Comparison of Sesamoid Bone Position and Hallux Valgus Angle in Weight Bearing Conditions between Subjects with and without Hallux Valgus

Category: Bunion Introduction/Purpose: Hallux valgus (HV) is one of the most common deformities of the foot resulting in pain and lifestyle modification of the patient. Recurrence rates of 10-47% have been documented in single individual osteotomy series. Unfortunately, surgical correction and recurrence are often defined as changes related to normal radiographs and not actually as the magnitude of correction lost with follow-up. Currently there have not been studies evaluating the percentage of recurrence of intermetatarsal angle (IMA) and hallux valgus angle (HVA). As there is substantial difference in starting IMA and HVA, as well as amount of surgical correction, our goal was to evaluate the percentage loss of correction over time comparing preoperative, initial postoperative and minimum of 2-year follow up radiographs among three different surgical correction techniques. Methods: This is a retrospective chart review study that examines the weight-bearing radiographic measurements of patients undergoing hallux valgus corrective surgery at a single institution over 5 years. Fifty-three patients were divided into first tarsometatarsal arthrodesis (i.e. Lapidus), mid-diaphyseal osteotomies (i.e. scarf), and distal metatarsal osteotomies (i.e. chevron). The preoperative, initial postoperative, and final follow up weight-bearing radiographs were measured for intermetatarsal angle (IMA) and hallux valgus angle (HVA). Primary outcome was percentage of recurrence of IMA and HVA, with the difference in angles between preoperative and initial postoperative weight-bearing films being considered 100% correction. The percentage of recurrence between initial postoperative and most recent follow up was then calculated (Figure 1A). A one-way analysis of variance (ANOVA) test and post-hoc Tukey-Kramer tests were used to compare preoperative IMA and HVA and percentage recurrence of IMA and HVA at most recent follow up. Results: There was no significant difference between Lapidus (14.3deg) and mid-diaphyseal osteotomies (12.7deg) in preoperative IMA (p-value=0.26). There was a significant difference between Lapidus (-0.3deg) and mid-diaphyseal (2.8deg) osteotomies for degree of hallux valgus recurrence as measured by IMA between initial postoperative films and final 2-year follow up (p-value=0.009). Lapidus procedure showed a greater magnitude decrease in IMA degrees from preoperation to final follow up compared to distal osteotomy (p-value=0.037) and trended toward significance compared to mid-diaphyseal (p-value=0.056). Mid-diaphyseal osteotomies (30%) showed a statistically significant higher percentage of IMA recurrence compared to Lapidus (-11%) (p-value=0.0014) (Figure 1B). When comparing percentage recurrence of HVA, distal osteotomies had a significantly smaller rate of recurrence when compared to the diaphyseal osteotomies (p-value=0.030). Conclusion: Though Lapidus and mid-diaphyseal osteotomies were performed for patients with a similar preoperative IMA, mid-diaphyseal osteotomies had a significantly higher percentage of recurrence at 2-year follow up compared to Lapidus procedures. Moreover, Lapidus procedures trended toward greater overall of IMA correction compared to mid-diaphyseal osteotomies. When either a Lapidus or mid-diaphyseal osteotomy is indicated, a Lapidus procedure may result in decreased rate of radiographic recurrence of hallux valgus at 2 years.

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Correlative Study Between the Sesamoid Bones under the Head of the First Metatarsal and the Development of Hallux Valgus Determined with Radiographs

10.21203/rs.3.rs-411401/v1 ◽

2021 ◽

Author(s):

Xiaozhong Li ◽

Dongxue Liu ◽

Xufang Wang

Keyword(s):

Hallux Valgus ◽

Metatarsal Head ◽

Sesamoid Bone ◽

Hallux Valgus Angle ◽

Intermetatarsal Angle ◽

First Metatarsal ◽

Valgus Angle ◽

Second Metatarsal ◽

Sesamoid Bones ◽

The Absolute

Abstract Objective. To study the correlative between the sesamoid bones under the head of the first metatarsal and the development of hallux valgus determined with radiographs.Methods.The measurements were performed on the X-ray of 300 normal feet and 300 cases of hallux valgus. The following parameters were measured: hallux valgus angle(HVA); the first-second intermetatarsal angle(IMA) between the axes of the first and second metatarsal;the length of the second metatarsal（CD）;the position of tibial sesamoid(TSP ) measured the percent formed between the tibial sesamoid and the centreline of the first metatarsal;the position of fibular sesamoid(FSP) measured tangent value between fibular sesamoid bone and lateral cortex of first metatarsal bone ; the absolute distances (AB) from the centre of the tibial sesamoid to the long axis of the second metatarsal, the absolute distances (EF) from the centre of the fibular sesamoid to the long axis of the second metatarsal and the absolute distance (GH) from the centre of the tibial sesamoid to the centre of the fibular sesamoid. Then calculate the ratio of AB to CD (K1), EF to CD (K2) and GH to CD (K3). Results.HVA moderately positively correlates with TSP and moderately negatively correlates with FSP in subjects with HVA ≥ 20°. HVA and FSP are strongly negatively correlated in the hallux valgus group. Conclusion.The dislocation of sesamoid bone under the first metatarsal head is an important pathological factor leading to valgus. HVA is positively correlated with TSP and negatively correlated with FSP.

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New screening method for hallux valgus with using smartphone

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00242 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0024

Author(s):

Shibuya Hayatoshi ◽

Tomoyuki Nakasa ◽

Mikiya Sawa ◽

Yusuke Tsuyuguchi ◽

Munekazu Kanemitsu ◽

...

Keyword(s):

Hallux Valgus ◽

Weight Bearing ◽

Screening Method ◽

Conventional Radiography ◽

Standing Position ◽

Mean Value ◽

Hallux Valgus Angle ◽

Valgus Angle ◽

The Mean ◽

Anterior Knee

Category: Midfoot/Forefoot Introduction/Purpose: We developed a new screening method for hallux valgus during weight bearing using the photo-capturing function in cell phones. Methods: We compared apparent hallux valgus angles measured from photographs of people in a standing position during weight bearing, which were captured on a smartphone (smartphone Hallux Valgus Angle: SP-HVA) (Smartphone Method), with hallux valgus angles determined using conventional radiography in a standing posture during weight-bearing (X-ray HVA: XR-HVA). We evaluated 37 feet of 25 patients (5 men and 25 women) who visited our hospital. The mean age at the time of the visit was 73.9 years. In the Smartphone Method, subjects stood upright and the examiner used a smartphone to take photos of both feet from above while holding the phone at the level of the anterior knee. Results: The mean value was 36.2° for SP-HVA and 36.7° for XR-HVA; the two methods showed a statistically significant correlation (correlation coefficient of 0.86). Conclusion: Our smartphone-assisted screening method for hallux valgus was possible to make a diagnosis equivalent to conventional radiography method without radiation exposure.

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Hallux valgus angle, sesamoid position, and distal metatarsal articular angle on immediate postoperative non-weight bearing radiograph

Foot and Ankle Surgery ◽

10.1016/j.fas.2016.05.079 ◽

2016 ◽

Vol 22 (2) ◽

pp. 35-36

Author(s):

D. Il Chun Park ◽

J.H. Cho

Keyword(s):

Hallux Valgus ◽

Weight Bearing ◽

Hallux Valgus Angle ◽

Valgus Angle

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Radiographic Assessment of Foot Alignment in Juvenile Hallux Valgus and Its Relationship to Flatfoot

Foot & Ankle International ◽

10.1177/1071100719850148 ◽

2019 ◽

Vol 40 (9) ◽

pp. 1079-1086

Author(s):

Hyun Woo Kim ◽

Kun Bo Park ◽

Yoon Hae Kwak ◽

Seokhwan Jin ◽

Hoon Park

Keyword(s):

Hallux Valgus ◽

Weight Bearing ◽

Hallux Valgus Angle ◽

Hindfoot Alignment ◽

First Metatarsal ◽

Metatarsal Angle ◽

Valgus Angle ◽

Significant Difference ◽

Metatarsus Adductus ◽

Foot Alignment

Background: The relationship between juvenile hallux valgus (JHV) and flatfoot has not been clearly established. The aim of this study was to assess radiographic measurements in feet with JHV compared with matched controls and to investigate whether the foot alignment of JHV is related to flatfoot. Methods: We retrospectively reviewed 163 patients with JHV as defined as hallux valgus angle greater than 20 degrees and intermetatarsal greater than angle than 10 degrees. Patients with open physes of the feet and who had weight-bearing radiographs of the feet were included. Another 55 normal participants served as controls. Patients with JHV were divided into 2 subgroups: Group 1 included patients with asymptomatic JHV and group 2 consisted of those treated with correctional surgery for painful JHV. Twelve radiographic indices were analyzed, including calcaneal pitch angle, tibiocalcaneal angle, talocalcaneal angle, naviculocuboid overlap, talonavicular coverage angle, lateral talo–first metatarsal angle, anteroposterior talo–first metatarsal angle, metatarsus adductus angle, hallux valgus angle, intermetatarsal angle, distal metatarsal articular angle, and first metatarsal cuneiform angle. The groups were compared by age, gender, and the above radiographic parameters. Results: There was no significant difference in hindfoot alignment of patients with JHV and controls. Naviculocuboid overlap ( P <.001), lateral talo–first metatarsal angle ( P = .002), and metatarsus adductus angle ( P = .004) were significantly greater in patients with JHV than in controls, whereas the anteroposterior talo–first metatarsal angle ( P = .026) was significantly less. Symptomatic and asymptomatic JHV patient subsets showed no significant radiologic differences. Conclusion: Radiographic profiles in patients with JHV were inconsistent with regard to features of flatfoot, and foot alignment was unrelated to the presence of symptoms or degree of deformity in JHV. Level of Evidence: Level III, retrospective comparative series.

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The interobserver reliability of first metatarsal rotational component of axial sesamoid radiographs in hallux valgus

Journal of the Foot & Ankle ◽

10.30795/jfootankle.2020.v14.1196 ◽

2020 ◽

Vol 14 (3) ◽

pp. 249-253

Author(s):

Mariel García-Limón ◽

Jaime Ortiz-Garza ◽

Abraham Espinosa-Uribe ◽

Eduardo Carranza-Cantú ◽

Javier Meza-Flores ◽

...

Keyword(s):

Hallux Valgus ◽

Bone Structure ◽

Interobserver Reliability ◽

Weight Bearing ◽

Case Series ◽

Rotational Component ◽

Hallux Valgus Angle ◽

Intermetatarsal Angle ◽

First Metatarsal ◽

Valgus Angle

Objective: Hallux valgus is a progressive triplanar deformity of the forefoot with an important rotational component (RC) in the first metatarsal, which has been associated with recurrence. There is controversy about using weight-bearing vs. non-weight-bearing radiographs in RC measurement. This study aims to assess interobserver reliability for RC of the first metatarsal using a non-weight-bearing sesamoid view, as well as to correlate the hallux valgus angle, intermetatarsal angle, distal metatarsal articular angle (DMAA) and sesamoid position regarding RC. Methods: An observational, cross-sectional and descriptive study was conducted with 81 feet from 48 patients (66.6% female). RC was evaluated regarding the first metatarsal proximal shaft in non-weight-bearing axial metatarsal radiographs and weight-bearing anteroposterior radiographs. Measurements were taken independently by two foot and ankle subspecialists and an orthopedic resident, all of whom were blinded. Results: Statistically significant intraclass correlations (p = 0.02) were obtained for first metatarsal RC assessment among the three observers (95%CI 0.01–0.65; Cronbach’s α =0.41) in non-weight-bearing axial metatarsal views. Significant correlations (Spearman ρ) were also found for hallux valgus angle (p = 0.04) and DMAA (p = 0.01), and non-significant correlations were found for intermetatarsal angle and sesamoid position (p > 0.05). Conclusion: The significant correlations between hallux valgus angle and DMAA for RC suggest that RC is isolated from the first metatarsal bone structure. This practical assessment method may isolate the first metatarsal head RC regarding the proximal metatarsal in the metaphyseal region and could be useful in centers where weight-bearing CT scans are not available. Level of Evidence IV; Therapeutic Studies; Case 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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Hallux Valgus Angle in Ballet, Mordern and Trditional Dancers

The Journal of the Korean Orthopaedic Association ◽

10.4055/jkoa.1996.31.5.1042 ◽

1996 ◽

Vol 31 (5) ◽

pp. 1042

Author(s):

In-Tak Chu ◽

Hyun-Jun Song

Keyword(s):

Hallux Valgus ◽

Hallux Valgus Angle ◽

Valgus Angle

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Natural Progression of Radiographic Indices in Juvenile Hallux Valgus Deformity

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00311 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0031

Author(s):

Seung Yeol Lee ◽

Soon-Sun Kwon ◽

Moon Seok Park ◽

Kyoung Min Lee

Keyword(s):

Hallux Valgus ◽

Older Patients ◽

Valgus Deformity ◽

Hallux Valgus Angle ◽

Intermetatarsal Angle ◽

Younger Patients ◽

Hallux Valgus Deformity ◽

Metatarsal Angle ◽

Valgus Angle ◽

Metatarsus Adductus

Category: Bunion Introduction/Purpose: There is a lack of quantitative studies on the progression of juvenile hallux valgus deformity. Therefore, we performed this study to estimate an annual change of radiographic indices for juvenile hallux valgus. Methods: We reviewed medical records of consecutive patients under the age of 15 with juvenile hallux valgus who underwent weight-bearing foot radiographs more than twice, and were followed over a period of one year or more. A total of 133 feet from 69 patients were included. Hallux valgus angle, hallux interphalangeal angle, intermetatarsal angle, metatarsus adductus angle, distal metatarsal articular angle, anteroposterior talo-1st metatarsal angle, anteroposterior talo-2nd metatarsal angle, and lateral talo-1st metatarsal angle were measured and were used as a study criteria. The progression rate of hallux valgus angle was adjusted by multiple factors including the use of a linear mixed model with gender and radiographic measurements as the fixed effects and laterality and each subject as the random effect. Results: Our results demonstrate that the value of hallux valgus angle on the radiographs progressed as the patients grew older. The hallux valgus angle increased by 0.8° per year (p<0.001)(Figure). The distal metatarsal articular angle also increased by 0.8 per year (p=0.003). Conversely, hallux interphalangeal angle decreased by 0.2° per year (p=0.019). Progression of the intermetatarsal angle and metatarsus adductus angle with aging were not statistically significant. There was a difference in progression of radiographic indices between older patients (≥10 years) and younger patients (<10 years). The hallux valgus angle increased by 1.5° per year (p<0.001) in younger patients, progression of the hallux valgus angle in older patients was not statistically significant (p=0.869) as children grew up. Conclusion: These results suggest that the hallux valgus angle increased in patients with juvenile hallux valgus under 10 years old, unlike the patients aged 10 or older. We believed that our results can help surgeons to determine a treatment strategy that uses the growth potential to achieve correction of deformity such as lateral hemiepiphyseodesis of the 1st metatarsal to patients with juvenile hallux valgus.

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