Influence of the Shape of the First Metatarsal Cuneiform Joint on the Development of Hallux Valgus Deformity

2021 ◽  
Author(s):  
Mirko Sovilj ◽  
Andreja Baljozović ◽  
Filip Pilipović ◽  
Maja Sovilj Banjac ◽  
Zoran Baščarević
Keyword(s):  
Hallux Valgus ◽  
Statistical Significance ◽  
Valgus Deformity ◽  
Severe Form ◽  
Convex Shape ◽  
First Metatarsal ◽  
Mild Degree ◽  
Hallux Valgus Deformity ◽  
Developmental Course ◽  
Severe Degree

Abstract Objective:To examine the presence of certain shapes of the first metatarsal-cuneiform joint (MTC) joint in feet with hallux valgus (HV) deformity. To determine whether the anatomical orientation of this joint affects the size of the hallux valgus angle (HVA) and the first intermetatarsal angle (IMA) and whether it contributes to the dynamics of the developmental course of HV deformity.Methods:The shape of the first MTC joint was determined on a sample of 315 feet with HV deformity. The influence of the shape of this joint on the values of HVA and IMA was explored. The relation between the position of the tibial sesamoid and the size of HVA and IMA as well as the dynamics of the development of this deformity depending on the shape of the first MTC joint, was examined.Results:The oblique shape of the first MTC joint was found in 165 (52.4%) feet, the transverse in 145 (46%), and the convex shape was registered in five feet (1.6%). In the oblique shape of this joint, a moderate and severe degree of HV deformity is predominant, while in the transverse shape a mild degree dominates. A statistically significant dependence of HVA on the shape of the first MTC joint was found (Sig. = 0.010), while the dependence of IMA did not show statistical significance (Sig. = 0.105). HVA values follow the position of the tibial sesamoid in both shapes of the MTC joint while the size of the IMA in the transverse shape is not consistent with the position of this sesamoid.Conclusion:The oblique shape of the first MTC joint is associated with the more severe form of HV deformity and its faster developmental course. In the analyzed sample, it was shown that HVA is higher in the oblique shape of the MTC joint and significantly depends on the anatomical orientation of this joint. Furthermore, IMA has a higher value in the oblique shape compared to transverse but this dependence is not statistically significant. The analysis showed that the oblique shape of the first MTC joint contributes to the development of HV deformity.

First Metatarsal Rotation in Hallux Valgus Deformity

2021 ◽  
Vol 42 (4) ◽  
pp. 510-522
Author(s):  
Jesse Steadman ◽  
Alexej Barg ◽  
Charles L. Saltzman
Keyword(s):  
Hallux Valgus ◽  
Potential Role ◽  
Axial Rotation ◽  
Valgus Deformity ◽  
Measurement Methods ◽  
Advanced Imaging ◽  
Level Of Evidence ◽  
First Metatarsal ◽  
Hallux Valgus Deformity ◽  
Biplanar Radiographs

Rotation of the first metatarsal (M1) as a potential etiological factor of hallux valgus (HV) deformity was described relatively early in the description of HV pathoanatomy. However, because biplanar radiographs have been the standard method for imaging HV, clinicians primarily developed measurement methods and corrective operations confined to 2 dimensions, medial-lateral and inferior-superior. Recently, as our understanding of HV pathoanatomy has further developed, aided in part by advanced imaging technology, M1 rotation about its axis (“axial rotation”) and its implications for HV deformity and treatment has reemerged. The goal of this review is to summarize M1 rotation in HV from a historical perspective, to present the current understanding of its potential role in the etiology/pathogenesis of HV, and to summarize relevant imaging and operative considerations with respect to M1 rotation. Level of Evidence: Level III, systematic review.

Comparison of Postoperative Height Changes of the Second Metatarsal Among 3 Osteotomy Methods for Hallux Valgus Deformity Correction

2016 ◽  
Vol 38 (1) ◽  
pp. 20-26 ◽  
Author(s):  
Jun Young Choi ◽  
Yu Min Suh ◽  
Ji Woong Yeom ◽  
Jin Soo Suh
Keyword(s):  
Hallux Valgus ◽  
Deformity Correction ◽  
Metatarsal Head ◽  
Valgus Deformity ◽  
Metatarsal Osteotomy ◽  
Level Of Evidence ◽  
First Metatarsal ◽  
Scarf Osteotomy ◽  
Hallux Valgus Deformity ◽  
Second Metatarsal

Background: We aimed to compare the postoperative height of the second metatarsal head relative to the first metatarsal head using axial radiographs among 3 different commonly used osteotomy techniques: proximal chevron metatarsal osteotomy (PCMO), scarf osteotomy, and distal chevron metatarsal osteotomy (DCMO). Methods: We retrospectively reviewed the radiographs and clinical findings of the patients with painful callosities under the second metatarsal head, complicated by hallux valgus, who underwent isolated PCMO, scarf osteotomy, or DCMO from February 2005 to January 2015. Each osteotomy was performed with 20 degrees of plantar ward obliquity. Along with lateral translation and rotation of the distal fragment to correct the deformity, lowering of the first metatarsal head was made by virtue of the oblique metatarsal osteotomy. Results: Significant postoperative change in the second metatarsal height was observed on axial radiographs in all groups; this value was greatest in the PCMO group (vs scarf: P = .013; vs DCMO: P = .008) but did not significantly differ between the scarf and DCMO groups ( P = .785). The power for second metatarsal height correction was significantly greater in the PCMO group (vs scarf: P = .0005; vs DCMO: P = .0005) but did not significantly differ between the scarf and DCMO groups ( P = .832). Conclusions: Among the 3 osteotomy techniques commonly used to correct hallux valgus deformity, we observed that PCMO yielded the most effective height change of the second metatarsal head. Level of Evidence: Level III, retrospective comparative series.

scholarly journals Response to the comment on Schuh et al.: Angular correction and complications of proximal first metatarsal osteotomies for hallux valgus deformity

2013 ◽  
Vol 38 (3) ◽  
pp. 669-670
Author(s):  
Reinhard Schuh ◽  
Madeleine Willegger ◽  
Johannes Holinka ◽  
Robin Ristl ◽  
Reinhard Windhager ◽  
...  
Keyword(s):  
Hallux Valgus ◽  
Valgus Deformity ◽  
First Metatarsal ◽  
Hallux Valgus Deformity ◽  
Angular Correction

Clinical, Quantitative Assessment of First Tarsometatarsal Mobility in the Sagittal Plane and Its Relation to Hallux Valgus Deformity

1994 ◽  
Vol 15 (1) ◽  
pp. 9-13 ◽  
Author(s):  
Kaj Klaue ◽  
Sigvard T. Hansen ◽  
Alain C. Masquelet
Keyword(s):  
Hallux Valgus ◽  
Sagittal Plane ◽  
Metatarsophalangeal Joint ◽  
Metatarsal Head ◽  
Valgus Deformity ◽  
Main Concern ◽  
First Metatarsophalangeal Joint ◽  
First Metatarsal ◽  
Hallux Valgus Deformity ◽  
First Ray

Today, bunion surgery is still controversial. Considering that a bunion deformity in fact may be a result of multiple causes, the rationale of the currently applied techniques of surgical treatment has not been conclusively demonstrated. In view of the known hypermobility syndrome of the first ray that results in insufficient weightbearing beneath the first metatarsal head, the relationship between this syndrome and hallux valgus deformity has been investigated. The results suggest a direct relationship between painful hallux valgus deformity and hypermobility in extension of the first tarsometatarsal joint. A pathological mechanism of symptomatic hallux valgus is proposed that relates this pathology with primary weightbearing disturbances in the forefoot where angulation of the first metatarsophalangeal joint is one of the consequences. The alignment of the metatarsal heads within the sagittal plane seems to be a main concern in many hallux valgus deformities. As a consequence, treatment includes reestablishing stable sagittal alignment in addition to the horizontal reposition of the metatarsal over the sesamoid complex. As an example, first tarsometatarsal reorientation arthrodesis regulates the elasticity of the multiarticular first ray within the sagittal plane and may be the treatment of choice in many hallux valgus deformities.

scholarly journals PO 18074 - Rotational biplanar Chevron osteotomy

2019 ◽  
Vol 13 (Supl 1) ◽  
pp. 9S
Author(s):  
Tiago Soares Baumfeld ◽  
Marcelo Pires Prado ◽  
Alberto Mendes ◽  
Caio Augusto De Souza Nery ◽  
Daniel Soares Baumfeld
Keyword(s):  
Internal Rotation ◽  
Hallux Valgus ◽  
Valgus Deformity ◽  
Metatarsal Bone ◽  
Distal Fragment ◽  
Rotational Deformity ◽  
First Metatarsal ◽  
Chevron Osteotomy ◽  
Hallux Valgus Deformity ◽  
Rotation Component

Introduction: The Chevron osteotomy is a reliable and popular osteotomy for treating hallux valgus worldwide. Many modifications have been described, but none of them address the rotational deformity of the first metatarsal. The objective of this study is to describe a variation of biplanar Chevron osteotomy that can address first metatarsal rotation when necessary. Methods: The indications for the Rotational Biplanar Chevron Osteotomy (RBCO) are mild to moderate hallux valgus deformity associated with hallux pronation related to internal rotation of the first metatarsal bone. We describe a technique that uses a medial-based wedge parallel to the plantar limb of the osteotomy to free the distal fragment for correct rotation. Results: The more recent concern about hallux valgus surgery represents a very interesting concept that this deformity truly occurs in three different planes, and we may have mistreated the rotation component using current techniques. Many authors have revisited numerous common techniques to adapt them to correct metatarsal pronation. To the best of our knowledge, this is the first paper to describe a modification of the Chevron osteotomy to address rotation of the first metatarsal.  Conclusion: We can conclude that rotational biplanar Chevron osteotomy is an useful tool in the treatment of mild hallux valgus associated with metatarsal pronation.

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