First metatarsal length in hallux valgus surgery

NewsBot · Feb 7, 2021

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Planning tool for first metatarsal length in hallux valgus surgery
Stephan H Wirth et al
Foot (Edinb). 2021 Jan 14;46:101774

Background: The precise planning of metatarsal (MT) I length in hallux valgus surgery is important. However, currently no tool exists which allows the surgeon to reliably predict this parameter.

Methods: 30 virtual 3-dimensional hallux valgus surgeries were performed on varied deformation models based on cadaveric feet scans. The shortening of the first ray during distal metatarsal I osteotomy for different osteotomy angles were measured. An algebraic 2-dimensional calculation was done and compared to the results obtained from the 3-dimensional models.

Results: Inadvertent shortening of the first metatarsal bone can be as much as 8 mm depending on the amount of intermetatarsal angle (IMA) correction and osteotomy angle. Comparison of the 3 dimensional simulations and the 2 dimensional model resulted in a very strong correlation (R > 0.99 p < 0.00001). Based on our findings an anterior pointing osteotomy of approximately 10° is necessary to restore the length in distal metatarsal I hallux valgus surgery.

Conclusion: A slight misdirection of the osteotomy plane in distal hallux valgus surgery may result in relevant unwanted alterations in first metatarsal bone length and triangulation by eye is insufficient in this complex geometrical situation without appropriate planning. The present study provides surgeons a practical tool to plan and control the change of first metatarsal length during hallux valgus procedure through exact orientation of the osteotomy angle. If no alteration of length is intended, it may be generalized that an anterior direction of the cut relative to the second metatarsal bone will preserve the length of the first metatarsal bone.
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NewsBot · Jun 9, 2021

Influence of the length of the first and second metatarsal bone measured distal from Maestro line upon severity of hallux valgus deformity
Mirko Sovilj, Andreja Baljozović & Zoran Baščarević
Scientific Reports volume 11, Article number: 11539 (2021)

To examine the influence of the configuration of the first and second metatarsal (MT) bones on the development of hallux valgus deformity. To determine the extent to which the difference in the lengths of the first and second MT bones, measured distal to the Maestro line, contribute to the severity of the hallux valgus (HV) deformity defined by the size of the hallux valgus angle (HVA) and inter-metatarsal angle (IMA). On a sample of 319 feet with HV deformity the difference of measured lengths R = d (I MT) − d (II MT) was calculated The influence of differences (R) on the values of IMA and HVA as well as on the severity of deformities according to the formed groups was investigated. The influence of age on the development of deformities was examined separately as well as in conjunction with the determined difference in lengths. In 203 feet or 63.7%, a shorter MT bone was measured, while in 80 feet or 25.1% the first MT bone was longer than second ones and only in 36 feet or 11.3% there is no difference in the length of the 1st and 2ndMT bones distal to the Maestro line. A statistically significant correlation was found between the difference between the measured lengths of 1st and 2nd MT bones and IMA, while this correlation with HVA was not statistically significant. There is no statistically significant correlation or the effect of the difference in measured lengths (R) on the severity of hallux valgus deformity classified into three groups. A statistically significant correlation and impact of the age on the intensity of the deformity are established. A shorter 1st MT bone in correlation to the 2nd MT bone is accompanied by an increase in IMA and this correlation and impact are statistically significant. It was not established that there was a statistically significant influence of the length of the first and second metatarsal bone measured distal from Maestro line upon the values of HVA and severity of HV deformity. Age significantly contributes to the severity of the deformity.
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NewsBot · Apr 18, 2023

The relationship between hallux valgus and the first metatarsal length; a case-control study
Ersin Tasatan et al
Fuß & Sprunggelenk 15 April 2023

Background
The relationship between hallux valgus (HV) and the length of the first metatarsal in comparison to the second metatarsal is still debatable. This study aimed to describe a new metatarsal protrusion index and examine the relationship between the new index and HV deformity.

Materials and methods
This retrospective case-control study included 140 patients with symptomatic HV and 179 subjects without HV. The relative length of the first metatarsal in comparison to the second metatarsal was measured according to the method described by Hardy and Clapham by two independent observers. An index was calculated by proportioning the length difference between the first ray and the second ray to the length of the second ray. The values between the first and third quartiles in the control group were considered normal. Accordingly, subjects in the first quartile were classified as index plus, those in the second and third quartiles were classified as index plus-minus, and those in the fourth quartile were classified as index minus foot. The case and control groups were comparatively analyzed using the student’s t-test for continuous variables. The Chi-square test was used for the comparison of categorical data. Binary logistic regression was used to calculate the Odds ratio. A p-value of <0.05 was considered statistically significant.

Results
Age (p = 0.933), gender distribution (p = 0.314), and side (p: 0.473) were similar between the groups. Although first metatarsal length was significantly longer in the HV group (p: 0.002), the second metatarsal length was similar between groups (p: 0.592). The difference between the first and second metatarsals (p: 0.001) and the metatarsal protrusion index (p: 0.001) was higher in the HV group. According to the metatarsal formula, index plus foot type was significantly common in the HV group in both genders (p: 0.001 for both comparisons). Regression analysis showed that having an index-plus foot type increased the risk of having HV by 24.2 times compared to having an index-minus foot type (OR: 24.2, 95% CI: 9.01–64.94, p: 0.001, R2: 0.311).

Conclusion
The new metatarsal protrusion index is a useful method to classify the foot according to the metatarsal formula. This study revealed that the index plus foot type is a strong possible risk factor for HV.
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NewsBot · Jul 17, 2024

First metatarsal shortening after hallux valgus surgery: Benefits of treatment with distraction osteogenesis
Frans-Jozef Vandeputte et al
Foot (Edinb). 2024 Jun 27:60:102117

Introduction: Iatrogenic shortening and elevation of the first metatarsal (MT1) is a common complication of hallux valgus surgery, inducing metatarsalgia underneath the lesser rays, a reason for patient dissatisfaction. For resolving this problem, different types of revision surgery are described, of which lengthening MT1 by distraction osteogenesis is underreported and therefore undervalued.

Materials and methods: We present three cases with iatrogenic shortening after hallux valgus surgery treated by distraction osteogenesis of MT1 using a custom-made frame, made of Ilizarov equipment. To evaluate the amount of lengthening, the length of the first and second metatarsal (MT2) and the parabolic distribution of the metatarsal heads were compared before and after distraction. To evaluate correction in the sagittal plane, Meary's angle was measured pre- and post-lengthening. Pain was noted by a visual analogic score during follow-up.

Results: In our series of three cases, lengthening of MT1 between 7 mm and 18 mm, resulted in an improved parabolic distribution of the MT heads. The average difference between the second and first MT-head, relative to the SM4 axis (M2-M1) improved from 9.4 mm (± 0.9 mm) to 2.8 mm (± 0.7 mm) resolving corresponding pain in all patients. Meary's angle was normalized in one case. The average duration of treatment was 116 days (± 9 days). Minimal follow up was 11 years.

Conclusion: Using Ilizarov equipment for distraction osteogenesis of MT1 is a low-cost and effective method. Over time, this technique has proven its utility in pronounced iatrogenic shortening of MT1. The possibility to lengthen more than 1 cm, to correct in multiple planes, as well as early mobilization and weight bearing are additional advantages, but one must be careful to avoid overcorrection. The need for strict follow-up with multiple radiographs and rigorous patient selection is mandatory.
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NewsBot · Jul 31, 2024

The Effect of First Metatarsal Shortening and Sagittal Displacement on Forefoot Pressure in Minimally Invasive Hallux Valgus Correction
Andres Lopez et al
Foot Ankle Spec. 2024 Jul 26

Background: Minimally invasive (MIS) treatment of hallux valgus (HV) deformity is increasing in popularity. A 2-mm diameter burr is used to create a distal first metatarsal osteotomy prior to capital fragment translation and fixation. The metatarsal will shorten by the burr's diameter (2 mm). Plantar or dorsal capital fragment displacement may also cause load transference and possibly transfer metatarsalgia. The purpose of this study is to examine the effect of MIS HV on forefoot loading mechanics with respect to metatarsal shortening and sagittal plane displacement.

Methods: Four lower-limb cadaveric specimens were studied. A pedobarography pressure-sensing mat was used to record forefoot plantar pressure in a controlled weight-bearing stance position. Control and postosteotomy measurements were obtained with the capital fragment fixated in 3 possible positions: 0 mm, 5 mm dorsal, and 5 mm plantar displacement. Pedobarography data yielded pressure data within measurable graphical depictions. Raw mean contact pressure measurements were taken under the first and fourth metatarsal heads to establish medial and lateral forefoot loading pressure ratios. An a priori power analysis was performed based on previous peer-reviewed pedobarographic data, and our study was adequately powered.

Results: Around 40 measurements were recorded, and ratios of medial-to-lateral forefoot loading were constructed. Medial forefoot pressure control versus 0 mm displacement, and control versus dorsal displacement were not found to be statistically significant (p = 0.525, p = 0.55, respectively). Medial pressure significantly increased when comparing control versus plantar displacement (P = .006). Lateral pressure significantly increased with dorsal displacement of the osteotomy (P = .013).

Conclusion: Our study found that MIS HV correction did not cause an increase in lateral forefoot pressure loading when sagittal plane displacements were controlled. Plantar displacement increased medial loading, and dorsal displacement increased lateral loading. It may be valuable for surgeons to consider metatarsal head position postosteotomy, as a decrease in medial loading and subsequent increase in lateral loading may lead to lateral forefoot pain and transfer metatarsalgia.
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NewsBot · Nov 15, 2024

The difference in second – third metatarsal length is associated with the risk of dislocation or arthritic change in the second metatarsophalangeal joint in patients with hallux valgus
Dan Moriwaki et al
Journal of Orthopaedic Science; 11 November 2024

Background
Chronic mechanical stress on the second metatarsal head (2 MH) can be a risk factor for osteoarthritis (OA) and dislocation of the second metatarsophalangeal joint (2MTPJ) in hallux valgus (HV). This study aimed to investigate the stress distribution of the 2 MH in HV patients and determine the factors associated with dislocation and OA of the 2MTPJ.
Methods
In total, 115 feet with HV were retrospectively reviewed and divided into two groups: those with subluxation or dislocation of the 2MTPJ (group D, 27 feet) and those without (group N, 88 feet). The control group (group C) included 33 feet without HV. Group N was divided into OA and non-OA (NOA) groups according to the presence or absence of OA of the 2MTPJ. The Hounsfield Unit (HU) value of the subchondral bone of the 2 MH was measured on sagittal slices of the preoperative computed tomography images and divided by the HU value of the navicular region (HU ratio). The relationship between the HU ratios and radiographic parameters was compared.
Results
The HU ratios were significantly higher in group N than those in groups C and D. In group N, the protrusion of the second metatarsal relative to the third and fourth metatarsals (M2-M3, M2-M4) was positively correlated with the dorsal and central HU ratios, respectively. Group D had a significantly larger HV angle (HVA) and M2-M3 than group N. HVA, the first-second intermetatarsal angle, M2-M3, M2-M4, and dorsal and central HU ratios were significantly larger in the OA group than in the NOA group. The cutoff value of M2-M3 was 5.5 mm when comparing groups D and N, and 4.4 mm when comparing the OA and NOA groups.
Conclusions
Severe HV and a longer M2-M3 and M2-M4 may be associated with a high risk of dislocation and OA of the 2MTPJ.
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First metatarsal length in hallux valgus surgery

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First metatarsal length in hallux valgus surgery

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