scholarly journals Radiographic Evaluation of Congruency of the First Metatarsophalangeal Joint in Hallux Valgus

2021 ◽  
Author(s):  
Yan Li ◽  
Xu Tao ◽  
Kanglai Tang
Keyword(s):  
Hallux Valgus ◽  
Correlation Coefficients ◽  
Metatarsophalangeal Joint ◽  
Radiographic Evaluation ◽  
Level Of Evidence ◽  
First Metatarsophalangeal Joint ◽  
Valgus Angle ◽  
Surgical Methods ◽  
History Of ◽  
Retrospective Comparative Study

Abstract Background Congruency of the first metatarsophalangeal (MTP) joint is extremely important for the selection of surgical methods and prognosis, while radiographic evaluation methods are relatively lacking. The purpose of this article was to explore radiographic indicators for evaluating congruency of the first MTP joint.Methods Patients who had a weightbearing X-ray in the outpatient system were selected, excluding patients with trauma, deformity, and history of surgery. A total of 183 patients with 245 feet were included. The hallux valgus angle (HVA), distal metatarsal articular angle (DMAA), metatarsophalangeal joint angle (MTPJA), congruency index (CI) and tibial sesamoid position (TSP) were measured and statistically analysed.Results The higher the degree of hallux valgus was, the higher the proportion of incongruency of the first MTP joint. Significant differences were found in the DMAA, MTPJA and CI between the congruency and incongruency groups of patients with moderate to severe hallux valgus (P<0.05). The areas under the curve (AUCs) of the receiver operating characteristic (ROC) curve for the MTPJA and CI were 0.906 and 0.884, the sensitivity values reached 0.791 and 0.949, the specificity values were 0.862 and 0.644, and the critical values were 10.67 and 0.765, respectively. The correlation test indicated that in the congruency group, the DMAA and HVA were positively correlated, but the MTPJA, CI and HVA had low correlation coefficients. The DMAA and HVA were not correlated in the incongruency group, while the MTPJA and HVA were significantly positively correlated and the CI and HVA showed a negative correlation (P<0.05).Conclusion The MTPJA and CI are indicators that can be used to quantitatively evaluate the congruency of the first MTP joint, taking 10° and 0.765 as the demarcation points, respectively. Clinically, congruency of the MTP joint should be considered when choosing surgical methods for different degrees of hallux valgus, and the MTPJA and CI can be used as quantitative evaluation indicators.Level of evidence: Level III, Retrospective Comparative Study

scholarly journals Radiographic evaluation of the congruency of the first metatarsophalangeal joint in hallux valgus

2021 ◽  
Author(s):  
li yan ◽  
Xu Tao ◽  
Kanglai Tang
Keyword(s):  
Hallux Valgus ◽  
Evaluation Method ◽  
Correlation Coefficients ◽  
Metatarsophalangeal Joint ◽  
Radiographic Evaluation ◽  
First Metatarsophalangeal Joint ◽  
Valgus Angle ◽  
History Of ◽  
Severe Hallux Valgus ◽  
Operating Methods

Abstract Background The congruency of the first metatarsophalangeal (MTP) joint was extremely important for the selection of operating methods and prognosis, while its radiographic evaluation method was relatively lacking. The purpose of this article was to explore the radiographic indicators for evaluating the congruency of the first MTP joint. Methods The patients who had X-ray of weightbearing in the outpatient system were selected, excluding patients with trauma, deformity, and history of operation. 183 patients with 245 feet were included. The hallux valgus angle (HVA), distal metatarsal articular angle (DMAA), metatarsophalangeal joint angle (MTPJA), congruency index (CI) and tibial sesamoid position (TSP) were measured and do statistical analysis. Results The higher the degree of hallux valgus, the higher the proportion of incongruency of the first MTP joint. Significant differences were found in DMAA, MTPJA and CI between the congruency and incongruency groups of patients with moderate to severe hallux valgus (P < 0.05). The area under curve (AUC) of the receiver operating characteristic(ROC) curve for MTPJA and CI was 0.906 and 0.884, the sensitivity and specificity reached 0.791 and 0.862, 0.949 and 0.644, and the critical values were 10.67 and 0.765 respectively. The correlation test indicated that in the congruency group, DMAA and HVA had positive correlation, but MTPJA, CI and HVA had low correlation coefficients. DMAA and HVA were not correlated in the incongruency group, while MTPJA and HVA were significantly positively correlated, and CI and HVA showed a negative correlation (P < 0.05). Conclusion MTPJA and CI are indicators that can quantitatively evaluate the congruency of the first MTP joint, taking 10° and 0.765 as the demarcation points respectively. Clinically, the congruency of MTP joint should be considered when choosing operating methods for different degrees of hallux valgus, MTPJA and CI can be used as quantitative evaluation indicators.

scholarly journals Hallux Valgus Recurrence After Simple Bunionectomy: Algorithm Treatment

2022 ◽  
Author(s):  
Josep Torrent ◽  
Raúl Figa ◽  
Iban Clares ◽  
Eduard Rabat
Keyword(s):  
Comparative Study ◽  
Hallux Valgus ◽  
Treatment Algorithm ◽  
Metatarsophalangeal Joint ◽  
Salvage Procedure ◽  
Bone Stock ◽  
Level Of Evidence ◽  
First Metatarsophalangeal Joint ◽  
Retrospective Comparative Study ◽  
End Stage

Abstract Background: Recurrences of hallux valgus can be difficult to manage, especially after a prior simple bunionectomy. This study aimed to present a treatment algorithm for the correction of recurrences after a simple bunionectomy.Methods: This was a single-center, descriptive, and retrospective comparative study. Thirty-four consecutive patients were classified according to the bone stock and the presence or absence of end-stage arthritis of the first metatarsophalangeal joint (MTPJ). According to our algorithm, we only performed an osteotomy as the salvage procedure in cases with sufficient bone stock and absence of or mild arthritis. In the other cases, we performed an MTPJ fusion. Exceptionally, we chose a Keller-Brandes arthroplasty for patients with advanced age and comorbidities. Results: We performed 17 scarf osteotomies (50%), 15 MTPJ arthrodeses (44.1%), and 2 Keller-Brandes arthroplasties (5.9%). Following the algorithm, we achieved an improvement of the AOFAS score of >30 points without severe complications in all groups.Conclusions: The proposed operative algorithm successfully addresses the recurrences considering the lack of bone stock and the presence of MTPJ arthritis.Level of EvidenceLevel 3: retrospective comparative study

Radiographic Evaluation of First Metatarsal and Medial Cuneiform Morphology in Juvenile Hallux Valgus

2018 ◽  
Vol 39 (10) ◽  
pp. 1223-1228 ◽  
Author(s):  
Philip Kaiser ◽  
Kristin Livingston ◽  
Patricia E. Miller ◽  
Collin May ◽  
Susan Mahan
Keyword(s):  
Hallux Valgus ◽  
Multivariable Analysis ◽  
Metatarsophalangeal Joint ◽  
Radiographic Evaluation ◽  
High Recurrence Rate ◽  
Level Of Evidence ◽  
First Metatarsal ◽  
Valgus Angle ◽  
Medial Cuneiform ◽  
Highly Correlated

Background: Operative treatment of juvenile hallux valgus (JHV) has a high recurrence rate. The aim of this study was to better understand the pattern of radiographic deformity. Methods: Standing radiographs of 93 feet in 57 patients with JHV, and 50 feet in 36 normal patients were measured. Measurements included: hallux valgus angle (HVA), first metatarsal physis status (open or closed), intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA), Meary’s angle, medial cuneiform angle (MCA), relative first to second metatarsal length ratio (1:2 MT ratio), cuneiform obliquity (CO), and congruency of the metatarsophalangeal joint (MTPJ). JHV groups were defined as normal (HVA 0-15 degrees), mild-moderate (HVA 15-35), or severe (HVA > 35) and were analyzed. Results: Seventy of 93 feet (75%) with JHV presented with mild-moderate JHV (average HVA of 26.2 ± 5.6 degrees), and 23 feet (25%, 23/93) presented with severe JHV (average HVA of 41.9 ± 5.3 degrees). Multivariable analysis determined that DMAA ( P < .001), MCA ( P = .04), and congruency ( P < .001) were independently associated with JHV and its severity (normal vs mild-moderate vs severe). Severe JHV cases had larger DMAA ( P = .01), larger IMA ( P = .01), larger 1:2 MT ratio ( P = .02), and were less frequently congruent ( P = .03) compared with mild-moderate JHV cases. Conclusion: Deformity in JHV was highly correlated with both the proximal and distal morphology of the first metatarsal and medial cuneiform. Severe JHV was associated with increased bony deformity and increased incongruity of the MTPJ. Treatment should be individualized, but JHV treatment algorithms can take this information into account. Level of Evidence: Level III, comparative study.

Correlation analysis of the x-ray and functional parameters from the results of chevron (Austin) osteotomy for hallux valgus

2020 ◽  
pp. 54-63
Author(s):  
Ruslan Khairutdinov ◽  
Timur Minasov ◽  
Ekaterina Yakupova ◽  
Elvina Mukhametzyanova
Keyword(s):  
Hallux Valgus ◽  
Rating Scale ◽  
Metatarsophalangeal Joint ◽  
Valgus Deformity ◽  
First Metatarsophalangeal Joint ◽  
Chevron Osteotomy ◽  
Hallux Valgus Deformity ◽  
Valgus Angle ◽  
The Right ◽  
Bone Structures

Hallux valgus is characterized by the appearance and growth of a painful “lump” in the region of the first metatarsophalangeal joint, the development of forefoot corns, and inability to choose the right shoes, which leads to a significant decrease in the quality of life of these patients. Corrective osteotomies that preserve the metatarsophalangeal joint, for example Austin (Chevron) osteotomy, are usually used for hallux valgus deformity of the I, II degrees. Radiography with the study of the hallux valgus angle (HVA), the intermetatarsal angle (IMA), the distal metatarsal articular angle (DMAA) is a research method that shows the true correlation between bone structures. The correlation between the radiological and functional indicators of osteotomy allows us to determine possible recommendations for indications for surgical treatment of Hallux valgus. Correlation shows that the largest correction of hallux valgus in older patients occurs due to a small adjustment of the angle of DMMA and HVA. IMA had the best correction after Austin osteotomy among patients of a younger age, then the HVA, and the DMMA had minimum correction according to the AOFAS rating scale (Kitaoka). The revealed correlations allow us to determine the correct tactics for the treatment of hallux valgus by identifying the benefits of Austin osteotomy.

Modified Austin Procedure for Correction of Hallux Valgus

1997 ◽  
Vol 18 (3) ◽  
pp. 119-127 ◽  
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.

scholarly journals First-Tarsometatarsal Joint Alignment After First-Metatarsophalangeal Joint Arthrodesis for Hallux Valgus

2021 ◽  
Vol 6 (2) ◽  
pp. 247301142110085
Author(s):  
Christopher Traynor ◽  
James Jastifer
Keyword(s):  
Hallux Valgus ◽  
Case Series ◽  
Metatarsophalangeal Joint ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
First Metatarsophalangeal Joint ◽  
First Metatarsal ◽  
Metatarsal Angle ◽  
Medial Cuneiform ◽  
Radiographic Alignment

Background: Instability of the first-tarsometatarsal (TMT) joint has been proposed as a cause of hallux valgus. Although there is literature demonstrating how first-TMT arthrodesis affects hallux valgus, there is little published on how correction of hallux valgus affects the first-TMT joint alignment. The purpose of this study was to determine if correction of hallux valgus impacts the first-TMT alignment and congruency. Improvement in alignment would provide evidence that hallux valgus contributes to first-TMT instability. Our hypothesis was that correcting hallux valgus angle (HVA) would have no effect on the first-TMT alignment and congruency. Methods: Radiographs of patients who underwent first-MTP joint arthrodesis for hallux valgus were retrospectively reviewed. The HVA, 1-2 intermetatarsal angle (IMA), first metatarsal–medial cuneiform angle (1MCA), medial cuneiform–first metatarsal angle (MC1A), relative cuneiform slope (RCS), and distal medial cuneiform angle (DMCA) were measured and recorded for all patients preoperatively and postoperatively. Results: Of the 76 feet that met inclusion criteria, radiographic improvements were noted in HVA (23.6 degrees, P < .0001), 1-2 IMA (6.2 degrees, P < .0001), 1MCA (6.4 degrees, P < .0001), MC1A (6.5 degrees, P < .0001), and RCS (3.3 degrees, P = .001) comparing preoperative and postoperative radiographs. There was no difference noted with DMCA measurements (0.5 degrees, P = .53). Conclusion: Our findings indicate that the radiographic alignment and subluxation of the first-TMT joint will reduce with isolated treatment of the first-MTP joint. Evidence suggests that change in the HVA can affect radiographic alignment and subluxation of the first-TMT joint. Level of Evidence: Level IV, retrospective case series.

scholarly journals Sesamoid malalignment in hallux valgus: Radiographic and MRI measurements and their correlation with internal derangement findings of the first metatarsophalangeal joint

2019 ◽  
Vol 92 (1100) ◽  
pp. 20190038
Author(s):  
Justin Skweres ◽  
Avneesh Chhabra ◽  
Jed Hummel ◽  
Nathan Heineman ◽  
Riham Dessouky ◽  
...  
Keyword(s):  
Hallux Valgus ◽  
Rotation Angle ◽  
Metatarsophalangeal Joint ◽  
Preoperative Assessment ◽  
X Rays ◽  
First Metatarsophalangeal Joint ◽  
Valgus Angle ◽  
Internal Joint ◽  
Reader Reliability ◽  
Mri Measurements

Objective: Sesamoid displacement (SD) and rotation are important components in the preoperative assessment of hallux valgus (HV). To date, Inter reader reliability (IRR) of SD on X-rays and MRI, correlations with hallux valgus angle (HVA), and qualitative changes of the hallux-sesamoid complex (HSC) on MRI have not been studied. The aim of this study was to correlate sesamoid malalignment with HV severity and findings of internal joint derangement. Methods: Two readers analyzed a series of 56 consecutive patients who had X-rays and MRI performed on the same foot within 3 months of each other. Multiple measures of SD on X-rays and MRI and the sesamoid rotation angle (SRA) on MRI were assessed and correlated with HVA and various qualitative features at the HSC including cartilage, plantar plate, and collateral ligament abnormalities. Results: We found excellent IRR (ICC = 0.79 – 0.99) for SRA on MR, but poor IRR for lateral sesamoid displacement (LDS) and tibial sesamoid position (TSP) scales on both modalities. Good IRR was also seen for morphologic abnormalities of HSC. The absolute value of the SRA on MR positively correlated with HVA ( p < 0.0001). LDS and TSP on both modalities lacked a significant correlation with HVA ( p > 0.05). No correlation was found between any measure of SD or rotation with HSC morphologic changes ( p > 0.05). Conclusion: Among different measures of sesamoid malalignment, sesamoid rotation angle measured on MRI can be used to judge the severity of HV; however, it does not correlate with qualitative morphologic abnormalities of the HSC. Advances in knowledge: The MRI measurement of SRA is a better indicator of sesamoid displacement relative to the HSC than standard AP radiographic measures of non-rotational sesamoid displacement; however, it should not be used to predict qualitative morphologic abnormalities of the HSC.

Pseudogout of the First Metatarsophalangeal Joint Associated with Hallux Valgus

2010 ◽  
Vol 100 (2) ◽  
pp. 138-142 ◽  
Author(s):  
Antonio Córdoba-Fernández ◽  
Rafael Rayo-Rosado
Keyword(s):  
Hallux Valgus ◽  
Metatarsophalangeal Joint ◽  
Calcium Pyrophosphate ◽  
Radiographic Evaluation ◽  
Calcium Pyrophosphate Dihydrate ◽  
Crystal Deposition ◽  
Radiographic Appearance ◽  
First Metatarsophalangeal Joint ◽  
Bilateral Case ◽  
Pyrophosphate Dihydrate

Calcium pyrophosphate dihydrate crystal deposition disease has various clinical features, and pseudogout is one of the six clinical forms. Chondrocalcinosis is the term used to describe the radiographic appearance of the disease. A review of the literature revealed that the appearance of this type of arthropathy in the foot is infrequent. We offer a review of the disease and report an atypical bilateral case of pseudogout in a patient 56 years of age without a history who presented with symptoms of arthritis localized in the first metatarsophalangeal joint associated with hallux valgus and was treated surgically. Radiographic evaluation of the feet did not reveal signs of chondrocalcinosis. The patient had no metabolic abnormalities, except for high uric acid values. Chemical analysis of the surgical samples demonstrated the presence of calcium pyrophosphate dihydrate crystals, confirming the diagnosis. We believe that arthropathy by deposition of calcium pyrophosphate dihydrate in the foot, although rare, must be considered in the podiatric physician’s differential diagnosis when a patient presents with articular pain in the foot associated or not with deformities. (J Am Podiatr Med Assoc 100(2): 138–142, 2010)

Effect of Bipartite Hallucal Sesamoid on Hallux Valgus Surgery

2017 ◽  
Vol 38 (6) ◽  
pp. 634-640 ◽  
Author(s):  
Young Hwan Park ◽  
Chan Dong Jeong ◽  
Gi Won Choi ◽  
Hak Jun Kim
Keyword(s):  
Hallux Valgus ◽  
Study Cohort ◽  
Aofas Score ◽  
Level Of Evidence ◽  
Radiographic Outcomes ◽  
Chevron Osteotomy ◽  
Radiographic Measurements ◽  
Valgus Angle ◽  
Retrospective Comparative Study

Background: Bipartite hallucal sesamoids are often found in patients with hallux valgus. However, it is unknown whether bipartite hallucal sesamoids affect the results of hallux valgus surgery or not. The purpose of the present study was to evaluate the outcomes of chevron osteotomy for hallux valgus with and without bipartite hallucal sesamoid. Methods: A total of 152 patients (168 feet) treated with distal or proximal chevron osteotomy for hallux valgus constituted the study cohort. The 168 feet were divided into 2 groups: bipartite hallucal sesamoid (31 feet) and without bipartite hallucal sesamoid (137 feet). Hallux valgus angle (HVA), intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA), tibial sesamoid position, and first metatarsal length were measured for radiographic outcomes and the American Orthopaedic Foot & Ankle Society (AOFAS) hallux metatarsophalangeal-interphalangeal (MTP-IP) score was measured for clinical outcomes. Results: All radiographic measurements and the AOFAS score showed significant ( P < .05) improvement at the time of final follow-up compared with preoperative measurements in both groups. No significant differences ( P > .05) were found between the 2 groups in terms of HVA, IMA, DMAA, tibial sesamoid position, metatarsal shortening, and AOFAS score on final follow-up. Conclusions: This study suggests that bipartite hallucal sesamoids do not affect the results of hallux valgus surgery. Level of Evidence: Level III, retrospective comparative study.

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