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 Assessment of First Metatarsal Head Bone Density for Optimal Screw Placement in Minimally-Invasive Hallux Valgus Surgery

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0003
Author(s):  
Katherine M. Dederer ◽  
Patrick J. Maloney ◽  
John T. Campbell ◽  
Clifford L. Jeng ◽  
Rebecca A. Cerrato
Keyword(s):  
Bone Density ◽  
Minimally Invasive ◽  
Hallux Valgus ◽  
Screw Fixation ◽  
Weight Bearing ◽  
Metatarsal Head ◽  
Screw Placement ◽  
Cannulated Screws ◽  
First Metatarsal ◽  
History Of

Category: Bunion; Basic Sciences/Biologics Introduction/Purpose: Minimally-invasive surgery (MIS) for hallux valgus correction has become increasingly common. This technique involves an osteotomy of the first metatarsal, followed by fixation with two cannulated screws. Since screws are typically not bicortical, they rely upon bone quality within the metatarsal head for fixation strength. However, bone mineral density (BMD) within different regions of the metatarsal head is unknown. Measuring the BMD in the target region may predict the strength of the bone-screw fixation. Similar to previous work which determined the optimal position for lag screw placement in the femoral head during hip fracture fixation, this study aimed to determine average BMD within four quadrants of the metatarsal head using CT and thus predict the optimal trajectories for cannulated screws during the MIS bunion procedure. Methods: All patients between 18-75 years of age scheduled to undergo MIS hallux valgus correction by one of two surgeons experienced in the MIS technique were eligible to participate. Patients were excluded if they had a prior first metatarsal surgery, pre-existing hardware, previous first metatarsal fracture, or a history of osteoporosis treatment. Patients were enrolled prospectively, and a weight-bearing CT scan of the affected foot was obtained pre-operatively. Demographic factors including age, sex, laterality, body mass index (BMI), comorbidities, and smoking status as well as standard three-view weight-bearing radiographs were collected for all patients.Using the coronal CT slice at maximal metatarsal head diameter, each head was divided into equal quadrants. Hounsfield units (HU) within each quadrant were measured independently by three study investigators using our hospital’s radiology viewing software (Merge PACS; IBM Corporation, Armonk, NY), and these density measurements were averaged. Statistical analysis was conducted using ANOVA and Student’s t-test. Results: Fifteen patients were included for preliminary analysis. All patients were female. The average age was 45.7 years. 9 of the 15 included feet were right feet. Average BMI was 28.0. One patient reported active smoking prior to surgery. Comorbidities included obesity in three patients; none were diabetic. One had a history of diplegic cerebral palsy. The average HVA on a weight- bearing AP foot x-ray was 28.2°, and the average IMA was 12.6°. The BMD within the metatarsal head varied by quadrant, with the two combined dorsal quadrants having higher average BMD than the two combined plantar quadrants (122 vs 85 HU; p<0.001). The dorsal lateral quadrant had the highest average BMD of any quadrant (132 HU, p<0.001; Table 1). Conclusion: The density of the metatarsal head did vary by region within the head. The highest BMD was found in the dorsal lateral quadrant, and the lowest in the plantar lateral and plantar medial quadrants, which did not differ significantly from each other. Because strength of screw fixation is predicated upon screw design as well as bone density, these results suggest that surgeons may wish to direct screws toward the dorsolateral region of the metatarsal head in order to achieve optimal fixation. Further work is needed to determine whether this varies with patient age, gender, or hallux valgus angle. [Table: see text]

The Shape of the Lateral Edge of the First Metatarsal Head as a Risk Factor for Recurrence of Hallux Valgus

2007 ◽  
Vol 89 (10) ◽  
pp. 2163-2172 ◽  
Author(s):  
Ryuzo Okuda ◽  
Mitsuo Kinoshita ◽  
Toshito Yasuda ◽  
Tsuyoshi Jotoku ◽  
Naoshi Kitano ◽  
...  
Keyword(s):  
Risk Factor ◽  
Hallux Valgus ◽  
Metatarsal Head ◽  
First Metatarsal ◽  
Lateral Edge ◽  
Risk Factor For Recurrence

scholarly journals Radiographic Outcomes after Fixation of Distal Metatarsal Osteotomy for Hallux Valgus Using a Tension Band Construct

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0042
Author(s):  
Alexander Volpi ◽  
Robert Zbeda ◽  
Christopher Katchis ◽  
Lon Weiner ◽  
Stuart Katchis
Keyword(s):  
Hallux Valgus ◽  
Postoperative Period ◽  
Weight Bearing ◽  
Line Tension ◽  
Tension Band ◽  
Metatarsal Osteotomy ◽  
First Metatarsal ◽  
Distal Metatarsal Osteotomy ◽  
The Mean

Category: Bunion Introduction/Purpose: Hallux valgus is a common deformity of the forefoot. There are over 130 procedures described to correct hallux valgus. Classically, the treatment of mild to moderate hallux valgus is with a distal metatarsal osteotomy. A variety of fixation techniques have been described for use with this osteotomy most of which require partial or non-weight bearing until the osteotomy is healed. Tension Band fixation is a well-known principle in orthopedic surgery. The goal of the present study is to radiographically assess the maintenance of distal first metatarsal osteotomy fixation using a novel tension band device (Re+Line tension band bunion plate system, Nextremity Solutions) with immediate post-operative weight-bearing. Methods: The patient database for one surgeon was retrospectively reviewed for patients that underwent hallux valgus correction with the Re+Line tension band device between 2014 and 2017. Postoperative protocol included a soft dressing, firm surgical shoe, and weight-bearing as tolerated with a cane. Patients were excluded if fixation was achieved with something other than a tension band construct. Radiographs were obtained and reviewed retrospectively by 3 authors. Pre and postoperative hallux valgus (HVA) and intermetatarsal angles (IMA) were measured as described previously in the literature, and the changes in correction compared. Maintenance of correction and hardware integrity were assessed at final follow-up after weight bearing as tolerated in a surgical shoe in the postoperative period. Statistical analysis was performed using a Wilcoxon signed-rank test for the changes in HVA and IMA. Results: There was a total of 72 patients and 76 toes that underwent hallux valgus correction with a tension band construct, at a mean follow-up of 4.36 months. 68 of 72 patients were female. The average age was 60.8 years old. The mean preoperative HVA was 27.1 degrees. The mean postoperative HVA was 6.14 degrees, with a mean correction of 20.22 degrees (p<0.001). The mean preoperative IMA was 14.14 degrees. The mean postoperative IMA was 6.10 degrees, with a mean correction of 7.98 degrees (p<0.001). There was loss of reduction found in 6 of 76 toes (7.89%).There were zero cases of hardware failure. All osteotomies healed at final follow-up. Conclusion: This study shows successful radiographic outcome after hallux valgus correction using a tension band construct and allowing immediate full weight-bearing in a surgical shoe in the postoperative period. Significant deformity correction was achieved and maintained and all osteotomies healed. The Re+Line tension band bunion correction system can be safely used as a successful option to fix distal first metatarsal osteotomies, while allowing patients to fully weight bear in a surgical shoe postoperatively and potentially return to activities faster than when using traditional fixation methods. Future studies are needed to assess functional outcomes and patient satisfaction with this novel technique.

The Shape of the Lateral Edge of the First Metatarsal Head as a Risk Factor for Recurrence of Hallux Valgus

2007 ◽  
Vol 89 (10) ◽  
pp. 2163-2172 ◽  
Author(s):  
Ryuzo Okuda ◽  
Mitsuo Kinoshita ◽  
Toshito Yasuda ◽  
Tsuyoshi Jotoku ◽  
Naoshi Kitano ◽  
...  
Keyword(s):  
Risk Factor ◽  
Hallux Valgus ◽  
Metatarsal Head ◽  
First Metatarsal ◽  
Lateral Edge ◽  
Risk Factor For Recurrence

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 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.

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.

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.

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