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

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.

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

Foot & Ankle Specialist ◽

10.1177/1938640020912135 ◽

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

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

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00175 ◽

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.

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

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00011 ◽

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.

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

Journal of the American Podiatric Medical Association ◽

10.7547/20-015 ◽

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 < 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 < 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 < 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.

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

Foot & Ankle International ◽

10.1177/10711007211061363 ◽

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.

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

Foot & Ankle International ◽

10.1177/10711007211027262 ◽

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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Minimally Important Difference in the Foot and Ankle Outcome Score Among Patients Undergoing Hallux Valgus Surgery

Foot & Ankle International ◽

10.1177/1071100719831392 ◽

2019 ◽

Vol 40 (6) ◽

pp. 694-701 ◽

Cited By ~ 3

Author(s):

Sameer Desai ◽

Alexander C. Peterson ◽

Kevin Wing ◽

Alastair Younger ◽

Trafford Crump ◽

...

Keyword(s):

Activities Of Daily Living ◽

Hallux Valgus ◽

Daily Living ◽

Patient Reported Outcomes ◽

Minimally Important Difference ◽

Foot And Ankle ◽

Outcome Score ◽

Patient Reported ◽

Bunion Correction ◽

Correction Surgery

Background: Patient-reported outcomes are increasingly used as measures of effectiveness of interventions. To make the tools more useful, therapeutic thresholds known as minimally important differences have been developed. The objective of this study was to calculate minimally important differences for the domains of the Foot and Ankle Outcome Score for hallux valgus surgery. Methods: The study was based on a retrospective analysis of patients newly scheduled for bunion correction surgery and completing patient-reported outcomes between October 2013 and January 2018. This study used anchor- and distribution-based approaches to calculate the minimally important difference for the instrument’s 5 domains. Confidence intervals were calculated for each approach. There were 91 participants included in the study. Results: Using anchor- and distribution-based approaches, the minimally important difference for the pain domain ranged from 5.8 to 10.2, from 0.3 to 6.9 for the symptoms domain, 8.3 to 10.3 for the activities of daily living domain, 7.4 to 11.1 for the quality of life domain, and from 7.0 to 15.7 for the sports and recreation domain. Small differences in the activities of daily living domain may be more clinically important for patients with better function. Discussion: The range of minimally important difference values for each domain indicate how the Foot and Ankle Outcome Score corresponded to bunion correction surgery. The sports and recreation domain showed considerable variability in the range of values and may be associated with the domain’s lack of responsiveness. Overall, most minimally important difference values for the domains of FAOS ranged from above 4 to below 16. Level of Evidence: Level III, retrospective comparative series.

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Modified Austin Procedure for Correction of Hallux Valgus

Foot & Ankle International ◽

10.1177/107110079701800302 ◽

1997 ◽

Vol 18 (3) ◽

pp. 119-127 ◽

Cited By ~ 55

Author(s):

Hans-Jörg Trnka ◽

Alexander Zembsch ◽

Hermann Wiesauer ◽

Marc Hungerford ◽

Martin Salzer ◽

...

Keyword(s):

Soft Tissue ◽

Hallux Valgus ◽

Metatarsophalangeal Joint ◽

Metatarsal Head ◽

Hallux Valgus Angle ◽

First Metatarsophalangeal Joint ◽

Intermetatarsal Angle ◽

Soft Tissue Procedure ◽

Valgus Angle

The Austin osteotomy is a widely accepted method for correction of mild and moderate hallux valgus. In view of publications by Kitaoka et al. in 1991 and by Mann and colleagues, a more radical lateral soft tissue procedure was added to the originally described procedure. From September 1992 to January 1994, 85 patients underwent an Austin osteotomy combined with a lateral soft tissue procedure to correct their hallux valgus deformities. Seventy-nine patients (94 feet) were available for follow-up. The average patient age at the time of the operation was 47.1 years, and the average follow-up was 16.2 months. The average preoperative intermetatarsal angle was 13.9°, and the average hallux valgus angle was 29.7°. After surgery, the feet were corrected to an average intermetatarsal angle of 5.8° and an average hallux valgus angle of 11.9°. Sesamoid position was corrected from 2.1 before surgery to 0.5 after surgery. The results were also graded according to the Hallux Metatarsophalangeal Interphalangeal Score, and the functional and cosmetic outcomes were graded by the patient. Dissection of the plantar transverse ligament and release of the lateral capsule repositioned the tibial sesamoid and restored the biomechanics around the first metatarsophalangeal joint. There was no increased incidence of avascular necrosis of the first metatarsal head compared with the original technique.

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

Foot & Ankle International ◽

10.1177/1071100718807699 ◽

2018 ◽

Vol 40 (3) ◽

pp. 287-296 ◽

Cited By ~ 8

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.

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Measuring Visualized Joint Surface in Hallux Metatarsophalangeal Arthroscopy

Foot & Ankle International ◽

10.1177/1071100718770365 ◽

2018 ◽

Vol 39 (8) ◽

pp. 978-983

Author(s):

Michael Hull ◽

John T. Campbell ◽

Clifford L. Jeng ◽

R. Frank Henn ◽

Rebecca A. Cerrato

Keyword(s):

Clinical Practice ◽

Clinical Relevance ◽

Articular Surface ◽

Proximal Phalanx ◽

Metatarsophalangeal Joint ◽

Metatarsal Head ◽

Lateral View ◽

Joint Surface ◽

Foot And Ankle ◽

Kirschner Wires

Background: Arthroscopy has been increasingly used to evaluate small joints in the foot and ankle. In the hallux metatarsophalangeal (MTP) joint, little data exist evaluating the efficacy of arthroscopy to visualize the articular surface. The goal of this cadaveric study was to determine how much articular surface of the MTP joint could be visualized during joint arthroscopy. Methods: Ten fresh cadaveric foot specimens were evaluated using standard arthroscopy techniques. The edges of the visualized joint surface were marked with curettes and Kirschner wires; the joints were then surgically exposed and imaged. The visualized surface area was measured using ImageJ® software. Results: On the distal 2-dimensional projection of the joint surface, an average 57.5% (range, 49.6%-65.3%) of the metatarsal head and 100% (range, 100%-100%) of the proximal phalanx base were visualized. From a lateral view of the metatarsal head, an average 72 degrees (range, 65-80 degrees) was visualized out of an average total articular arc of 199 degrees (range, 192-206 degrees), for an average 36.5% (range, 32.2%-40.8%) of the articular arc. Conclusion: Complete visualization of the proximal phalanx base was obtained. Incomplete metatarsal head visualization was obtained, but this is limited by technique limitations that may not reflect clinical practice. Clinical Relevance: This information helps to validate the utility of arthrosocpy at the hallux metatarsophalangeal joint.

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