclusion: The chevron osteotomy showed significant correction for HVA, IMA, and DMAA. Preoperative deformity, in terms of IMA, HVA, DMAA, and sesamoid position, correlated with the loss of correction and could be assessed preoperatively for HVA and IMA. Loss of correction at 3 months persisted during the follow-up period. Level of Evidence: Level IV, retrospective case series.

Radiographic and Clinical Results of Minimally Invasive Chevron Akin Osteotomy for Moderate to Severe Hallux Valgus Deformities

2021 ◽  
pp. 193864002110459
Author(s):  
Toshinori Kurashige
Keyword(s):  
Minimally Invasive ◽  
Hallux Valgus ◽  
Inclination Angle ◽  
Case Series ◽  
Metatarsal Head ◽  
Clinical Results ◽  
Level Of Evidence ◽  
First Metatarsal ◽  
Akin Osteotomy ◽  
Severe Hallux Valgus

Background: Few studies have reported results of minimally invasive chevron Akin osteotomy (MICA) for moderate to severe hallux valgus correction. This study aims to evaluate MICA for moderate to severe hallux valgus radiographically and clinically. Methods: Forty feet were prospectively reviewed. Twenty-eight feet (70%) had a severe deformity (hallux valgus angle (HVA) ≥40° and/or first intermetatarsal angle (IMA) ≥18°). We measured HVA, IMA, lateral shape of the metatarsal head (round sign), tibial sesamoid position, first metatarsal shortening on anteroposterior weightbearing radiographs, and inclination angle of first metatarsal on lateral weightbearing radiographs. We evaluated the Japanese Society for Surgery of the Foot hallux scale and Self-Administered Foot Evaluation Questionnaire responses preoperatively and at the most recent follow-up. Results: All measurements except shortening and inclination angle improved significantly. Both clinical scale and all subscores significantly improved. Conclusions: MICA improved moderate to severe hallux valgus both radiographically and clinically. Level of Evidence: Level IV: case series

scholarly journals Distal Chevron Osteotomy Increases Anatomic Intermetatarsal Angle in Hallux Valgus

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0016
Author(s):  
Jeremy Y. Chan ◽  
Naudereh B. Noori ◽  
Stephanie Chen ◽  
Glenn B. Pfeffer ◽  
Timothy P. Charlton ◽  
...  
Keyword(s):  
Hallux Valgus ◽  
Case Series ◽  
Metatarsal Head ◽  
Rank Test ◽  
Metatarsal Osteotomy ◽  
Recurrence Rates ◽  
Intermetatarsal Angle ◽  
First Metatarsal ◽  
Chevron Osteotomy

Category: Bunion; Midfoot/Forefoot Introduction/Purpose: Loss of correction in hallux valgus (HV) deformity following distal chevron metatarsal osteotomy (DCO) has been demonstrated in short-term follow-up with HV recurrence rates of up to 75% reported in the long-term. The purpose of this study was to evaluate the radiographic effect of the DCO on the anatomic and mechanical axes of the first metatarsal. Our hypothesis was that patients undergoing DCO would have improvement in the mechanical metatarsal axis but worsening of the anatomic axis. Methods: This was a retrospective single surgeon case series of all patients who underwent DCO for HV between 2017 and 2019. Patients were included if they had both preoperative and postoperative weightbearing foot radiographs. The primary outcomes were the change in anatomic first-second intermetatarsal angle (a1-2IMA, defined by the metatarsal diaphyseal axis) and the change in mechanical first-second intermetatarsal angle (m1-2IMA, defined by the axis from the center of the metatarsal head to the metatarsal base). Secondary outcomes included the change in hallux valgus angle (HVA) and medial sesamoid position (medial sesamoid in relation to the mechanical axis of the metatarsal). Change in second-third intermetatarsal angle (2-3IMA, defined by the metatarsal diaphyseal axis) was measured to control for any inconsistencies in radiographic technique. Given the relatively small patient cohort, the non-parametric Wilcoxon signed rank test and Mann Whitney U test were used for statistical analysis. Results: 41 feet were included for analysis with a mean follow-up of 20.4 weeks. The a1-2IMA increased significantly (mean, 4.0 degrees, p<0.001) while the m1-2IMA decreased significantly (mean, 4.6 degrees, p<0.001) following DCO. There was a significant improvement in HVA (mean, 13.2 degrees, p<0.001). No changes were noted in 2-3IMA (mean, 0.0 degrees, p=0.834). (Table 1) Medial sesamoid position was improved in 22 feet (53.7%). Patients with improved sesamoid position were noted to have a significantly larger decrease in m1-2IMA (mean, 5.3 versus 3.8 degrees, p=0.01) and a smaller increase in a1-2IMA (mean, 3.4 versus 4.7 degrees, p=0.02) compared to patients with no improvement in sesamoid position. Conclusion: Distal chevron osteotomy for HV is associated with an increase in the anatomic intermetatarsal angle despite improvements in the m1-2IMA, HVA and medial sesamoid position. Patients with improved sesamoid position were associated with greater correction of the mechanical first metatarsal axis. Our findings may suggest the presence of intermetatarsal instability, which could limit the power of DCO in HV correction for more severe deformities and provide a mechanism for HV recurrence. [Table: see text]

scholarly journals Influence of First Metatarsophalangeal Joint Degenerative Changes on Functional Outcomes Following Hallux Valgus Correction

2020 ◽  
Vol 5 (2) ◽  
pp. 2473011420S0001
Author(s):  
Ryan G. Rogero ◽  
Andrew Fischer ◽  
Daniel Corr ◽  
Joseph T. O’Neil ◽  
Daniel J. Fuchs ◽  
...  
Keyword(s):  
Hallux Valgus ◽  
Functional Outcomes ◽  
Proximal Phalanx ◽  
Metatarsal Head ◽  
Degenerative Changes ◽  
Foot And Ankle ◽  
First Metatarsophalangeal Joint ◽  
Pain Scores ◽  
Plantar Aspect ◽  
Exposed Bone

Category: Bunion; Other Introduction/Purpose: Previous studies have documented the prevalence of 1st metatarsophalangeal (MTP) joint arthritis in the setting of hallux valgus, with the articulation between the metatarsal head and the sesamoids being particularly vulnerable. However, little is known as to whether such degenerative changes of the metatarsal head-sesamoid articulation have any influence on postoperative functional and pain scores following hallux valgus correction. The purpose of this study is to determine the influence of degenerative changes of the 1st metatarsal head on outcomes at 2 years postoperatively. Methods: Patients who underwent correction of a hallux valgus deformity from 2016 to 2017 with 1 of 4 foot and ankle fellowship-trained orthopaedic surgeons were included in this study. Degenerative changes were classified using a novel grading system dividing the articular surface of the metatarsal head into 6 zones, with zones 1 through 4 representing the surface which articulates with the base of the proximal phalanx and zones 5 and 6 representing the plantar aspect of the metatarsal head. Cartilage loss in each zone was graded from 0-2, with a score of 0 representing the absence of arthritis, a score of 1 indicating fissures without exposed bone, and a score of 2 representing degenerative changes with exposed bone, for a maximum score of 12. Scoring was performed by the operating surgeon at the time of the index procedure by direct visualization. Photographic documentation of the metatarsal head was obtained in every case for secondary confirmation. At 2 years postoperatively, patients with intraoperative grading were contacted to complete the Foot and Ankle Ability Measure (FAAM) Activities of Daily Living (ADL) and Sports subscales and Visual Analog Scale (VAS) for pain. Spearman’s correlations and one-way ANOVA were performed to determine if the degree of arthritis had any influence on outcomes. Results: Seventy-six patients (92.1% female) with both intraoperative arthritic grading and 2-year functional outcomes were included. At a mean of 24.6 (range, 23-28) months postoperatively, patients reported a mean (+- standard deviation) FAAM-ADL of 93.0 +- 11.9/100, FAAM-Sport of 84.8 +- 21.4/100, and VAS pain of 16.8 +- 22.2/100. Arthritis in zone 1 (r=0.345, p= 0.005) and zone 4 (r=0.249, p=0.044) was found to be positively correlated with FAAM-Sport scores. ANOVA analysis revealed those with a total arthritis grade of 0 or 2 or more in zones 1-4 had a significantly greater reduction in VAS pain scores (means of -36.5 and -48.1, respectively) than those with a grade of 1 (mean: +5.0) (p=0.005). Conclusion: We have demonstrated a significant influence of arthritis on 2-year functional outcomes following HV correction, with higher levels of degenerative changes in zones 1 and 4 generally associated with better functional outcomes. While this finding was unexpected, it demonstrates that those with arthritis may benefit more from surgical correction of HV. Furthermore, surgeon intraoperative evaluation of arthritis may allow for improved counseling of patients regarding expected postoperative functional improvement.

scholarly journals Surgical treatment of hallux valgus using a modified Reverdin-Isham technique

2021 ◽  
Vol 15 (1) ◽  
pp. 49-53
Author(s):  
Luiz Lara ◽  
Lúcio Torres Filho ◽  
Gabriel Cervone ◽  
Juan Grajales ◽  
Glaucia Bordignon ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Hallux Valgus ◽  
Case Series ◽  
Metatarsal Head ◽  
Level Of Evidence ◽  
Valgus Angle ◽  
Significant Correction ◽  
The Mean ◽  
American Orthopaedic

Objective: To evaluate the postoperative results of patients who underwent surgical treatment of hallux valgus with a modified Reverdin-Isham (RI) technique and to compare the achieved correction with that reported by studies using the original technique. Methods: This is a retrospective study with patients with mild to moderate hallux valgus who underwent surgery from June 2010 to July 2019. All patients were operated using the modified RI technique. Data were collected through the American Orthopaedic Foot and Ankle Society (AOFAS) questionnaire, in addition to pre and postoperative radiographic studies of the intermetatarsal angle (IMA), the hallux valgus angle (HVA), and the distal metatarsal articular angle (DMAA). Results: The mean postoperative follow-up was 30.1 months, and the mean age of patients was 56.4 years. The median AOFAS score in the postoperative period was increased by 56 points. The mean HVA was reduced in 16.5°, the mean IMA was reduced in 4.3°, and the mean DMAA was reduced in 10°. There were no cases of displacement or deviation of the first metatarsal head during the postoperative follow-up. Conclusion: The modified RI technique provided considerable stability to the osteotomy, in addition to a significant correction of the measured angles and an improvement in AOFAS scores, demonstrating itself as an effective technique for correcting mild to moderate hallux valgus. Level of Evidence IV, Therapeutic Studies, Case Series.

Routine Histopathologic Evaluation in Hallux Valgus Surgery

2009 ◽  
Vol 30 (8) ◽  
pp. 763-766 ◽  
Author(s):  
Irvin C. Oh ◽  
Scott J. Ellis ◽  
Martin J. O'Malley
Keyword(s):  
Cost Effectiveness ◽  
Hallux Valgus ◽  
Gouty Arthritis ◽  
Case Series ◽  
Cost Effective ◽  
Postoperative Management ◽  
Degenerative Changes ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
New Diagnosis

Background: Anecdotal evidence suggests that specimens submitted for histopathologic assessment during hallux valgus surgery most commonly reveal degenerative changes. The purpose of this study was to evaluate the cost effectiveness of routine examination of tissue from hallux valgus procedures. We hypothesized that such examination rarely diagnoses a new condition and does not alter postoperative management. Materials and Methods: Specimens from 315 consecutive primary hallux valgus reconstructions performed between November 1995 and August 2002 were retrospectively analyzed. Patient charts were reviewed to determine the number of cases in which new diagnoses were made or treatment altered based upon histopathologic examination. Cost effectiveness was assessed by identifying the reimbursement for professional fees charged for these analyses. The total reimbursement per new diagnosis made and per alteration of treatment were calculated. Results: Degenerative changes were diagnosed in the majority of speciments (97.5%, 307 of 315). Other diagnoses included rheumatoid arthritis (1.3%, four of 315), gouty arthritis (1.0%, three of 315), and pseudogout (0.3%, one of 315). A new diagnosis was made only in the one patient (0.3%, one of 315) with pseudogout. Postoperative management was unchanged in every case. Conclusion: Routine submission of specimens obtained during hallux valgus surgery is not cost effective. New diagnoses are very rare and postoperative management did not change. Level of Evidence: IV, Retrospective Case Series

Short-Term Radiographic Outcome After Distal Chevron Osteotomy for Hallux Valgus Using Intramedullary Plates With an Amended Algorithm for the Surgical Management of Hallux Valgus

2018 ◽  
Vol 12 (1) ◽  
pp. 25-33 ◽  
Author(s):  
Takumi Matsumoto ◽  
Christopher E. Gross ◽  
Selene G. Parekh
Keyword(s):  
Hallux Valgus ◽  
Case Series ◽  
Metatarsal Head ◽  
Valgus Deformity ◽  
Osteotomy Site ◽  
Radiographic Outcome ◽  
Short Term ◽  
Chevron Osteotomy ◽  
Hallux Valgus Deformity ◽  
Valgus Angle

Distal Chevron osteotomy is a well-established surgical procedure for mild to moderate hallux valgus deformity. Many methods have been described for fixation of osteotomy site; secure fixation, enabling large displacement of the metatarsal head, is one of the essentials of this procedure. The purpose of the present study was to evaluate the short-term radiographic outcome of a distal Chevron osteotomy using an intramedullary plate for the correction of hallux valgus deformity. The present study evaluated 37 patients (40 feet) who underwent distal Chevron osteotomy using an intramedullary plate by periodic radiographs obtained preoperatively and at 4 weeks, 8 weeks, 3 months, and 6 months postoperatively. Correction of the hallux valgus angle averaged 17.8°, intermetatarsal angle 7.4°, distal metatarsal articular angle 2.7°, and sesamoid position 1.4 stages at 3 months postoperatively. The average lateral shift of the capital fragment was 6.5 mm. All patients achieved bone union, and there were no cases of dislocation, displacement, or avascular necrosis of the metatarsal head fragment. In conclusion, a distal Chevron osteotomy using an intramedullary plate was a favorable method for the correction of mild to moderate hallux valgus deformity. Levels of Evidence: Level IV: Case series

scholarly journals Radiographic analysis of the effects of first metatarsal rotation in hallux valgus surgery

2021 ◽  
Vol 15 (1) ◽  
pp. 43-48
Author(s):  
Alexandre Budin ◽  
Helencar Ignacio ◽  
Marcio Gomes Figueiredo
Keyword(s):  
Hallux Valgus ◽  
Weight Bearing ◽  
Case Series ◽  
Metatarsal Head ◽  
Mean Difference ◽  
Surgical Correction ◽  
Rotational Deformity ◽  
Level Of Evidence ◽  
First Metatarsal ◽  
Initial Degree

Objective: To evaluate whether the initial degree of metatarsal rotation interferes with the surgical correction of severe hallux valgus. Methods: A retrospective study was performed using weight-bearing AP radiographs to measure first metatarsal rotation based on the shape of the lateral edge of the metatarsal head and the hallux valgus (HVA) and intermetatarsal (IMA) angles. Participants were then classified into two groups. Those with less rotational deformity were placed in the negative pronation group, while those with greater rotational deformity were placed in the positive pronation group. Mean HVA and IMA correction were calculated and compared between groups. Participants underwent the modified Lapidus procedure with correction of pronation. Results: Data were collected for 26 feet with hallux valgus. The negative and positive pronation groups contained 14 and 12 feet, respectively. Successful surgical correction of pronation was observed in 11 of the 12 feet, which were ultimately classified in the negative pronation group based on postoperative radiographs. The negative pronation group showed a mean difference of 15.05o in the HVA and 4.20o in the IMA. The positive pronation group showed a mean difference of 14.22o in the HVA and 3.2o in the IMA. These values did not significantly differ between groups. Conclusion: The initial degree of pronation does not affect the degree of angular correction as long as metatarsal rotation is also addressed. Level of Evidence IV; Diagnostic Studies; Case Series.

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