Effects of various walking intensities on leg muscle fatigue and plantar pressure distributions

Abstract Background Physical activity may benefit health and reduce risk for chronic complications in normal and people with diabetes and peripheral vascular diseases. However, it is unclear whether leg muscle fatigue after weight-bearing physical activities, such as brisk walking, may increase risk for plantar tissue injury. In the literature, there is no evidence on the effect of muscle fatigue on plantar pressure after various walking intensities. The objectives of this study were to investigate the effects of various walking intensities on leg muscle fatigue and plantar pressure patterns. Methods A 3 × 2 factorial design, including 3 walking speeds (1.8 (slow and normal walking), 3.6 (brisk walking), and 5.4 (slow running) mph) and 2 walking durations (10 and 20 min) for a total of 6 walking intensities, was tested in 12 healthy participants in 3 consecutive weeks. The median frequency and complexity of electromyographic (EMG) signals of tibialis anterior (TA) and gastrocnemius medialis (GM) were used to quantify muscle fatigue. Fourier transform was used to compute the median frequency and multiscale entropy was used to calculate complexity of EMG signals. Peak plantar pressure (PPP) values at the 4 plantar regions (big toe, first metatarsal head, second metatarsal head, and heel) were calculated. Results Two-way ANOVA showed that the walking speed (at 1.8, 3.6, 5.4 mph) significantly affected leg muscle fatigue, and the duration factor (at 10 and 20 min) did not. The one-way ANOVA showed that there were four significant pairwise differences of the median frequency of TA, including walking speed of 1.8 and 3.6 mph (185.7 ± 6.1 vs. 164.9 ± 3.0 Hz, P = 0.006) and 1.8 and 5.4 mph (185.7 ± 6.1 vs. 164.5 ± 5.5 Hz, P = 0.006) for the 10-min duration; and walking speed of 1.8 and 3.6 mph (180.0 ± 5.9 vs. 163.1 ± 4.4 Hz, P = 0.024) and 1.8 and 5.4 mph (180.0 ± 5.9 vs. 162.8 ± 4.9 Hz, P = 0.023) for the 20-min duration. The complexity of TA showed a similar trend with the median frequency of TA. The median frequency of TA has a significant negative correlation with PPP on the big toe ( r = -0.954, P = 0.003) and the first metatarsal head ( r = -0.896, P = 0.016). Conclusions This study demonstrated that brisk walking and slow running speeds (3.6 and 5.4 mph) cause an increase in muscle fatigue of TA compared to slow walking speed (1.8 mph); and the increased muscle fatigue is significantly related to a higher PPP.

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Dynamic Pedobarography Shows Pain Avoidance Gait of Symptomatic Severe Flatfoot Patient

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00010 ◽

2018 ◽

Vol 3 (2) ◽

pp. 2473011418S0001

Author(s):

Woo-Chun Lee ◽

Chihoon Ahn ◽

Ji-Beom Kim ◽

Mu Hyun Kim

Keyword(s):

Plantar Pressure ◽

Weight Bearing ◽

Metatarsal Head ◽

Assessment System ◽

Medial Longitudinal Arch ◽

Head Elevation ◽

Radiographic Parameters ◽

Longitudinal Arch ◽

Bearing Load ◽

The Mean

Category: Basic Sciences/Biologics, Midfoot/Forefoot Introduction/Purpose: In the flatfoot patients, collapsed medial longitudinal arch during gait induced pain and it results decreased center of progression excursion index(CPEI) in dynamic pedobarography. Although the CPEI decreased is pathologic gait of flatfoot patients, range of the CPEIs is wide even in similar severity of flatfoot patients. We hypothesized that some flatfoot patients inverted forefoot or elevated first metatarsal head during gait for avoiding the pain from collapsed medial longitudinal arch, which resulted wide range of the CPEIs in flatfoot patients. The purposes of this study were to investigate the incidence of forefoot inversion and 1st metatarsal head elevation during gait in severe symptomatic flatfoot patients, and to confirm whether forefoot inversion and 1st metatarsal head elevation increases the CPEI, by using the dynamic pedobarography. Methods: We retrospectively evaluated patients who underwent surgery for flatfoot in our clinic from January, 2017 to May, 2017. Before surgery, all patients underwent plain weight-bearing radiographs and dynamic pedobarography by using in-shoe plantar pressure assessment system (Tekscan, Inc., South Boston, MA). Radiographic parameters, talonavicular coverage angle, Meary angle and moment arm, and the CPEI in dynamic pedobarogrpahy were measured. The forefoot inversion and the 1st metatarsal head elevation were defined when sum of 3rd-4th and 5th submetatarsal plantar pressure was higher than sum of 1st and 2nd submetatarsal plantar pressure, and when 2nd submetatarsal plantar pressure was higher than 1st submetatarsal plantar pressure, respectively. Correlations between the radiographic parameters and the CPEI were investigated. Incidence of the forefoot inversion and the 1st metatarsal head elevation was investigated. The CPEIs in flatfeet with forefoot inversion or 1st metatarsal head elevation were compared with those in flatfeet without these pain avoidance gait. Results: Twenty-eight flatfeet from 28 patients were included in the present study. The average age of patients was 42.3 years (range: 19-71). Means of the three radiographic parameters and the CPEI of the 28 flatfeet were listed at table.1. There was no significant correlation between the CPEI and the three radiographic parameters.(Table.2) The incidence of forefoot inversion and 1st metatarsal head elevation were 11%(3 feet), 54%(15 feet) respectively. The mean CPEI of the flatfeet with forefoot inversion or 1st metatarsal head elevation was 8(range: -10 – 18), and the mean CPEI of the flatfeet without these two compensations was 5 (range: -3 – 12). The CPEI in the flatfeet with the two compensations was significant larger than that of the flatfeet without the two compensations. (P=0.027) Conclusion: In the present study, forefoot inversion or 1st metatarsal head elevation were happened in 65% of symptomatic flatfoot patients. These two pain avoidance gait shifts weight-bearing load laterally, which decreases collapsing medial longitudinal arch and pain on the flatfoot. Because lateral shifting of weight-bearing load increases the CPEI, flatfoot patients with these two gaits showed high the CPEI. Therefore, the degree of the CPEIs are various even in similar severity of flatfoot and are not correlated with the severity of the flatfoot. Clinicians should consider these pain avoidance gait of flatfoot patients when they interpret a dynamic pedobarography of flatfoot.

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

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00038 ◽

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]

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Impact of First Metatarsal Shortening on Forefoot Loading Pattern: A Finite Element Model Study

10.21203/rs.2.15569/v2 ◽

2019 ◽

Author(s):

Geng Xiang ◽

Shi Jiaqi ◽

Chen Wenming ◽

Xin Ma ◽

Wang Xu ◽

...

Keyword(s):

Finite Element ◽

Finite Element Model ◽

Plantar Pressure ◽

Load Ratio ◽

Element Model ◽

Metatarsal Head ◽

Critical Threshold ◽

Metatarsal Osteotomy ◽

Loading Pattern ◽

First Metatarsal

Abstract Backgrounds There has long been agreement that shortening of the first metatarsal during hallux valgus reconstruction could lead to postoperative transfer metatarsalgia. But appropriate shortening is sometimes beneficial for correcting severe deformities or relieving stiff joints. So this study is to investigate, from the biomechanical perspective, whether and how much shortening of the first metatarsal could be allowed. Methods A finite element model of the human foot simulating the push-off phase of the gait was established and validated by subject-specific plantar pressure data. Shortening of the first metatarsal for 2mm, 4mm, 6mm, 8mm were sequentially applied to the model, and the corresponding instant forefoot loading pattern during push-off phase, especially the loading ratio at the central rays, was respectively calculated. The effect of depressing the first metatarsal head was also observed at last. Results With increasing shortening level of first metatarsal, the plantar pressure of the first ray decreased, while the lateral rays continued to rise. When the shortening reaches 6 mm, the load ratio of the central rays exceeds a critical threshold of 55%, which was considered risky. But it could still be manipulated to normal if the distal end of the first metatarsal displaced plantarly by 3 mm. Conclusions During the first metatarsal osteotomy, a maximum of 6 mm of shortening is considered to be within the safe range. Whenever a higher level of shortening is necessary, pushing down the distal metatarsal segment could be a compensatory procedure to maintain normal plantar force distributions.

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

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00374 ◽

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.

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A radiological study of anatomical variants of hallux sesamoids

National Journal of Clinical Anatomy ◽

10.1055/s-0040-1701726 ◽

2018 ◽

Vol 7 (03) ◽

pp. 128-133

Author(s):

Mallikarjun Adibatti ◽

Muthiah Pitchandi ◽

Bhuvaneswari V.

Keyword(s):

Early Diagnosis ◽

Weight Bearing ◽

Metatarsal Head ◽

Flexor Hallucis Longus ◽

First Metatarsophalangeal Joint ◽

Anatomical Variants ◽

First Metatarsal ◽

Foot Bones ◽

Plantar Aspect ◽

Sesamoid Bones

Abstract Background and Aims: Hallux sesamoid bones forms an integral part of the first metatarsophalangeal joint for stability during weight bearing. Hallux sesamoids are paired bones located on the plantar aspect of the first metatarsal head within the flexor hallucis longus tendon. Hallucal sesamoids vary in shape and size; can be single, double, bipartite and multipartite. Traumatic insult to the hallux sesamoids can lead to fracture & dislocation, while majority of symptomatic hallux sesamoids can be treated non-surgically; certain specific injuries require a high index of suspicion, careful management, and surgical intervention. Hence present study was taken up to know the incidence, presence/absence, number and partition of hallux sesamoid to enlighten the surgeons and radiologists in early diagnosis and treatment of cases presenting with history of trauma, pain and fractures of foot. Methods: Retrospective radiographic study on the incidence, anatomical variants & distribution ofhallux sesamoids inlOOO radiographs ofthe foot. Result: Hallux Sesamoid bones were seen plantar to first metatarsal head in 994 radiographs [99.4%], while the absence ofHallucal sesamoids were noted in 6 radiographs [0.6%], Single Hallucal sesamoid were noted in 9 radiographs [0.9%], medial bipartition was noted in 20 radiographs [2%], lateral bipartition was noted in 15 radiographs [1.5%]. Conclusion: Knowledge regarding hallux sesamoids helps us in differentiating the various conditions arising out of fractures of foot bones with overlapping signs and symptoms, from actual involvement of sesamoid bone itself, which assists in the early diagnosis and management of foot pathologies.

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Reduction of plantar pressure with the rigid relief orthosis

Journal of the American Podiatric Medical Association ◽

10.7547/87507315-83-3-115 ◽

1993 ◽

Vol 83 (3) ◽

pp. 115-122 ◽

Cited By ~ 19

Author(s):

A Novick ◽

J Stone ◽

JA Birke ◽

DM Brasseaux ◽

JB Broussard ◽

...

Keyword(s):

Mechanical Stress ◽

Plantar Pressure ◽

Pressure Transducer ◽

Clinical Effectiveness ◽

Metatarsal Head ◽

Lesion Site ◽

Measurement Systems ◽

Plantar Surface ◽

First Metatarsal

The rigid relief orthosis was developed to protect vulnerable sites on the plantar surface of the insensitive foot against reulceration by providing both a nonyielding relief under the healed lesion site and a total contact fit. Clinically, the rigid relief orthosis has been effective in protecting the foot against the trauma induced by the repetitive mechanical stress of walking. This study used both the Hercules and F-Scan pressure transducer systems to measure pressure at the first metatarsal head in three orthotic treatments. Both measurement systems recorded significant reductions in pressure at the first metatarsal head with the rigid relief orthosis, establishing a quantitative rationale explaining its clinical effectiveness. Significant pressure differences were also recorded at the secondary sites of the heel, midfoot, and third metatarsal head.

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Effects of Preconditioning Local Vibrations on Subsequent Plantar Skin Blood Flow Response to Walking

The International Journal of Lower Extremity Wounds ◽

10.1177/1534734620905744 ◽

2020 ◽

pp. 153473462090574 ◽

Cited By ~ 1

Author(s):

Xiaotong Zhu ◽

Fu-Lien Wu ◽

Ting Zhu ◽

Fuyuan Liao ◽

Yuanchun Ren ◽

...

Keyword(s):

Blood Flow ◽

Skin Blood Flow ◽

Repeated Measures ◽

Recovery Time ◽

Reactive Hyperemia ◽

Weight Bearing ◽

Metatarsal Head ◽

Foot Ulcers ◽

Sham Control ◽

First Metatarsal

Weight-bearing exercise such as walking may increase risk of foot ulcers in people with diabetes mellitus (DM) because of plantar ischemia due to repetitive, high plantar pressure. Applications of local vibrations on plantar tissues as a preconditioning intervention before walking may reduce plantar tissue ischemia during walking. The objective of this study was to explore whether preconditioning local vibrations reduce reactive hyperemia after walking. A double-blind, repeated-measures, and crossover design was tested in 10 healthy participants without DM. The protocol included 10-minute baseline, 10-minute local vibrations (100 Hz or sham), 10-minute walking, and 10-minute recovery periods. The order of local vibrations was randomly assigned. Skin blood flow (SBF) was measured over the first metatarsal head during baseline and recovery periods. SBF responses were characterized as peak SBF, total SBF, and recovery time of reactive hyperemia. SBF was expressed as a ratio of recovery to baseline SBF to quantify the changes. Peak SBF in the vibration protocol (6.98 ± 0.87) was significantly lower than the sham control (9.26 ± 1.34, P < .01). Total SBF in the vibration protocol ([33.32 ± 7.98] × 103) was significantly lower than the sham control ([48.09 ± 8.9] × 103, P < .05). The recovery time in the vibration protocol (166.08 ± 32.71 seconds) was not significantly different from the sham control (223.53 ± 38.85 seconds, P = .1). Local vibrations at 100 Hz could reduce walking-induced hyperemic response on the first metatarsal head. Our finding indicates that preconditioning local vibrations could be a potential preventive intervention for people at risk for foot ulcers.

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Using Elastographic Ultrasound to Assess Plantar Tissue Stiffness after Walking at Different Speeds and Durations

Applied Sciences ◽

10.3390/app10217498 ◽

2020 ◽

Vol 10 (21) ◽

pp. 7498

Author(s):

Chi-Wen Lung ◽

Fu-Lien Wu ◽

Keying Zhang ◽

Ben-Yi Liau ◽

Runnell Townsend ◽

...

Keyword(s):

Walking Speed ◽

Weight Bearing ◽

Metatarsal Head ◽

Foot Ulcers ◽

Ultrasound Images ◽

Tissue Stiffness ◽

Significant Difference ◽

Increase Risk ◽

Speed Effect ◽

Walking Speeds

Exercise has been demonstrated to improve health in people with diabetes. However, exercise may increase risk for foot ulcers because of increased plantar pressure during most weight-bearing physical activities. To date, there is no study investigating the effect of various walking speeds and durations (i.e., the most common form of exercise in daily living) on the plantar foot. The objective of this study was to investigate the effect of various walking intensities on plantar tissue stiffness. A 3 × 2 factorial design, including three walking speeds (1.8, 3.6 and 5.4 mph) and two durations (10 and 20 min), was tested in 12 healthy participants. B-mode and elastographic ultrasound images were measured from the first metatarsal head to quantify plantar tissue stiffness after walking. Two-way ANOVA was used to examine the results. Our results showed that the walking speed factor caused a significant main effect of planar stiffness of the superficial layers (p = 0.007 and 0.003, respectively). However, the walking duration factor did not significantly affect the plantar stiffness. There was no interaction between the speed and duration factors on plantar tissue stiffness. Regarding the walking speed effect, there was a significant difference in the plantar stiffness between 1.8 and 3.6 mph (56.8 ± 0.8% vs. 53.6 ± 0.9%, p = 0.017) under 20 min walking duration. This finding is significant because moderate-to-fast walking speed (3.6 mph) can decrease plantar stiffness compared to slow walking speed (1.8 mph). This study suggests people at risk for foot ulcers walk at a preferred or fast speed (3.6 mph) rather than walk slowly (1.8 mph).

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Analysis of Plantar Pressure Pattern after Metatarsal Head Resection. Can Plantar Pressure Predict Diabetic Foot Reulceration?

Journal of Clinical Medicine ◽

10.3390/jcm10112260 ◽

2021 ◽

Vol 10 (11) ◽

pp. 2260

Author(s):

Marta García-Madrid ◽

Yolanda García-Álvarez ◽

Francisco Javier Álvaro-Afonso ◽

Esther García-Morales ◽

Aroa Tardáguila-García ◽

...

Keyword(s):

Plantar Pressure ◽

Metatarsal Head ◽

First Metatarsal ◽

Metatarsal Bones ◽

Second Metatarsal ◽

Patients With Diabetes ◽

Peak Plantar Pressure ◽

One Year ◽

The Moment ◽

A Minor

To evaluate the metatarsal head that was associated with the highest plantar pressure after metatarsal head resection (MHR) and the relations with reulceration at one year, a prospective was conducted with a total of sixty-five patients with diabetes who suffered from the first MHR and with an inactive ulcer at the moment of inclusion. Peak plantar pressure and pressure time integral were recorded at five specific locations in the forefoot: first, second, third, fourth, and fifth metatarsal heads. The highest value of the four remaining metatarsals was selected. After resection of the first metatarsal head, there is a displacement of the pressure beneath the second metatarsal head (p < 0.001). Following the resection of the minor metatarsal bones, there was a medial displacement of the plantar pressure. In this way, plantar pressure was displaced under the first metatarsal head following resection of the second or third head (p = 0.001) and under the central heads after resection of the fourth or fifth metatarsal head (p < 0.009 and p < 0.001 respectively). During the one-year follow-up, patients who underwent a metatarsal head resection in the first and second metatarsal heads suffered transfer lesion in the location with the highest pressure. Patients who underwent a minor metatarsal head resection (second–fifth metatarsal heads) showed a medial transference of pressure. Additionally, following the resection of the first metatarsal head there was a transference of pressure beneath the second metatarsal head. Increase of pressure was found to be a predictor of reulceration in cases of resection of the first and second metatarsal heads.

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Effect of Metatarsal Head Shape on the Development of Hallux Valgus Deformity: 10 Years of Natural Follow-up

Journal of the American Podiatric Medical Association ◽

10.7547/16-090 ◽

2020 ◽

Vol 110 (3) ◽

Author(s):

Ulunay Kanatli ◽

Onur Unal ◽

Muhammet Baybars Ataoglu ◽

Tacettin Ayanoglu ◽

Mustafa Ozer ◽

...

Keyword(s):

Hallux Valgus ◽

Plantar Pressure ◽

Metatarsal Head ◽

Valgus Deformity ◽

Radiographic Evaluation ◽

Hallux Valgus Angle ◽

Head Shape ◽

First Metatarsal ◽

Hallux Valgus Deformity ◽

Valgus Angle

Background We investigated the role of first metatarsal head shape in the etiology of hallux valgus. By pedobarographic analysis, we evaluated whether first metatarsal head shape causes an alteration in plantar pressure values that would result in metatarsalgia. Methods Referrals to our clinic for metatarsalgia, plantar fasciitis, and calcaneal spur were scanned retrospectively. Patients with severe hallux valgus, pes planus, gastrocnemius stiffness, generalized joint laxity, neuromuscular disease, or a history of lower-extremity orthopedic surgery were excluded. Sixty-two patients with plantar pressure assessment and radiographic evaluation were included. These patients were invited for reassessment after 10 years. Feet were divided into three groups by metatarsal head shape: round, square, and chevron. On anteroposterior radiographs, the hallux valgus and intermetatarsal angles, relative first metatarsal length, lateral sesamoid subluxation, and presence of bipartite sesamoid were noted. Plantar pressure was assessed with pedobarography. Results Feet with round-shaped first metatarsal heads had a statistically significantly greater progression in hallux valgus angle than the other shapes. Plantar pressures under the first, second and third, and fourth and fifth metatarsals increased with time. This can explain the mechanism of transfer metatarsalgia and painful callosities under the first metatarsal in hallux valgus. There was no correlation between hallux valgus angle, relative metatarsal length, and lateral sesamoid subluxation. Conclusions We found a strong relation between round-shaped first metatarsal head and hallux valgus angle progression. No patients had a risk factor responsible for hallux valgus. In other words, this study gives approximately 10-year natural history results in nearly normal feet.

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