First Metatarsophalangeal Head Morphology --> Hallux Rigidus or Hallux Valgus

NewsBot · May 17, 2017

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Quantitative Relationship Of First Metatarsophalangeal Head Morphology To Hallux Rigidus And Hallux Valgus
James D. Michelson, et al
Foot and Ankle Surgery; Article in Press

Highlights
•Hallux rigidus metatarsal heads are quantitatively flatter than in hallux valgus.
•Hallux rigidus metatarsal heads are less circular than in hallux valgus.
•The measured differences are similar to subjective classifications.
•The less circular hallux rigidus heads have a chevron shape.
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Background
Previous qualitative studies have linked first metatarsal head morphology with hallux valgus (HV) and hallux rigidus (HR). This study used a quantitative measurement of 1st MT radius of curvature to assess if HR MT heads were flatter than HV heads.

Methods
Weight bearing foot films were used in HV, HR, and normal patients (no forefoot complaints) to measure the metatarsal head radius of curvature (normalized by dividing the radius of curvature by the first metatarsal length to adjust for magnification and foot size).

Results
Radiographs from 299 feet were analyzed (105 normal, 57 HR, and 137 HV). The mean normalized radius of curvature was smaller in HV than HR, with normal feet in between (p<.05 for all comparisons). Metatarsal head curvature did not vary with age, weight, or BMI.

Conclusion
These quantitative measurements are consistent with qualitative observations, validating the use of subjective metatarsal head morphology assessments.
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NewsBot · Aug 3, 2017

An Imaged-Based Three-Dimensional Study of First Metatarsal Protrusion Distance in Women With and Without Hallux Valgus.
Ward M Glasoe, Michael W Rodriguez, and Kara E Pioske
Journal of the American Podiatric Medical Association In-Press.

BACKGROUND:First metatarsal protrusion distance (MPD) has been commonly studied as a characteristic of hallux valgus deformity. To date, the majority of investigations have used radiographic methods, with most reporting first metatarsal (ray) protrusion to be associated with deformity. As an alternative, this study used a three dimensional (3D) image acquisition and data analysis method to quantify MPD.

METHODS: Magnetic resonance images were acquired in weightbearing on 29 women (19 with hallux valgus; 10 controls). After the 3D images were reconstructed into virtual bone models, two examiners measured MPD in relation to the navicular. In addition to a reliability analysis, a t-test assessed for group differences in demographics, foot posture (hallux valgus, intermetatarsal angles), and MPD.

RESULTS: Group demographics were not different, while measures of hallux valgus and intermetatarsal angles were different (P < 0.01) between groups. The measurement of MPD was highly reliable (ICC {greater than or equal to} 0.99; SEM {less than or equal to} 0.78 mm). Metatarsal protrusion averaged approximately -2.0 mm in both groups. There was no statistical group difference (P = 0.89) in MPD.

CONCLUSIONS: The reconstructed image datasets captured the 3D spatial relationship of the anatomy. Measurements of MPD were reliable. The first ray measured 2 mm shorter than the second ray in both the hallux valgus and control groups. Though unexpected, this result may prompt future study of the pathokinematics associated with hallux valgus that include the quantification of metatarsal protrusion with 3D methods, instead of relying solely on single plane radiograph reports.
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NewsBot · Dec 25, 2018

Morphology of the first metatarsal head as a risk factor for hallux valgus interphalangeus
Stephanus Johannesvan et al
Foot and Ankle Surgery; 24 December 2018

Highlights
•First metatarsal head articular morphology is proposed as a risk factor for hallux valgus interphalangeus.
•Foot radiographs are used for required angular and linear measurements.
•Metatarsal head shape is defined as round, flat or chevron.
•Distinction between round and flat is made upon the calculated radius of the curvature of the head.
•There was no statistically significant relationship between first metatarsal head shape and the frequency of HVI.
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Introduction
The aetiology of hallux valgus interphalangeus (HVI) is not well understood. First metatarsophalangeal joint stability, influenced by first metatarsal head shape, may be linked to HVI. We hypothesised that first metatarsal head shape is a risk factor for HVI. No published article could be found in the literature investigating this hypothesis.

Methods
127 standardised foot radiographs were analysed retrospectively. The hallux valgus angle (HVA) and interphalangeus angle (IPA) were measured. The first metatarsal head shape was divided into chevron, round and flat groups. Statistical analysis was then performed to investigate the relationship between first metatarsal head shape and the occurrence of HVI.

Results
There was no statistically significant relationship between first metatarsal head shape and the occurrence of HVI. There was however a negative relationship between HVA and HVI.

Conclusion
The morphology of the first metatarsal head does not seem to be a risk factor for HVI. A known negative relationship between HVA and IPA is reinforced.
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NewsBot · Dec 27, 2018

Triplanar Quantitative Radiographic Analysis of the First Metatarsal-Phalangeal Joint in the Hallux Abductovalgus Deformity.
Hasenstein T Meyr AJ
J Foot Ankle Surg. 2019 Jan;58(1):66-74

Although hallux abductovalgus (HAV) is widely considered to be a triplanar deformity involving the transverse, sagittal, and frontal planes, most of the published literature has focused on evaluating the deformity in only the transverse plane, and we are unaware of any investigation objectively evaluating the relationship among the 3 planes in the setting of HAV deformity. The objective of this investigation was to quantitatively evaluate radiographic measurement of the relationship between the transverse, sagittal, and frontal planes in the HAV deformity. Anteroposterior, lateral, and sesamoid axial radiographs from 42 consecutive feet were evaluated with measurement of the first intermetatarsal angle, hallux abductus angle, metatarsal sesamoid position, first metatarsal inclination angle, sesamoid rotation angle, and tibial sesamoid grade. Variables were graphically depicted against each other on frequency scatter plots with calculation of a regression line and Pearson's correlation coefficient. As transverse plane deformity increased, the frontal plane deformity also tended to increase and the first metatarsal inclination angle tended to decrease. And as frontal plane deformity increased, the first metatarsal inclination angle tended to decrease. To our knowledge, these are the first quantitative and objective data in support of a triplanar component to the HAV deformity, and we believe this reinforces the evaluation of this deformity with emphasis on all 3 planes.
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NewsBot · Jul 23, 2019

The shape of the first metatarsal head and its association with the presence of sesamoid-metatarsal joint osteoarthritis and the pronation angle.
Ono Y et al
J Orthop Sci. 2019 Jul 17

BACKGROUND:
The purpose of this study was to evaluate the associations of the shape of the first metatarsal head with (1) the presence of osteoarthritis in the sesamoid-metatarsal joint and (2) the pronation angle of the first metatarsal head on foot radiographs.

METHODS:
A total of 121 patients, with the mean age of 61 years, underwent weight-bearing dorsoplantar, lateral, and first metatarsal axial radiographs. The shape of the first metatarsal head's lateral edge was classified as either rounded, intermediate, or angular in shape in the dorsoplantar view. The presence of osteoarthritis in the sesamoid-metatarsal joint and the pronation angle of the first metatarsal head were assessed in the first metatarsal axial view. Other variables that could affect the first metatarsal shape, including the lateral first metatarsal inclination angle, were also assessed. Univariate and multivariate analyses were performed to determine the associations.

RESULTS:
The prevalence of sesamoid-metatarsal osteoarthritis was significantly higher (77%, 27%, and 29% for rounded, intermediate, and angular, respectively, P < .001), and the metatarsal pronation angle was significantly larger (14°, 8°, and 4° for rounded, intermediate, and angular, respectively, P < .001) in feet with a rounded metatarsal head. These associations were also significant in the multiple regression analysis.

CONCLUSION:
A rounded metatarsal head was associated with a higher prevalence of osteoarthritis within the sesamoid-metatarsal joint, as well as a larger first metatarsal head pronation angle. A negative round sign can be used as a simple indicator of an effective correction to the first metatarsal pronation angle during hallux valgus surgery. However, in feet with sesamoid-metatarsal osteoarthritis, surgeons will need to be cautious as overcorrection may occur.
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NewsBot · Aug 2, 2020

Effect of Metatarsal Head Shape on the Development of Hallux Valgus Deformity: 10 Years of Natural Follow-up
Ulunay Kanatli, Onur Unal, Muhammet Baybars Ataoglu, Tacettin Ayanoglu, Mustafa Ozer, Mehmet Cetinkaya
J Am Podiatr Med Assoc. 2020 May 1;110(3)

Background: We investigated the role of first metatarsal head shape in the etiology of hallux valgus. By pedobarographic analysis, we evaluated whether first metatarsal head shape causes an alteration in plantar pressure values that would result in metatarsalgia.

Methods: Referrals to our clinic for metatarsalgia, plantar fasciitis, and calcaneal spur were scanned retrospectively. Patients with severe hallux valgus, pes planus, gastrocnemius stiffness, generalized joint laxity, neuromuscular disease, or a history of lower-extremity orthopedic surgery were excluded. Sixty-two patients with plantar pressure assessment and radiographic evaluation were included. These patients were invited for reassessment after 10 years. Feet were divided into three groups by metatarsal head shape: round, square, and chevron. On anteroposterior radiographs, the hallux valgus and intermetatarsal angles, relative first metatarsal length, lateral sesamoid subluxation, and presence of bipartite sesamoid were noted. Plantar pressure was assessed with pedobarography.

Results: Feet with round-shaped first metatarsal heads had a statistically significantly greater progression in hallux valgus angle than the other shapes. Plantar pressures under the first, second and third, and fourth and fifth metatarsals increased with time. This can explain the mechanism of transfer metatarsalgia and painful callosities under the first metatarsal in hallux valgus. There was no correlation between hallux valgus angle, relative metatarsal length, and lateral sesamoid subluxation.

Conclusions: We found a strong relation between round-shaped first metatarsal head and hallux valgus angle progression. No patients had a risk factor responsible for hallux valgus. In other words, this study gives approximately 10-year natural history results in nearly normal feet.
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NewsBot · Aug 9, 2020

Radiographic Analysis on the Distortion of the Anatomy of First Metatarsal Head in Dorsoplantar Projection
Jessica Grande-Del-Arco et al
Diagnostics (Basel). 2020 Aug 2;10(8):E552

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.
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NewsBot · Apr 26, 2021

Abnormalities in distal first metatarsal joint surface orientation: Distal Metatarsal Articular Angle and Distal Metatarsal-2 Articular Angle
Manon Bolzinger et al
Orthop Traumatol Surg Res. 2021 Apr 22

Background: Hallux valgus (HV) in adults is an acquired pathology related to 1st metatarsal (M1) abduction. In children, it is related to abnormal M1 joint surface orientation.

Hypothesis: HV deformities in children and adults differ.

Objective: Descriptive study of radiologic abnormalities in a pediatric population of symptomatic HV, with comparison to a population without symptomatic HV.

Materials and methods: Weight-bearing X-rays were studied in pediatric patients undergoing surgery for HV and in a control population. Measurements comprised M1P1, M1M2, DMAA, DM2AA, MPAA, and sesamoid subluxation index.

Results: 25 patients (42 feet) were included in the HV group, and 16 patients (29 feet) in the control group. Mean age was 13 years in both. Interobserver reproducibility was excellent for M1P1, and good for M1M2, DMAA and DM2AA. In HV, 71% of feet showed M1M2 angle >12° and 98% DMAA >10°; DM2AA was >0°, except in 1 foot.

Discussion: Normal values are the same in children and adults: M1P1 <15°, DMAA <10° and M1M2 <12°. In the HV group, DMAA was systematically pathological, while M1M2 was pathological in only 71% of cases. Childhood HV is related to abnormal DMAA, sometimes associated with increased M1M2 angle, especially in severe forms. DM2AA assesses distal M1 joint surface orientation with respect to the M2 axis; in the HV group, it was systematically >0° (except in 1 foot). Thus, in case of concomitant DMAA and M1M2 abnormalities, DMAA is more severely abnormal than M1M2 (DM2AA=DMAA-M1M2).

Conclusion: Childhood HV is mainly due to abnormal M1 joint surface orientation, sometimes associated with increased 1st metatarsal abduction. DM2AA reflects the balance between 1st metatarsal abduction and M1 joint surface orientation abnormality.
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NewsBot · Nov 26, 2021

Distal Metatarsal Articular Angle in Hallux Valgus Deformity. Fact or Fiction? A 3-Dimensional Weightbearing CT Assessment
Matthieu Lalevée, MD, Nacime Salomao Barbachan Mansur, MD, PhD, Hee Young Lee, MD, ...
Foot & Ankle International November 13, 2021

Background
The Distal Metatarsal Articular Angle (DMAA) was previously described as an increase in valgus deformity of the distal articular surface of the first metatarsal (M1) in hallux valgus (HV). Several studies have reported poor reliability of this measurement. Some authors have even called into question its existence and consider it to be the consequence of M1 pronation resulting in projection of the round-shaped lateral edge of M1 head.

Our study aimed to compare the DMAA in HV and control populations, before and after computer correction of M1 pronation and plantarflexion with a dedicated weightbearing CT (WBCT) software. We hypothesized that after computerized correction, DMAA will not be increased in HV compared to controls.

Methods:
We performed a retrospective case-control study including 36 HV and 20 control feet. In both groups, DMAA was measured as initially described on conventional radiographs (XR-DMAA) and WBCT by measuring the angle between the distal articular surface and the longitudinal axis of M1. Then, the DMAA was measured after computerized correction of M1 plantarflexion and coronal plane rotation using the α angle (3d-DMAA).

Results:
The XR-DMAA and the 3d-DMAA showed higher significant mean values in HV group compared to controls (respectively 25.9 ± 7.3 vs 7.6 ± 4.2 degrees, P < .001, and 11.9 ± 4.9 vs 3.3 ± 2.9 degrees, P < .001).

Comparing a small subset of precorrected juvenile HV (n=8) and nonjuvenile HV (n=28) demonstrated no significant difference in the measure DMAA values. On the other hand, the α angle was significantly higher in the juvenile HV group (21.6 ± 9.9 and 11.4 ± 3.7 degrees; P = .0046).

Conclusion:
Although the valgus deformity of M1 distal articular surface in HV is overestimated on conventional radiographs, comparing to controls showed that an 8.6 degrees increase remained after confounding factors’ correction.

Clinical Relevance:
After pronation computerized correction, an increase in valgus of M1 distal articular surface was still present in HV compared to controls.
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NewsBot · Feb 9, 2022

Imaging Findings and First Metatarsal Rotation in Hallux Valgus
Ali-Asgar Najefi et al
Foot Ankle Int. 2022 Feb 8

Background: Failure to identify and correct malrotation of the first metatarsal may lead to recurrent hallux valgus deformity. We aimed to identify the proportion of hallux valgus patients with increased first metatarsal pronation using weightbearing computed tomography (WBCT) and to identify the relationship with conventional radiographic measurements.

Methods: WBCT scans were analyzed for 102 feet with a hallux valgus angle (HVA) and intermetatarsal angle (IMA) greater than or equal to 16 and 9 degrees, respectively. Metatarsal pronation angle (MPA), alpha angle, sesamoid rotation angle (SRA), and sesamoid position were measured on standardized coronal WBCT slices. Pronation was recorded as positive. Hindfoot alignment angle (HAA) was assessed using dedicated software. Pearson correlation and multiple regression analyses were used to assess differences between groups.

Results: Mean HVA was 29.8±9.4 degrees and mean IMA was 14.1±3.7 degrees. Mean MPA was 11.9±5.8 (range 0-26) degrees and mean alpha angle was 11.9±6.8 (range -3 to 29) degrees. In a previous study, we demonstrated the upper limit of normal MPA as 16 degrees and alpha angle as 18 degrees. Based on these criteria, we identified abnormal metatarsal pronation in 32 feet (31.4%). We found a strong positive correlation between SRA and HVA/IMA (R = 0.67/0.60, respectively, P < .001). IMA and HAA weakly correlated with MPA and alpha angle (IMA: R = 0.26/0.27, respectively, P < .01; HAA: R = 0.26/0.27, respectively, P < .01). Regression analyses suggested that increasing IMA was the most significant radiographic predictor of increased pronation. In this cohort, there was no correlation between HVA or sesamoid position and MPA / alpha angle (HVA: P = .36/.12, respectively, sesamoid position, P = .86/.77, respectively).

Conclusion: In this cohort of 102 feet that met plain radiographic criteria for hallux valgus deformity, first metatarsal pronation was found abnormal in 31.4% of patients. We found a weak association between the IMA and hindfoot valgus, but not the HVA.
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NewsBot · Aug 5, 2022

Proximal to distal phalangeal articular angle of the first proximal phalanx: Reliability and correlation with round sign
BerndLutzThomasKappeHeikoReichelRitaTaurman
Foot and Ankle Surgery 4 August 2022

Background
To reduce the rate of correction loss in hallux valgus surgery, a proximal to distal phalangeal articular angle (PDPAA) of the proximal phalanx of the greater toe of > 8° is considered an indication for a combined Akin and Chevron osteotomy. The PDPAA is measured between the articular surfaces of the proximal phalanx of the greater toe. Viewed from a sagittal perspective, the joint surfaces are not perpendicular aligned to the phalanx axis. Therefore, the PDPAA might be confounded by pronation. This study aims to, first, evaluate the intra- and interobserver reliability of the PDPAA and, second, to analyze the correlation to first ray pronation.

Methods
In a consecutive series of 59 feet who underwent hallux valgus (HV) surgery, PDPAA, round sign and other angles were measured on weight-bearing radiographs pre- and postoperatively. After power analysis, the intraclass correlation coefficient (ICC) was used to calculate the intra- and interobserver reliability. The correlation of PDPAA with the round sign as well as angles defining the HV and the Hallux valgus interphalangeus (HVI) were evaluated.

Results
The PDPAA showed an excellent intra- and interobserver reliability (ICC 0.92 and 0.89, p < 0.05). The round sign did not correlate significantly with the PDPAA (p = 0.51). However, the PDPAA showed a moderate correlation with the interphalangeal angle (r = 0.51, p < 0.05) and fair inversely with the intermetatarsal angle (r = -0.45, p < 0.05).

Conclusion
First, measurement of PDPAA is reliable. Second, PDPAA is not associated with first ray pronation, but a false low PDPAA is geometrically possible. A high PDPAA correlates with a relevant HVI and inversely correlates with the HV like the HVI. Hence, first ray pronation should be treated first and a remaining PDPAA of > 8° after intraoperatively reevaluation separately.
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Rob Kidd · Aug 5, 2022

And yet again the world runs away from serious thinking. Metatarsal head shape: cause of, or caused by? Very basic thinking recognises that bone remodels in response to abnormal stresses, just on a time scale greater than soft tissue.

NewsBot · Feb 7, 2023

Multiple Factors Contributing to the Metatarsal Head Eversion in Hallux Valgus Deformity. A Prospective Study Using Weight-Bearing CT
Jill S. Kawale et al
The Foot; 2 February 2023, 101965

Highlights
•Not all patients will benefit from surgical de-rotation of the first metatarsal.
•Multiple factors appear to contribute to first metatarsal eversion in hallux valgus.
•Metatarsal torsion can be a significant influence on overall metatarsal eversion.
•De-rotational osteotomies may be preferred over the triplane Lapidus arthrodesis.
•Frontal plane sesamoid displacement can be measured via use of a novel CT angle.
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Purpose
Recently first tarsometatarsal arthrodesis for hallux abducto valgus (HAV) has been advocated as the sole procedure to correct the multiplanar components of the deformity. However, recent debate suggests other factors such as rearfoot pronation and metatarsal torsion affect frontal plane metatarsal eversion and sesamoid positioning. Using weight-bearing CT, 12 feet (12 subjects) with HAV deformities were placed in positions of maximum rearfoot pronation and supination in order to study the effects on metatarsal eversion, sesamoid rotation/displacement, and secondarily the influence of first metatarsal torsion. Sesamoid displacement was quantified by the novel use of the sesamoid displacement angle.

Principle Results
Although first metatarsal eversion was nearly double in the pronated versus supinated foot, the difference was not statistically significant. Therefore, the bulk of first metatarsal eversion was not secondary to rearfoot eversion. Conversely, a significant positive correlation was found between metatarsal torsion and metatarsal head eversion angles in both supinated and pronated foot positions, with the strongest correlation with rearfoot pronation. Finally, significant increases in sesamoid displacement angles were noted with pronation.

Major Conclusions
The findings of the present study support the contention that multiple factors are associated with frontal plane first metatarsal eversion and sesamoid displacement. Weight-bearing CT scanning can be used to effectively evaluate the frontal plane components in HAV deformities. The sesamoid displacement angle appears to be a useful adjunct to evaluating the hallucal sesamoids. For surgical correction of the deformity, consideration should be given to pre-operative weight-bearing CT evaluation of the foot. This can illuminate the effects of rearfoot/medial column pronation and the potential influence of metatarsal torsion on the frontal plane components of this triplane deformity. In this way the potential for post-operative HAV recurrence can be minimized.
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NewsBot · Sep 14, 2023

Evaluate the Influencing Factors of Congruency of the First Metatarsophalangeal Joint in Hallux Valgus Based on Weight-bearing CT
Chao Wang, MD et al
Source

The purpose of this study was to explore the difference between congruency and incongruency of the first metatarsophalangeal (MTP) joint in hallux valgus using weight-bearing CT (WBCT) and to identify the risk factors for incongruency. From January 2019 to January 2021, WBCT scans were retrospectively analyzed for 110 (191 feet) consecutive patients. According to whether the metatarsal articular surface and phalanx articular surface were parallel, they were divided into congruency (73 feet) and incongruency groups (118 feet). The age, intermetatarsal angle (IMA), hallux valgus angle (HVA), distal metatarsal articular surface angle (DMAA), first metatarsal coronal pronation angle (α angle), tibial sesamoid 7 positions (TSP), and tibial sesamoid coronal grading (TSCG) were compared between the two groups. Binary logistic regression was used to analyze the influencing factors of incongruency. Receiver operating characteristic (ROC) curve analysis was applied to determine the cutoff value. There were significant differences in IMA, HVA, DMAA, α angle, age, TSP, and TSCG between congruency and incongruency groups (P<0.05). Binary logistic regression analysis showed that TSCG, HVA, α angle were the influencing factors of incongruency. ROC curve analysis demonstrated that the cutoff values for incongruency were 1 position for TSCG (sensitivity:0.835; specificity:0.884) with the area under curve (AUC) of 0.892, 30˚ (sensitivity:0.795; specificity:0.812) for HVA with the AUC of 0.878, and 24° (sensitivity:0.530; specificity:0.797) for α angle with the AUC of 0.686. Incongruency of the first MTP joint indicated a more severe hallux valgus, and was associated with increased HVA, α angle, and TSCG.
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NewsBot · Mar 7, 2024

The Effect of the Lateral First Metatarsal Head Shape on Hallux Valgus in Forced Turnout in Pre-Pointe Female Ballet Dancers: A Pilot Study
Paul H Doan et al
J Am Podiatr Med Assoc. 2024 Jan-Feb;114(1):21-129

Background: A rounded lateral first metatarsal head shape is associated with higher rates of hallux abducto valgus recurrence following corrective surgery; however, the effect of the lateral first metatarsal head shape on the hallux abduction angle (HAA) has not yet been explored in a nonpathologic, pre-pointe ballet dancer population. The primary purpose of this study was to investigate the effect of the lateral first metatarsal head shape on the HAA when pre-pointe female dancers force their turnout.

Methods: Seventeen female, pre-pointe ballet students (mean age, 10.8 ± 0.95 years) participated in this study. Fluoroscopic images of each dancer's dominant foot were taken, and the lateral first metatarsal head shape was classified visually. Each dancer performed three consecutive stances of natural double-leg upright posture: both functional and forced turnout. HAAs were obtained by marking medial bony landmarks on paper and were compared to photographic measurements.

Results: No significant difference was found between the round and angular lateral first metatarsal head shape for the change in HAA from natural double-leg upright posture to forced turnout. Hallux abduction angle significantly increased by 4.6° (P < .001) in forced turnout compared to the natural double-leg upright posture for the photographic method, whereas the paper method demonstrated an increase of 2.6° (P = .007). No statistical differences were found between the paper and photographic methods in measuring the HAA for all stances.

Conclusions: Our findings suggest no association between the HAA and lateral first metatarsal head shape; however, HAA does increase when a dancer assumes forced turnout. The paper method demonstrated similar reliability to the photographic method and shows the potential for future use as a clinical tool in assessing hallux abducto valgus.
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