scholarly journals PO 18235 - New tomographic method for measuring metatarsal rotation in hallux valgus

2019 ◽  
Vol 13 (Supl 1) ◽  
pp. 52S
Author(s):  
Bruno Rodrigues de Miranda ◽  
Rui Dos Santos Barroco ◽  
Leticia Zaccaria Prates de Oliveira ◽  
Mahmoud Beerens Abdul Ghani Abdul Ghani ◽  
Antonio Candido de Paula Neto ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Hallux Valgus ◽  
Weight Bearing ◽  
Alpha Angle ◽  
Metatarsal Bone ◽  
3 Dimensional ◽  
First Metatarsal ◽  
Computed Tomography Scans ◽  
Tomographic Method ◽  
The Relationship

Introduction: Hallux valgus is a 3-dimensional deformity involving an increased intermetatarsal I/II angle and a rotational deformity of the first metatarsal bone. Kim et al. developed a method for measuring the tibial sesamoid position relative to the coronal rotation of the first metatarsal bone in computed tomography scans under simulated weight-bearing conditions. Objective: To describe a method for the topographic assessment of the correction of tibial sesamoid and metatarsal pronation using computed tomography scans under simulated weight-bearing and active toe extension. Method: We performed computed tomography under simulated weight-bearing conditions with and without active toe dorsiflexion, observing the degree of metatarsal pronation and sesamoid subluxation. For measurement purposes, we used the classifications of Kim et al. and Smith et al. Results: We observed tomographic correction, both angular and rotational, by measuring the intermetatarsal angle and tibial sesamoid position, which were confirmed by the change in the alpha angle suggested by Kim et al. Discussion: Toe extension was described as a peroneus longus tendon activation test by Klemola et al., who used this maneuver to demonstrate clinical rotational correction of hallux valgus. We described the use of a tomographic technique that followed this principle to preoperatively observe the underlying factors that may affect the rotational correction of the deformity. Conclusion: The method has the capacity for correction in various planes involving derotation of the first metatarsal bone and the relationship between such derotation and the change in sesamoid position in relation to the coronal plane of the foot.

Three-Dimensional Analysis of the First Metatarsal Bone in Minimally Invasive Distal Linear Metatarsal Osteotomy for Hallux Valgus

2019 ◽  
Vol 41 (1) ◽  
pp. 84-93 ◽  
Author(s):  
Hiroyuki Seki ◽  
Satoshi Oki ◽  
Yasunori Suda ◽  
Kenichiro Takeshima ◽  
Tetsuro Kokubo ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Hallux Valgus ◽  
Morphological Changes ◽  
Case Series ◽  
Metatarsal Bone ◽  
Ct Scans ◽  
Metatarsal Osteotomy ◽  
Level Of Evidence ◽  
3 Dimensional ◽  
First Metatarsal

Background: Modified Bösch osteotomy (distal linear metatarsal osteotomy [DLMO]) is one of the minimally invasive correctional surgeries for hallux valgus. The 3-dimensional correctional angles and distances of the first metatarsal bone in DLMO have not been clarified. The purpose of this study was to analyze the 3-dimensional postoperative morphological changes of the first metatarsal bone in DLMO. Methods: Twenty patients (30 feet) who underwent DLMO were enrolled. Preoperative plain radiographs and computed tomography (CT) scans of the feet were examined. Postoperative radiographs and CT scans were also obtained after bone union. The surface data of the pre- and postoperative first metatarsals were reconstructed from the CT data. The positions of the distal ends of the first metatarsals described with respect to the proximal ends were calculated using CT surface-matching technique. Results: The distal end of the first metatarsal after DLMO was significantly supinated (10.2 ± 6.0 degrees, P < .001), adducted (6.0 ± 11.8 degrees, P = .004), dorsiflexed (11.1 ± 10.9, P < .001), shortened (7.4 ± 2.5 mm, P < .001), elevated (2.3 ± 3.1 mm, P = .001), and laterally shifted (8.2 ± 3.0 mm, P < .001) compared to the preoperative metatarsal distal end. Supination correction demonstrated a significant correlation with adduction correction ( r = 0.659, P < .001) on correlation analyses between these parameters. Conclusion: The 3-dimensional corrections of the first metatarsal bone after DLMO were evaluated. Pronation and abduction were successfully corrected. Furthermore, adduction correction might be an important factor affecting correction of pronation. Level of Evidence: Level IV, retrospective case series.

The Role of Weightbearing Computed Tomography Scan in Hallux Valgus

2020 ◽  
pp. 107110072096239
Author(s):  
Karim Mahmoud ◽  
Sreenivasulu Metikala ◽  
Samir D. Mehta ◽  
George W. Fryhofer ◽  
Daniel C. Farber ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Linear Relationship ◽  
Hallux Valgus ◽  
Interobserver Reliability ◽  
Alpha Angle ◽  
Area Under The Curve ◽  
Level Of Evidence ◽  
Musculoskeletal Radiology ◽  
First Metatarsal ◽  
Computed Tomography Images

Background: Hyperpronation of the first metatarsal in hallux valgus (HV) is poorly understood by conventional weightbearing radiography. We aimed to evaluate this parameter using weightbearing computed tomography (WBCT) and to understand its association with other standard measurements. Methods: Retrospective evaluation of WBCT and weightbearing radiographs (WBXRs) was performed for 20 patients with HV feet and 20 controls with no such deformity. Axial computed tomography images of both groups were compared for the first metatarsal pronation angle (alpha angle) and tibial sesamoid subluxation (TSS) grades. The HV angle (HVA), first-second intermetatarsal angle (IMA), first metatarsal-medial cuneiform angle (MMCA), Meary’s angle, and calcaneal pitch (CP) angle of the study and control groups were compared on both WBXR and the corresponding 2-dimensional images of WBCT. All measurements were independently performed by 1 musculoskeletal radiology fellow and 1 foot and ankle surgical fellow. Measurements were averaged and interobserver reliability was calculated. Results: The HV group demonstrated significantly higher values for TSS grade ( P < .001) but not for alpha angle ( P = .121) compared with controls. Likewise, significantly elevated HVA and IMA were noted in the HV group on both imaging modalities, while no such differences were observed for the CP angle. Higher MMCA and Meary’s angle in the HV group were evident only on WBXR (MMCA, P = .039; Meary’s, P = .009) but not on WBCT (MMCA, P = .183; Meary’s, P = .171). Among all, the receiver operating characteristic (ROC) curves demonstrated the greatest area under the curve (AUC) for HVA, followed by IMA. The alpha angle performed only just outside the range of chance (AUC, 0.65; 95% CI, 0.52-0.69). The Pearson’s correlations of the alpha angle, in the HV group, revealed a significant linear relationship with TSS grade and with HVA on WBXR, and only trended toward a weak linear relationship with IMA and with HVA on WBCT. Conclusion: The alpha angle, a measure of abnormal hyperpronation of the first metatarsal, was an independent factor that may coexist with other parameters in HV, but in isolation had limited diagnostic utility. “Abnormal” alpha angles were even observed in individuals without HV. Increases in IMA and MMCA were not necessarily associated with similar increases in alpha angle, despite moderate correlations with TSS grade and HVA on WBXR. Nevertheless, the WBCT was a useful method for assessing hyperpronation and guiding surgical management in individual cases. Level of Evidence: Level III, retrospective comparative study.

Correlation of Different Methods of Measuring Pronation of the First Metatarsal on Weightbearing CT Scans

2021 ◽  
pp. 107110072110030
Author(s):  
Matthew S. Conti ◽  
Tamanna J. Patel ◽  
Kristin C. Caolo ◽  
Joseph M. Amadio ◽  
Mark C. Miller ◽  
...  
Keyword(s):  
Hallux Valgus ◽  
Computer Aided Design ◽  
Foot And Ankle ◽  
Level Of Evidence ◽  
3 Dimensional ◽  
3D Cad ◽  
First Metatarsal ◽  
Hallux Valgus Deformity ◽  
Second Metatarsal ◽  
Α Angle

Background: There is no consensus in the foot and ankle literature regarding how to measure pronation of the first metatarsal in patients with hallux valgus. The primary purpose of this study was to compare 2 previously published methods for measuring pronation of the first metatarsal and a novel 3-dimensional measurement of pronation to determine if different measurements of pronation are associated with each other. Methods: Thirty patients who underwent a modified Lapidus procedure for their hallux valgus deformity were included in this study. Pronation of the first metatarsal was measured on weightbearing computed tomography (WBCT) scans using the α angle with reference to the floor, a 3-dimensional computer-aided design (3D CAD) calculation with reference to the second metatarsal, and a novel method, called the triplanar angle of pronation (TAP), that included references to both the floor (floor TAP) and base of the second metatarsal (second TAP). Pearson’s correlation coefficients were used to determine if the 3 calculated angles of pronation correlated to each other. Results: Preoperative and postoperative α angle and 3D CAD had no correlation with each other ( r = 0.094, P = .626 and r = 0.076, P = .694, respectively). Preoperative and postoperative second TAP and 3D CAD also had no correlation ( r = 0.095, P = .624 and r = 0.320, P = .09, respectively). However, preoperative and postoperative floor TAP and α angle were found to have moderate correlations ( r = 0.595, P = .001 and r = 0.501, P = .005, respectively). Conclusion: The calculation of first metatarsal pronation is affected by the reference and technique used, and further work is needed to establish a consistent measurement for the foot and ankle community. Level of Evidence: Level III, retrospective cohort study.

Geometric Data of Hallux Valgus Feet

1996 ◽  
Vol 17 (9) ◽  
pp. 548-554 ◽  
Author(s):  
Kenneth S. Lamur ◽  
Anton Huson ◽  
Chris J. Snijders ◽  
Rob Stoeckart
Keyword(s):  
Hallux Valgus ◽  
Least Squares Method ◽  
Metatarsal Bone ◽  
Flexor Hallucis Longus ◽  
Independent Variables ◽  
First Metatarsal ◽  
Linear Dependency ◽  
Geometric Data ◽  
Longus Muscle ◽  
Stepwise Procedure

The aim of this study is to find basic quantitative geometric data that may contribute to the understanding of the etiology of hallux valgus. Embalmed specimens with existing hallux valgus (N = 39) were dissected; 28 variables were measured with a Vernier caliper gauge and toe goniometer. Correlations between pairs of independent variables were calculated. Linear dependency of the hallux angle, varus angle, and the width of the forefoot on a number of independent variables was analyzed by multiple linear regression. A least squares method and a stepwise procedure were used. The distance from the tendon of the flexor hallucis longus muscle to the head of the first metatarsal bone explains more than other variables the variation in hallux angle and width of the forefoot. A widened forefoot is significantly correlated with both hallux and varus angles. The interrelation of the predictor parameters illustrates the complicated hallux valgus phenomenon.

scholarly journals Radiographic Outcomes after Fixation of Distal Metatarsal Osteotomy for Hallux Valgus Using a Tension Band Construct

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0042
Author(s):  
Alexander Volpi ◽  
Robert Zbeda ◽  
Christopher Katchis ◽  
Lon Weiner ◽  
Stuart Katchis
Keyword(s):  
Hallux Valgus ◽  
Postoperative Period ◽  
Weight Bearing ◽  
Line Tension ◽  
Tension Band ◽  
Metatarsal Osteotomy ◽  
First Metatarsal ◽  
Distal Metatarsal Osteotomy ◽  
The Mean

Category: Bunion Introduction/Purpose: Hallux valgus is a common deformity of the forefoot. There are over 130 procedures described to correct hallux valgus. Classically, the treatment of mild to moderate hallux valgus is with a distal metatarsal osteotomy. A variety of fixation techniques have been described for use with this osteotomy most of which require partial or non-weight bearing until the osteotomy is healed. Tension Band fixation is a well-known principle in orthopedic surgery. The goal of the present study is to radiographically assess the maintenance of distal first metatarsal osteotomy fixation using a novel tension band device (Re+Line tension band bunion plate system, Nextremity Solutions) with immediate post-operative weight-bearing. Methods: The patient database for one surgeon was retrospectively reviewed for patients that underwent hallux valgus correction with the Re+Line tension band device between 2014 and 2017. Postoperative protocol included a soft dressing, firm surgical shoe, and weight-bearing as tolerated with a cane. Patients were excluded if fixation was achieved with something other than a tension band construct. Radiographs were obtained and reviewed retrospectively by 3 authors. Pre and postoperative hallux valgus (HVA) and intermetatarsal angles (IMA) were measured as described previously in the literature, and the changes in correction compared. Maintenance of correction and hardware integrity were assessed at final follow-up after weight bearing as tolerated in a surgical shoe in the postoperative period. Statistical analysis was performed using a Wilcoxon signed-rank test for the changes in HVA and IMA. Results: There was a total of 72 patients and 76 toes that underwent hallux valgus correction with a tension band construct, at a mean follow-up of 4.36 months. 68 of 72 patients were female. The average age was 60.8 years old. The mean preoperative HVA was 27.1 degrees. The mean postoperative HVA was 6.14 degrees, with a mean correction of 20.22 degrees (p<0.001). The mean preoperative IMA was 14.14 degrees. The mean postoperative IMA was 6.10 degrees, with a mean correction of 7.98 degrees (p<0.001). There was loss of reduction found in 6 of 76 toes (7.89%).There were zero cases of hardware failure. All osteotomies healed at final follow-up. Conclusion: This study shows successful radiographic outcome after hallux valgus correction using a tension band construct and allowing immediate full weight-bearing in a surgical shoe in the postoperative period. Significant deformity correction was achieved and maintained and all osteotomies healed. The Re+Line tension band bunion correction system can be safely used as a successful option to fix distal first metatarsal osteotomies, while allowing patients to fully weight bear in a surgical shoe postoperatively and potentially return to activities faster than when using traditional fixation methods. Future studies are needed to assess functional outcomes and patient satisfaction with this novel technique.

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

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]

scholarly journals The Role of Weight-Bearing Computed Tomography Scan in Hallux Valgus

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0035
Author(s):  
Sreenivasulu Metikala ◽  
Karim Mahmoud Khamis ◽  
George W. Fryhofer ◽  
Samir Mehta ◽  
Daniel C. Farber
Keyword(s):  
Computed Tomography ◽  
Hallux Valgus ◽  
Weight Bearing ◽  
Roc Curves ◽  
Musculoskeletal Radiology ◽  
Valgus Angle ◽  
Medial Cuneiform ◽  
Axial Ct ◽  
Α Angle ◽  
And Control

Category: Midfoot/Forefoot; Bunion Introduction/Purpose: Hyperpronation of the 1st metatarsal in hallux valgus (HV) is poorly understood by conventional weightbearing radiography. We aimed to evaluate this parameter using weightbearing computed tomography (WBCT) and understand its association with other standard measurements. Methods: Retrospective evaluation of WBCT and weightbearing radiographs (WBXR) was performed for 20 patients with hallux valgus (HV) feet and 20 controls with no such deformity. Axial CT images of both groups were compared for 1st metatarsal pronation angle (α angle) and tibial sesamoid subluxation (TSS) grades. The hallux valgus angle (HVA), first-second intermetatarsal angle (IMA), 1st metatarsal-medial cuneiform angle (MMCA), Meary’s angle, and calcaneal pitch (CP) angle of the study and control groups were compared on both WBXR and the corresponding 2D images of WBCT. All the measurements were independently studied by a dedicated musculoskeletal radiology fellow. Results: HV group demonstrated significantly higher values for TSS grade (p < 0.001) but not for α angle (p = 0.19) compared to controls. Pearson’s correlations of the α angle, in the HV group, revealed no significant linear relationship with TSS grades, IMA and MMCA, and only a moderate positive correlation with HVA as per WBXR (r = 0.38, p = 0.014) but not by WBCT (p = 0.084). Also, α angle performed within the range of a chance (AUC 0.64, 95% CI: 0.49 to 0.66) when measured by receiver operating characteristic (ROC) curves. Conclusion: The α angle - a measure of abnormal hyperpronation of the 1st metatarsal - is an independent factor that may co- exist with other parameters in HV, but in isolation has limited diagnostic utility. ‘Abnormal’ α angles may even be observed in individuals without HV deformity. An increase in the HVA, IMA, MMCA or TSS grade is not necessarily associated with a similar increase in the α angle and hence, the severity of HV deformity may not be judged on this parameter alone. The WBCT is a reliable method to assess hyperpronation and guide physicians during surgical management. [Table: see text][Table: see text]

scholarly journals Effect on Foot Width With Triplanar Tarsometatarsal Arthrodesis for Hallux Valgus

2020 ◽  
Vol 5 (3) ◽  
pp. 247301142093480
Author(s):  
Justin Vaida ◽  
Justin J. Ray ◽  
Taylor L. Shackleford ◽  
William T. DeCarbo ◽  
Daniel J. Hatch ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Functional Outcome ◽  
Hallux Valgus ◽  
Metatarsal Head ◽  
Level Of Evidence ◽  
3 Dimensional ◽  
First Metatarsal ◽  
Institutional Review ◽  
Retrospective Comparative Study ◽  
Width Reduction

Background: Foot width reduction is a desirable cosmetic and functional outcome for patients with hallux valgus. Triplanar first tarsometatarsal (TMT) arthrodesis could achieve this goal by 3-dimensional correction of the deformity. The aim of this study was to evaluate changes in bony and soft tissue width in patients undergoing triplanar first TMT arthrodesis. Methods: After receiving Institutional Review Board approval, charts were retrospectively reviewed for patients undergoing triplanar first TMT arthrodesis for hallux valgus at 4 institutions between 2016 and 2019. Patients who underwent concomitant first metatarsal head osteotomies (eg, Silver or Chevron) or fifth metatarsal osteotomies were excluded. Preoperative and postoperative anteroposterior weightbearing radiographs were compared to evaluate for changes in bony and soft tissue width. One hundred forty-eight feet from 144 patients (48.1 ± 15.7 years, 92.5% female) met inclusion criteria. Results: Preoperative osseous foot width was 96.2 mm, compared to 85.8 mm postoperatively ( P < .001). Preoperative soft tissue width was 106.6 mm, compared to 99.3 mm postoperatively ( P < .001). Postoperatively, patients had an average 10.4 ± 4.0 mm reduction (10.8% reduction) in osseous width and average 7.3 ± 4.0 mm reduction (6.8% reduction) in soft tissue width. Conclusions: Triplanar first TMT arthrodesis reduced both osseous and soft tissue foot width, providing a desirable cosmetic and functional outcome for patients with hallux valgus. Future studies are needed to determine if patient satisfaction and outcome measures correlate with reductions in foot width. Level of evidence: Level III, retrospective comparative study

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