Shape of the first metatarsal head in hallux rigidus and hallux valgus

1988 ◽  
Vol 78 (6) ◽  
pp. 300-304 ◽  
Author(s):  
SM Brahm
Keyword(s):  
Hallux Valgus ◽  
Metatarsal Head ◽  
Hallux Rigidus ◽  
First Metatarsal

Great Toe Metatarsophalangeal Joint Arthrodesis: A User-Friendly Technique

Foot & Ankle ◽  
1992 ◽  
Vol 13 (7) ◽  
pp. 367-377 ◽  
Author(s):  
Ronald W. Smith ◽  
Terry L. Joanis ◽  
Phyllis D. Maxwell
Keyword(s):  
Hallux Valgus ◽  
Metatarsophalangeal Joint ◽  
Metatarsal Head ◽  
Hallux Rigidus ◽  
First Metatarsal ◽  
Pin Fixation ◽  
Patient Responses ◽  
K Wires ◽  
User Friendly

Thirty-four feet (23 patients) were treated with a metatarsophalangeal (MP) joint fusion of the hallux using five threaded 0.062-in K wires for fixation. Operations were done for the following diagnoses: rheumatoid arthritis (26 procedures), hallux rigidus (1), salvage of previous bunionectomies (3), hallux valgus with absent toe, bilateral fusion (2), severe hallux valgus with chronic MP joint synovitis (1), and congenital hallux varus (1). The ages ranged from 17 to 73 years, with an average of 55 years. Follow-up was available on 31 of the fusions by questionnaire and telephone contact, with an average follow-up of 24 months and a minimum of 1 year. The successful arthrodesis rate was 97%. In 9% of the procedures (three cases), the patients were dissatisfied: This was due to pain under the first metatarsal head in two cases and to impingement between the first and second toes in a third case. In 91% of the fusions (29 of 32 patient responses), the patients stated that they would have the surgery if they had to choose again. Patients indicated “complete satisfaction” in 15 fusions and “satisfaction with reservations” in 14. Patients felt that their ability to wear desired shoes was improved in 48% of the procedures, was unchanged by the fusions in 26%, and was worse than before the operation in 26%. Based on this study and review of the literature, a recommendation is made for fusing the rheumatoid hallux with 25° to 30° of valgus and 10° of extension. In general, selection of toe position for fusion is based on reducing stress on the hallux interphalangeal joint and accommodating the position of the second toe. The multiple pin fixation technique gives a high incidence of fusion, it is easy to perform, and it is adaptable to the varying requirements for toe position.

scholarly journals Radiographic Analysis on the Distortion of the Anatomy of First Metatarsal Head in Dorsoplantar Projection

Diagnostics ◽  
2020 ◽  
Vol 10 (8) ◽  
pp. 552
Author(s):  
Jessica Grande-del-Arco ◽  
Ricardo Becerro-de-Bengoa-Vallejo ◽  
Patricia Palomo-López ◽  
Daniel López-López ◽  
César Calvo-Lobo ◽  
...  
Keyword(s):  
Hallux Valgus ◽  
Interobserver Agreement ◽  
Metatarsal Head ◽  
Hallux Rigidus ◽  
Kappa Statistics ◽  
Head Shape ◽  
X Ray ◽  
Anatomical Dissection ◽  
First Metatarsal ◽  
Anatomic Dissection

Background: The diagnostic of flat and crest-shaped of first metatarsal heads has been associated as an important risk factor for hallux deformities, such as hallux valgus and hallux rigidus. The rounded form of the first metatarsal head on the dorsoplantar radiograph of the foot has been believed to be associated with the development of hallux valgus. Purpose: The aim of this study was to clarify the effect of tube angulation on the distortion of first metatarsal head shape, and verify the real shape of the metatarsal head in anatomical dissection after an X-ray has been taken. Materials and Methods: In this prospective study at Universidad Complutense de Madrid, from December 2016 to June 2019, 103 feet from embalmed cadavers were included. We performed dorsoplantar radiograph tube angulation from 0° until 30° every 5° on all specimens; then, two observers verified the shape of the first metatarsal head in the radiographs and after its anatomic dissection. Kappa statistics and McNemar Bowker tests were used to assess and test for intra and interobserver agreement of metatarsal shape. Results: We calculated the intraobserver agreement, and the results showed that the first metatarsal head is distorted and crested only when the angle of the X-ray beam is at 20° of inclination (p < 0.001). The interobserver agreement showed good agreement at 0°, 5°, 10°, 20°, and 25° and was excellent at 30° (p < 0.001). Conclusion: All of the studies that we identified in the literature state that there are three types of shapes of the first metatarsal head and relate each type of head to the diagnosis of a foot pathology, such as hallux valgus or hallux rigidus. This study demonstrates that there is only the round-shaped form, and not three types of metatarsal head shape. Therefore, no diagnoses related to the shape of the first metatarsal head can be made.

The Shape of the Lateral Edge of the First Metatarsal Head as a Risk Factor for Recurrence of Hallux Valgus

2007 ◽  
Vol 89 (10) ◽  
pp. 2163-2172 ◽  
Author(s):  
Ryuzo Okuda ◽  
Mitsuo Kinoshita ◽  
Toshito Yasuda ◽  
Tsuyoshi Jotoku ◽  
Naoshi Kitano ◽  
...  
Keyword(s):  
Risk Factor ◽  
Hallux Valgus ◽  
Metatarsal Head ◽  
First Metatarsal ◽  
Lateral Edge ◽  
Risk Factor For Recurrence

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]

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.

Disorders of the forefoot

2011 ◽  
Author(s):  
Andrew H.N. Robinson ◽  
Maneesh Bhatia
Keyword(s):  
Surgical Treatment ◽  
Hallux Valgus ◽  
Early Mobilization ◽  
Metatarsal Head ◽  
Hallux Rigidus ◽  
Indications For Surgery ◽  
Forefoot Surgery ◽  
First Ray

♦ The aim of modern forefoot surgery is to refunction the first ray, and balance the lesser rays around it♦ The indications for surgery in hallux valgus are of pain over the bunion, or of pain with subluxation or dislocation of the lesser rays as a result of first ray insufficiency♦ Hallux valgus surgery aims to reposition the metatarsal head over the sesamoids whilst maintaining length. The osteotomy should be stable to allow early mobilization♦ The mainstays of the surgical treatment of hallux rigidus are dorsal cheilectomy and fusion of the first MTPJ♦ 96% excellent and good results in reconstruction of the rheumatoid forefoot have been reported with fusion of the first MTPJ and resection of the lesser metatarsal heads.

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

First Metatarsal Head and Medial Eminence Widths with and Without Hallux Valgus

2016 ◽  
Vol 106 (5) ◽  
pp. 323-327 ◽  
Author(s):  
Robin C. Lenz ◽  
Darshan Nagesh ◽  
Hannah K. Park ◽  
John Grady
Keyword(s):  
Hallux Valgus ◽  
Frontal Plane ◽  
Metatarsal Head ◽  
Head Width ◽  
Plane Rotation ◽  
First Metatarsal ◽  
Significant Difference ◽  
Medial Eminence ◽  
And Control

Background: Resection of the medial eminence in hallux valgus surgery is common. True hypertrophy of the medial eminence in hallux valgus is debated. No studies have compared metatarsal head width in patients with hallux valgus and control patients. Methods: We reviewed 43 radiographs with hallux valgus and 27 without hallux valgus. We measured medial eminence width, first metatarsal head width, and first metatarsal shaft width in patients with and without radiographic hallux valgus. Results: Medial eminence width was 1.12 mm larger in patients with hallux valgus (P &lt; .0001). Metatarsal head width was 2.81 mm larger in patients with hallux valgus (P &lt; .001). Metatarsal shaft width showed no significant difference (P = .63). Conclusions: Metatarsal head width and medial eminence width are significantly larger on anteroposterior weightbearing radiographs in patients with hallux valgus. However, frontal plane rotation of the first metatarsal likely accounts for this difference.

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