Hallux Valgus Deformity and Postural Sway: A Cross-sectional Study

2021 ◽  
Author(s):  
Hiroaki Omae ◽  
Takashi Ohsawa ◽  
Naohiro Hio ◽  
Kazuhiko Tsunoda ◽  
Takuya Omodaka ◽  
...  
Keyword(s):  
Hallux Valgus ◽  
Muscle Mass ◽  
Lower Limb ◽  
Postural Sway ◽  
Valgus Deformity ◽  
Lower Limb Muscle ◽  
Limb Muscle ◽  
Hallux Valgus Angle ◽  
Hallux Valgus Deformity ◽  
Valgus Angle

Abstract Background: Hallux valgus deformity has been reported to be associated with increased postural sway. However, the direction and magnitude of postural sway associated with hallux valgus remain inconclusive. We assessed the association between hallux valgus deformity and postural sway using a force plate.Methods: The subjects were 169 healthy volunteers, >40 years old (63 males, 106 females, average age: 66.0 ± 12.4 years old), who took part in an annual medical examination. We investigated the photographic hallux valgus angle (°), total trajectory length of the gravity center fluctuation (mm), area of the center of pressure (mm2), mediolateral and anteroposterior postural sway (mm) in a standing position with 2-legged stance and eyes open, hallux pain (Numerical Rating Scale), trunk and lower limb muscle mass (kg). We classified the subjects into a hallux valgus group (n=44, photographic hallux valgus angle of 1 or both feet ≥20°) and a no hallux valgus group (n=125, photographic hallux valgus angle of both feet <20°) and analyzed the relationship between hallux valgus and postural sway. Results: The anteroposterior postural sway in the hallux valgus group (6.5 ± 2.8) was significantly greater than in the no hallux valgus group (5.4 ± 2.2, p=0.014), and the lower limb muscle mass in the hallux valgus group (12.4 ± 2.2) was significantly smaller than in the no hallux valgus group (13.5 ± 3.2, p=0.016). The total value of the photographic hallux valgus angle on both feet was positively correlated with the anteroposterior postural sway (p=0.021) and negatively correlated with the lower limb muscle mass (p=0.038). The presence of hallux valgus (p=0.024) and photographic hallux valgus angle were (p=0.008) independently related to the magnitude of anteroposterior postural sway. Conclusions: Hallux valgus deformity and its severity were positively associated with the magnitude of the anteroposterior postural sway. Trial registration: 2017-135. Registered 22 August 2017

scholarly journals Hallux valgus deformity and postural sway: a cross-sectional study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Hiroaki Omae ◽  
Takashi Ohsawa ◽  
Naohiro Hio ◽  
Kazuhiko Tsunoda ◽  
Takuya Omodaka ◽  
...  
Keyword(s):  
Hallux Valgus ◽  
Muscle Mass ◽  
Lower Limb ◽  
Postural Sway ◽  
Valgus Deformity ◽  
Lower Limb Muscle ◽  
Limb Muscle ◽  
Hallux Valgus Angle ◽  
Hallux Valgus Deformity ◽  
Valgus Angle

Abstract Background Hallux valgus deformity has been reported to be associated with increased postural sway. However, the direction and magnitude of postural sway associated with hallux valgus remain inconclusive. We assessed the association between hallux valgus deformity and postural sway using a force plate. Methods The subjects were 169 healthy volunteers, > 40 years old (63 males, 106 females, average age: 66.0 ± 12.4 years old), who took part in an annual medical examination. We investigated the photographic hallux valgus angle (°), total trajectory length of the gravity center fluctuation (mm), area of the center of pressure (mm2), mediolateral and anteroposterior postural sway (mm) in a standing position with 2-legged stance and eyes open, hallux pain (Numerical Rating Scale), trunk and lower limb muscle mass (kg). We classified the subjects into a hallux valgus group (n = 44, photographic hallux valgus angle of 1 or both feet ≥ 20°) and a no hallux valgus group (n = 125, photographic hallux valgus angle of both feet < 20°) and analyzed the relationship between hallux valgus and postural sway. Results The anteroposterior postural sway in the hallux valgus group (6.5 ± 2.8) was significantly greater than in the no hallux valgus group (5.4 ± 2.2, p = 0.014), and the lower limb muscle mass in the hallux valgus group (12.4 ± 2.2) was significantly smaller than in the no hallux valgus group (13.5 ± 3.2, p = 0.016). The total value of the photographic hallux valgus angle on both feet was positively correlated with the anteroposterior postural sway (p = 0.021) and negatively correlated with the lower limb muscle mass (p = 0.038). The presence of hallux valgus (p = 0.024) and photographic hallux valgus angle (p = 0.008) were independently related to the magnitude of anteroposterior postural sway. Conclusions Hallux valgus deformity and its severity were positively associated with the magnitude of the anteroposterior postural sway. Trial registration 2017 − 135. Registered 22 August 2017.

scholarly journals Natural Progression of Radiographic Indices in Juvenile Hallux Valgus Deformity

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.

The Reliability of Angular Measurements in Hallux Valgus Deformities

2001 ◽  
Vol 22 (5) ◽  
pp. 369-379 ◽  
Author(s):  
Michael J. Coughlin ◽  
Elisha Freund
Keyword(s):  
Hallux Valgus ◽  
Valgus Deformity ◽  
Hallux Valgus Angle ◽  
Observer Reliability ◽  
Hallux Valgus Deformity ◽  
Metatarsal Angle ◽  
Valgus Angle ◽  
Wide Range ◽  
Angular Measurements ◽  
Minimum Interval

The purpose of this study was to determine the intra-observer and inter-observer reliability of physicians on a repetitive basis in making angular measurements of hallux valgus deformities. The hallux valgus angle, the 1–2 intermetatarsal angle, and the distal metatarsal articular angle and the assessment of congruency/subluxation of the first MTP joint were evaluated on a repetitive basis. Physicians were provided with a series of black and white photographs of radiographs with a hallux valgus deformity. Three different sets of photographs randomly ordered were sent at a minimum interval of six weeks to the participants. Participating physicians were extremely reliable in the measurement of the 1–2 metatarsal angle. 96.7% of the photographs were repeatedly measured within a range of 5 degrees or less. The angular measurements to determine the hallux valgus angle were slightly less reliable, but 86.2% of photos were repeatedly measured within a range of 5 degrees or less. In the measurement of the distal metatarsal articular angle, 58.9% of photographs were repeatedly measured within a range of 5 degrees or less. There was a wide range within physician evaluators who recognized very few congruent joints (2 of 21) and those who recognized several congruent joints (11 of 21). Most physicians appeared to be internally consistent in the assessment of MTP congruency; however, some photographs were much more difficult to assess than others. This study validates the reliability of the measurement of the hallux valgus and the 1–2 metatarsal angle. The inter-observer reliability in the measurement of the distal metatarsal articular angle is questioned.

scholarly journals Is Generalized Ligamentous Laxity a Prognostic Factor for Recurred Hallux Valgus Deformity?

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0018
Author(s):  
Byung-Ki Cho ◽  
Seung-myung Choi
Keyword(s):  
Hallux Valgus ◽  
Postoperative Recurrence ◽  
Valgus Deformity ◽  
Foot And Ankle ◽  
Hallux Valgus Angle ◽  
Ligamentous Laxity ◽  
Chevron Osteotomy ◽  
Hallux Valgus Deformity ◽  
Valgus Angle

Category: Bunion Introduction/Purpose: It is still unclear whether generalized ligamentous laxity is a risk factor for recurred hallux valgus deformity. This study was performed to evaluate the intermediate-term clinical outcomes after proximal chevron osteotomy for hallux valgus in patients with generalized ligamentous laxity, and to determine the effect on postoperative recurrence of deformity. Methods: A total of 198 feet from 169 female patients were treated with a proximal chevron osteotomy for hallux valgus with a mean follow-up of 46.3 months. When generalized ligamentous laxity was defined as Beighton score ≥ 5 points, there were 18 patients (10.7%) in laxity group and 151 patients (89.3%) in non-laxity group. Clinical evaluation consisted of the American Orthopaedic Foot and Ankle Society (AOFAS) scores, Foot and Ankle Ability Measure (FAAM), and radiographic measurement of hallux alignment. Risk factors associated with postoperative recurrence were evaluated using univariate analysis. Results: Recurrence rates were 21.7% in the laxity group and 17.1% in non-laxity group (p = 0.218), when defined as hallux valgus angle ≥ 20°. No significant differences of measurement at final follow-up were found between the 2 groups in terms of AOFAS score, FAAM, recurrence rate, hallux valgus angle (HVA), intermetatarsal angle (IMA) and distal metatarsal articular angle (DMAA). Preoperative HVA and IMA were found to be predictive factors of recurrence (OR = 6.3, 4.2; P = .001, .018, respectively). Conclusion: There were no statistical differences in the clinical and radiographic outcomes between hallux valgus with and without generalized ligamentous laxity. Generalized ligamentous laxity demonstrated no definitive effects on postoperative recurrence of hallux valgus deformity.

scholarly journals Comparison of the clinical outcomes of Scarf and Chevron Osteotomy for Hallux Valgus Deformity: a meta-analysis of randomized controlled trial

2019 ◽  
Author(s):  
Wei Ye ◽  
Yafang Liu ◽  
WeiFeng Liu ◽  
XiaoLong Li ◽  
Yanqiang Fei ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Hallux Valgus ◽  
Meta Analysis ◽  
Valgus Deformity ◽  
Hallux Valgus Angle ◽  
Scarf Osteotomy ◽  
Randomized Controlled ◽  
Chevron Osteotomy ◽  
Hallux Valgus Deformity ◽  
Valgus Angle

Abstract Background Scarf and Chevron Osteotomy have been widely used for Hallux Valgus Deformity(HVD) to correcting hallux valgus angle (HVA) and intermetatarsal 1-2 angle (IMA), but there still have controversy which approach is the best way to repair HVD,this study aims to use meta-analysis to evaluate the clinical outcomes of Scarf and Chevron Osteotomy for Hallux Valgus Deformity.Methods Pubmed, Embase, Medline and Cochrane library databases were searched for relevant studies published before September 1, 2019. Studies clearly reporting a comparison of Scarf and Chevron Osteotomy for Hallux Valgus Deformity were selected. The Post-operative hallux valgus angle (HVA) and intermetatarsal 1-2 angle (IMA) were evaluated and also the correction of HVA and IMA. The weighted mean differences and relative risks were calculated using a fixed-effects or random-effects model.Results Five studies were included in this meta-analysis,one were prospective randomized controlled trials and three were randomized control trials.A total of 434 patients (210 Scarf and 224 Chevron) were enrolled in the studies.Compare Scarf Osteotomy,Chevron Osteotomy can significantly decreaseed Post-operative hallux valgus angle (HVA)[MD = 1.92 95% CI (1.21 to 2.63),P < 0.0001],but there have no significantly difference between Scarf and Chevron Osteotomy groups in terms of Postoperative intermetatarsal angle (IMA),the correction of IMA and HVA(C-IMA/HVA),DMAA,AOFAS and complication incidence[MD = 0.42, 95% CI (-0.34 to 1.17),P=0.28;MD = -0.30, 95% CI (-0.72 to 0.12),P =0.16; MD = -0.88, 95% CI (-2.34 to 0.57),P =0.23;MD = -0.78, 95% CI (-2.29 to 0.72),P =0.31;MD = -2.01, 95% CI (-9.81 to 5.61),P =0.59 and OR=0.80, 95% CI (0.40 to 1.60),P=0.53 respectively].Conclusion Compare Scarf osteotomy,Chevron Osteotomy can significantly decreaseed Post-operative hallux valgus angle (HVA) and other clinical outcomes are similar between the two treatments.

Foot Pressure Measurement Differences Between Boys and Girls With Reference to Hallux Valgus Deformity and Hypermobility

2005 ◽  
Vol 26 (9) ◽  
pp. 739-747 ◽  
Author(s):  
Jill Ferrari ◽  
David Watkinson
Keyword(s):  
Hallux Valgus ◽  
Center Of Pressure ◽  
Valgus Deformity ◽  
Joint Hypermobility ◽  
Pressure Measurements ◽  
Hallux Valgus Angle ◽  
Foot Pressure ◽  
Hallux Valgus Deformity ◽  
Valgus Angle ◽  
Heel Contact

Background: Previous studies that compared foot pressures in boys and girls found that girls had greater peak pressures under the hallux than did boys. Only one of these studies considered plantar pressure measurements in children. The purpose of the study was to investigate the effect of gender on foot pressure measurements in children. Methods: This is a comparative study using the F-Scan pressure platform (F-Mat; Texscan® Boston, MA) on a sample of children attending a podiatric clinic. Pressure measurements and temporal parameters were measured in 61 children between the ages of 5 and 16 years. Associations between joint hypermobility and hallux valgus angle also were investigated. Results: Girls were found to have significantly greater peak pressure under the hallux, faster timing of heel contact to first metatarsal head loading, and a more medially placed center of pressure trajectory. No associations were found between these significant variables and hypermobility scores or hallux valgus angle. Conclusion: The results indicate that there are differences in pressure measurements between boys and girls, but the reasons for these remain unclear. Differences in pressure measurements in the feet of boys and girls may be useful in establishing the cause of foot pathologies for which a prevalence has been shown in boys or girls, such as hallux valgus deformity, which is known to be more frequent in females of all ages.

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

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.

Scarf Osteotomy for Hallux Valgus Deformity

2010 ◽  
Vol 100 (1) ◽  
pp. 35-40 ◽  
Author(s):  
Jeroen J. K. De Vil ◽  
Peter Van Seymortier ◽  
Willem Bongaerts ◽  
Pieter-Jan De Roo ◽  
Barbara Boone ◽  
...  
Keyword(s):  
Hallux Valgus ◽  
Prospective Studies ◽  
Valgus Deformity ◽  
Hallux Valgus Angle ◽  
Intermetatarsal Angle ◽  
Scarf Osteotomy ◽  
Hallux Valgus Deformity ◽  
Valgus Angle ◽  
Severe Hallux Valgus

Background: Scarf midshaft metatarsal osteotomy has become increasingly popular as a treatment option for moderate-to-severe hallux valgus deformities because of its great versatility. Numerous studies on Scarf osteotomy have been published. However, no prospective studies were available until 2002. Since then, only short-term follow-up prospective studies have been published. We present the results of a prospective study of 21 patients treated by Scarf osteotomy for hallux valgus with follow-up of 8 years. Methods: Between August 1, 1999, and October 31, 1999, 23 patients (23 feet) with moderate-to-severe hallux valgus deformity were included. Clinical (American Orthopaedic Foot and Ankle Society score) and radiologic (hallux valgus angle, first intermetatarsal angle, and sesamoid position) evaluations were performed preoperatively and 1 and 8 years postoperatively. Results: Clinical evaluation showed a significant improvement in the mean forefoot score from 47 to 83 (of a possible 100) at 1 year (P &lt; .001). Radiographic evaluation showed significant improvement in the hallux valgus angle (mean improvement, 19°; P &lt; .001) and in the intermetatarsal angle (mean improvement, 6°; P &lt; .001). These clinical and radiographic results were maintained at the final evaluation 8 years postoperatively. Conclusions: Scarf osteotomy tends to provide predictable and sustainable correction of moderate-to-severe hallux valgus deformities. (J Am Podiatr Med Assoc 100(1): 35–40, 2010)

scholarly journals Is a Flatfoot Associated with a Hallux Valgus Deformity?

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0001
Author(s):  
Nicholas Cheney ◽  
Kyle Rockwell ◽  
Joseph Long ◽  
John Weis ◽  
Dylan Lewis ◽  
...  
Keyword(s):  
Hallux Valgus ◽  
Valgus Deformity ◽  
Hallux Valgus Angle ◽  
Radiographic Evidence ◽  
Intermetatarsal Angle ◽  
Hallux Valgus Deformity ◽  
Valgus Angle ◽  
Grand Rapids ◽  
Collapse Model ◽  
Almost All

Category: Bunion Introduction/Purpose: An arch collapse model has been described for a multitude of foot and ankle problems that is based on a gastrocnemius equinus contracture producing a predictable collapse that has been described in five distinct phases. Previous studies have evaluated the presence of pes planovlagus in hallux valgus patients and concluded that this is a rare occurance. The Grand Rapids arch collapse model reviews adult foot pathology and believes there is a link between bunions and flatfeet. We wanted to evaluate patients with flatfeet and determine if they had an associated bunion deformity. Based upon the arch collapse model, there should be a significant number of flatfeet with an associated bunion deformity and our goal was to see if this proved to be true. Methods: We retrospectively reviewed the radiographs of patients diagnosed with a flatfoot based upon their ICD 9 and 10 codes in the senior author’s practice. For each patient, we used standard anteroposterior and lateral foot radiographs obtained on all new patients. Initially, we had 254 feet but had to exclude 93 feet due to inadequate radiographs, normal radiographs (normal meary’s angle and talonavicular coverage angle) or in patients who already had surgical procedures to the foot. This left 161 feet radiographs for review. We then measured the Meary’s angle on the lateral images and the talonavicular coverage angle, hallux valgus angle, intermetatarsal angle and sesamoid position on the anteroposterior radiographs. Results: Of the 161 feet that remained in the study, only 6 feet (3.7%) had no radiographic evidence of a bunion based upon sesamoid position, hallux valgus angle or the intermetatarsal angle. We did find a correlation with the severity of the flatfoot based upon the Meary’s angle and the talonavicular coverage angle with the severity of the bunion deformity defined by the sesamoid position, hallux valgus angle and the intermetatarsal angle. As the flatfoot got worse, the bunion did so as well. Conclusion: Our findings would seem to fit with the Grand Rapids arch collapse model. The hypermobility of the first ray that creates the bunion deformity then allows the arch to ultimately collapse. It also does not seem to contradict what has been found previously. Earlier studies showed a low association between patients with bunions who also had flatfeet. This would make sense as the deformity may not have progressed to the flatfoot yet. However, in our study the deformity has already progressed to a flatfoot and almost all have some radiographic evidence of a bunion.

Hallux Valgus in Men: Effect of the Distal Metatarsal Articular Angle on Hallux Valgus Correctiong

1997 ◽  
Vol 18 (8) ◽  
pp. 463-470 ◽  
Author(s):  
Michael J. Coughlin
Keyword(s):  
Soft Tissue ◽  
Hallux Valgus ◽  
Valgus Deformity ◽  
Metatarsal Osteotomy ◽  
Hallux Valgus Angle ◽  
First Metatarsal ◽  
Soft Tissue Procedure ◽  
Hallux Valgus Deformity ◽  
Valgus Angle ◽  
Mtp Joints

The results of hallux valgus correction were reviewed for 34 male patients (41 feet). The severity of the preoperative deformity determined the operative technique of correction. A distal soft tissue procedure with proximal first metatarsal osteotomy was performed in 30 patients (35 feet) with an average correction of the hallux valgus angle of 22°. A chevron procedure was performed in five cases and a McBride procedure in one other case, all with less severe deformities. Complications included one deep wound infection, one broken screw at the metatarsal osteotomy site, and three cases of hallux varus. No patients underwent reoperation. Undercorrection was noted in 10 of 35 cases (29%) where a distal soft tissue procedure with proximal first metatarsal osteotomy was performed. A nonsubluxated (congruent) metatarsophalangeal (MTP) joint associated with a hallux valgus deformity was present in 15 of 41 (37%) of all cases and 10 of 35 (29%) of cases that underwent a distal soft tissue procedure with proximal metatarsal osteotomy (DSTR with PMO). A subluxated (noncongruent) MTP joint associated with hallux valgus was present in 26 of 41 (63%) of all cases and 25 of 35 (71 %) of cases undergoing a DSTR with PMO. There was a highly significant difference in the average distal metatarsal articular angle (DMAA) as measured in the nonsubluxated (congruent) MTP joints (20.7°) and the subluxated (noncongruent) MTP joints with hallux valgus (10°) ( P = 0.0001). The average distal metatarsal articular angle for all cases undergoing DSTR with PMO was 13°. When the postoperative hallux valgus angle was compared with the DMAA, the average residual hallux valgus angle was 10.1°. With a subluxated (noncongruent) first MTP joint with hallux valgus (a low DMAA), the percent of hallux valgus correction (hallux valgus correction [in degrees])preoperative hallux valgus deformity [in degrees]) was 77%. In patients with a nonsubluxated (congruent) first MTP joint with hallux valgus (a high DMAA), the percent correction was 46%, an almost twofold difference in percent correction. There was a close correlation between the preoperative DMAA and the postoperative hallux valgus angle in both the subluxated and congruent subgroups ( P = 0.0003). With an intra-articular repair (a DSTP with PMO), the magnitude of correction of a hallux valgus deformity is limited at the MTP joint by the distal metatarsal articular angle.

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