Metatarsus adductus and selected radiographic measurements of the first ray in normal feet

1992 ◽  
Vol 82 (12) ◽  
pp. 616-622 ◽  
Author(s):  
TA Griffiths ◽  
SJ Palladino
Keyword(s):  
Normal Values ◽  
Valgus Deformity ◽  
The Other ◽  
Radiographic Evaluation ◽  
Intermetatarsal Angle ◽  
Radiographic Measurements ◽  
First Ray ◽  
Metatarsus Adductus ◽  
Document Relationships

Radiographic evaluation of hallux abducto valgus frequently involves the measurement of the metatarsus adductus angle, first-second intermetatarsal angle, hallux abductus angle, and proximal articular set angle. While the concept that there is a relationship between untreated metatarsus adductus and hallux abducto valgus deformity is not new, a quantifiable relationship between the metatarsus adductus angle and intermetatarsal angle, hallux abductus angle, and the proximal articular set angle in normal feet is relatively undocumented. The purpose of this study is to document relationships between the metatarsus adductus angle and the other three measurements, and to establish normal values for the intermetatarsal angle, hallux abductus angle, and proximal articular set angle within metatarsus adductus angle subgroups.

Radiographic Measurements of the Affected and Unaffected Feet in Patients with Unilateral Hallux Limitus

2016 ◽  
Vol 106 (3) ◽  
pp. 172-181
Author(s):  
Andrew F. Knox ◽  
Alan R. Bryant
Keyword(s):  
Metatarsal Head ◽  
Radiographic Evaluation ◽  
Head Shape ◽  
Intrinsic Factors ◽  
Hallux Limitus ◽  
First Metatarsal ◽  
Radiographic Measurements ◽  
Angle Data ◽  
Significant Difference ◽  
First Ray

Background: Controversy exists regarding the structural and functional causes of hallux limitus, including metatarsus primus elevatus, a long first metatarsal, first-ray hypermobility, the shape of the first metatarsal head, and the presence of hallux interphalangeus. Some articles have reported on the radiographic evaluation of these measurements in feet affected by hallux limitus, but no study has directly compared the affected and unaffected feet in patients with unilateral hallux limitus. This case-control pilot study aimed to establish whether any such differences exist. Methods: Dorsoplantar and lateral weightbearing radiographs of both feet in 30 patients with unilateral hallux limitus were assessed for grade of disease, lateral intermetatarsal angle, metatarsal protrusion distance, plantar gapping at the first metatarsocuneiform joint, metatarsal head shape, and hallux abductus interphalangeus angle. Data analysis was performed using a statistical software program. Results: Mean radiographic measurements for affected and unaffected feet demonstrated that metatarsus primus elevatus, a short first metatarsal, first-ray hypermobility, a flat metatarsal head shape, and hallux interphalangeus were prevalent in both feet. There was no statistically significant difference between feet for any of the radiographic parameters measured (Mann-Whitney U tests, independent-samples t tests, and Pearson χ2 tests: P > .05). Conclusions: No significant differences exist in the presence of the structural risk factors examined between affected and unaffected feet in patients with unilateral hallux limitus. The influence of other intrinsic factors, including footedness and family history, should be investigated further.

Follow-up of the Isolated Medial Approach to Hallux Abducto Valgus Correction Without Interspace Release

2002 ◽  
Vol 92 (10) ◽  
pp. 555-562 ◽  
Author(s):  
Jeffrey S. Boberg ◽  
Molly S. Judge
Keyword(s):  
Metatarsophalangeal Joint ◽  
Valgus Deformity ◽  
Study Group ◽  
Entire Study ◽  
First Metatarsophalangeal Joint ◽  
Intermetatarsal Angle ◽  
Medial Approach ◽  
Average Decrease ◽  
First Ray

A retrospective radiographic review was performed of 29 patients (37 feet) who underwent an isolated medial approach for correction of hallux abducto valgus deformity from March 1993 to November 1998. Only those patients who had a traditional Austin-type osteotomy with a reducible first metatarsophalangeal joint and flexible first ray were included in the study. The average follow-up period for the entire study group was 18.4 months, with 13 patients (44.83%; 17 feet) having a follow-up period of longer than 2 years. The average decrease in the intermetatarsal angle was 9.89°, and the average decrease in the hallux abductus angle was 14.0°, results that correlated well with those of other studies on correction of hallux abducto valgus. No clinical or radiographic recurrence of hallux abducto valgus was noted throughout the follow-up period. The authors believe that an isolated medial approach to hallux abducto valgus correction without a lateral interspace release yields predictable results when performed in appropriately selected patients. (J Am Podiatr Med Assoc 92(10): 555-562, 2002)

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.

scholarly journals Shortening of first metatarsalia after ReveL procedure depends on the osteotomy angle

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0003
Author(s):  
Arnd Viehöfer ◽  
Stephan Wirth ◽  
Felix Waibel ◽  
Philipp Fürnstahl
Keyword(s):  
Hallux Valgus ◽  
Valgus Deformity ◽  
Clinical Impact ◽  
Ct Scans ◽  
Dimensional Model ◽  
Intermetatarsal Angle ◽  
3 Dimensional ◽  
Hallux Valgus Deformity ◽  
First Ray ◽  
Severe Hallux Valgus

Category: Midfoot/Forefoot Introduction/Purpose: Recent studies have shown that Hallux valgus deformity can lead to transfermetatarsalgia due to an impairment and relative shortening of the first ray. During ReveL osteotomy the relative shortening of the MT I is not addressed. Furthermore, a posterior deviation of the osteotomy angle results in additional iatrogenic shortening of the MT I and might favor postoperative transfermetatarsalgia. Methods: A 3-dimensional model of a foot was obtained from CT scans of a cadaveric foot. The MT I of the 3-dimensional model was then pivoted medially to simulate a severe hallux valgus deformity of an intermetatarsal angle (IMA) of 18° and an intermediate hallux valgus deformity of an IMA of 13°. A ReveL operation was simulated to correct the IMA to 8° for the severe and the intermediate Hallux valgus. Therefore the osteotomy angle in the coronal plane (f=0) was chosen perpendicular to the axis of the second metatarsalia. Afterwards the length of MT I was measured. This procedure was repeated for an posterior altered osteotomy angle (f = 5°,10°, 15° and 20°). Results: The change in MT I length resulting from an osteotomy perpendicular to the axis of MT II was 0.6 mm for a severe hallux valgus (IMA correction from 18° to IMA 8°) and 0.3 mm for a moderate hallux valgus (IMA 13° to IMA 8°). A posterior deviation of the osteotomy angle led to additional shortening (max. 2.9 mm) with a total shortening of up to 3.5 mm (Figure 3). To avoid any shortening of MT I an osteotomy slightly pointing anterior (negative f) of 3.5° (IMA change of 10°) and 3° (IMA change of 5°) was found. Conclusion: ReveL procedure led only to a maximum shortening of 3.5 mm for a posterior deviation of 20°. Considering recently described MT I length cut off values of 2-3 mm for avoiding transfermetatarsalgia the osteotomy should be performed within an anterior directed cut angle of 4° and a posterior directed cut angle of 10° for the correction of a severe hallux valgus. However, further studies are needed to investigate the clinical impact of our findings.

scholarly journals A Comparison of First Ray Length and Dorsiflexion after Arthrodesis, Osteotomy and Suture Button Procedures for Hallux Valgus Deformity

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0021
Author(s):  
Ian Foran ◽  
Nasima Mehraban ◽  
Stephen K. Jacobsen ◽  
Daniel D. Bohl ◽  
Johnny L. Lin ◽  
...  
Keyword(s):  
Hallux Valgus ◽  
Valgus Deformity ◽  
Wedge Osteotomy ◽  
Treatment Groups ◽  
Suture Button ◽  
Hallux Valgus Deformity ◽  
Radiographic Measurements ◽  
Valgus Angle ◽  
First Ray ◽  
Postoperative Symptoms

Category: Bunion; Lesser Toes; Midfoot/Forefoot Introduction/Purpose: Shortening and dorsiflexion of the first metatarsal are a known side effect of metatarsal osteotomies for hallux valgus (HV) deformity with the potential to cause transfer metatarsalgia. We compared the effect of the first tarsometatarsal joint arthrodesis (Lapidus), proximal lateral closing wedge osteotomy (PLCWO), and intermetatarsal suture button fixation procedures on the length and dorsiflexion of the first ray. Methods: We retrospectively evaluated 123 feet in 115 patients. The average age was 54. There were 106 females. Eighty-four feet had a Lapidus procedure, 14 had a PLCWO, and 24 had intermetatarsal suture button fixation. Digital radiographic measurements were made for pre- and postoperative hallux valgus angle (HVA) and intermetatarsal angle (IMA), absolute and relative shortening of the first ray, and dorsiflexion. Results: Preoperative HVA and IMA did not differ between treatment groups (p>0.05 for each). Similar corrections of HVA (30.1 to 12.3 degrees) and IMA (14.7 to 7.0 degrees) were achieved in all three groups (p>0.05). There were significant differences in absolute first-cuneiform-metatarsal length (FCML) between Lapidus (-1.5mm), PLCWO (-2.5mm), and intermetatarsal suture button fixation (+1.1mm) (p<0.05). There were also significant differences in relative 1st metatarsal shortening between Lapidus (0.32mm relative lengthening), PLCWO (1.05mm relative shortening), and intermetatarsal suture button fixation (1.24mm lengthening) (p<0.05). Average dorsiflexion differed between the Lapidus (1.95 degrees) and PLCWO groups (0.49 degrees) (p<0.05). Conclusion: The use of the intermetatarsal suture button fixation relatively lengthens the first ray, whereas the Lapidus and PLCWO shorten it. Dorsiflexion may be higher with Lapidus and osteotomy procedures. These findings may be helpful to explain postoperative symptoms of metatarsalgia and for the surgeon’s selection of the appropriate surgical technique for preoperative planning. [Table: see text]

Metatarsus Adductus Angle in Male and Female Feet

2008 ◽  
Vol 98 (5) ◽  
pp. 364-369 ◽  
Author(s):  
Gabriel Domínguez ◽  
Pedro V. Munuera
Keyword(s):  
Normal Values ◽  
Measurement Techniques ◽  
Mean Value ◽  
Reference Points ◽  
The Other ◽  
Radiographic Images ◽  
Male And Female ◽  
Mean Values ◽  
Metatarsus Adductus ◽  
Comparison Of The Results

Background: The literature contains several techniques for calculating metatarsal adductus angle. Most common systems use the fourth metatarsal cuboid joint and the fifth metatarsal cuboid joint. Although both systems are quite different, normal values of metatarsus adductus angle have not been established with each system of measurement. Methods: Two hundred six radiographic images of feet in dorsoplantar projection were used to measure the metatarsus adductus angle using two different reference points: the joint between the fourth metatarsal and the cuboid and the joint between the fifth metatarsal and the cuboid. Results: Comparison of the results of the two measurement techniques showed significant differences (P &lt; .05). The values of the metatarsus adductus angle also showed significant differences in men versus women (P &lt; .05). The reliability of the measurements was checked by using an intra- and inter-evaluator test performed by two evaluators. Conclusion: Data showed the reliability of both systems of measurement, although significant differences in the metatarsal adductus angle mean value were found using these systems of measurement in the same foot. On the other hand, significant differences were found in mean values of metatarsus adductus angle between male and female feet. (J Am Podiatr Med Assoc 98(5): 364–369, 2008)

Plantar Pressure and Radiographic Changes to the Forefoot After the Austin Bunionectomy

2005 ◽  
Vol 95 (4) ◽  
pp. 357-365 ◽  
Author(s):  
Alan R. Bryant ◽  
Paul Tinley ◽  
Joan H. Cole
Keyword(s):  
Hallux Valgus ◽  
Plantar Pressure ◽  
Peak Pressure ◽  
Normal Values ◽  
Valgus Deformity ◽  
Pressure Measurements ◽  
First Metatarsal ◽  
Plantar Pressure Distribution ◽  
Hallux Valgus Deformity ◽  
Radiographic Measurements

We describe the effects of the Austin bunionectomy on plantar pressure distribution and radiographic measurements in the forefoot in 31 subjects (44 feet) with mild-to-moderate hallux valgus deformity and 36 control subjects (36 feet). Plantar pressure measurements before and 24 months after surgery showed peak pressure beneath the hallux reduced to normal values. Peak pressure measurements beneath the first, second, and third metatarsal heads in hallux valgus feet were relatively unchanged after surgery and remained higher than normal values. The operation produced significant decreases in mean preoperative radiographic measurements of hallux abductus, metatarsus primus varus, and first metatarsal protrusion distance in these patients to below-normal values. (J Am Podiatr Med Assoc 95(4): 357–365, 2005)

scholarly journals Intermetatarsal Angle and Hallux Abductus Angle Reduction After First Metatarsophalangeal Joint Arthrodesis in Mild, Moderate, and Severe Hallux Valgus

2021 ◽  
Vol 111 (2) ◽  
Author(s):  
Kimberly S. Cravey ◽  
Ian M. Barron ◽  
Said A. Atway ◽  
Michael L. Anthony ◽  
Erik K. Monson
Keyword(s):  
Hallux Valgus ◽  
Metatarsophalangeal Joint ◽  
Valgus Deformity ◽  
First Metatarsophalangeal Joint ◽  
Intermetatarsal Angle ◽  
Hallux Valgus Deformity ◽  
First Ray ◽  
Severe Hallux Valgus ◽  
Preoperative Deformity

Background First metatarsophalangeal joint fusion is a commonly used procedure for treating many pathologic disorders of the first ray. Historically, hallux valgus deformity with severely increased intermetatarsal angle or metatarsus primus adductus indicated need for a proximal metatarsal procedure. However, the effectiveness and reliability of first metatarsophalangeal joint arthrodesis in reducing the intermetatarsal angle has been increasingly described in the literature. We compared findings at our institution with current literature for further validation of this well-accepted procedure in correcting hallux valgus deformity with high intermetatarsal angle. Methods Weightbearing preoperative and postoperative radiographs of 43 patients, 31 women and 12 men, meeting the inclusion and exclusion criteria were identified. Two independent investigators measured the hallux abductus and intermetatarsal angles. Preoperative and postoperative measurements for each angle were compared and average reduction calculated. The data were further analyzed by grouping deformities as mild, moderate, and severe. Mean follow-up was 10 months. Results The overall mean preoperative intermetatarsal and hallux abductus angles decreased significantly (from 13.09° to 9.33° and from 23.72° to 12.19°, respectively; both P &lt; .01). When grouping deformities as mild, moderate, and severe, all of the categories maintained reduction of intermetatarsal and hallux abductus angles (P &lt; .01). Furthermore, the mean reduction of the intermetatarsal and hallux abductus angles seemed to correlate with preoperative deformity severity. Conclusions In patients undergoing correction of hallux valgus deformity, first metatarsophalangeal joint arthrodesis produced consistent reductions in the intermetatarsal and hallux abductus angles. Furthermore, these findings are consistent with those reported by other institutions.

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

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0000
Author(s):  
Sangho Chun ◽  
Soon-Sun Kwon ◽  
Kyoung min Lee ◽  
Moon Seok Park ◽  
Ki Hyuk Sung ◽  
...  
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, Midfoot/Forefoot 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.

Normative Distribution of First Metatarsal Axial Rotation

2021 ◽  
pp. 107110072110010
Author(s):  
Jesse Steadman ◽  
Neil Bakshi ◽  
Christopher Arena ◽  
Richard Leake ◽  
Alexej Barg ◽  
...  
Keyword(s):  
Plain Radiograph ◽  
Axial Rotation ◽  
Valgus Deformity ◽  
Intraobserver Reliability ◽  
Foot Deformities ◽  
Level Of Evidence ◽  
Mean Values ◽  
First Metatarsal ◽  
Hallux Valgus Deformity ◽  
First Ray

Background: First metatarsal (M1) axial rotation is recognized as a clinically relevant component of hallux valgus deformity. Methods to realign the M1 in 3 dimensions have been developed. One goal of these operations is to restore normal rotation of the first ray. The aim of this study is to provide estimates for the normal distribution of M1 rotation in patients without relevant anatomic pathology. Methods: Using stringent clinical and radiographic criteria, we evaluated a set of plain radiograph and weightbearing computed tomography (WBCT) images of 62 feet from a consecutive patient database. Subjects included had normal foot alignment without bunion symptoms. M1 rotation of each foot was measured using 2 unique methods (Saltzman et al and Kim et al methods). Measurement of rotation was performed by 2 observers from coronal WBCT images. Mean values and confidence intervals (CIs) of M1 rotation were calculated for each method. Inter- and intraobserver reliability values were also reported. Results: Mean M1 rotation values of 2.1 degrees (95% CI: 0.9-3.4) and 6.1 degrees (95% CI: 4.4-7.8) were identified using the Saltzman et al and Kim et al methods, respectively. Inter- and intraobserver reliability values were interpreted as excellent for both methods. Conclusion: In this study, we describe the natural distribution of the M1 axial rotation in subjects without bunion or other identifiable bony foot deformities. This information should provide a normative reference for surgeons correcting rotational issues of the first metatarsal. Level of Evidence: Level III.

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