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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