The role of the first metarsocuneiform joint in hallux valgus.

NewsBot · Nov 13, 2010

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The role of the first metarsocuneiform joint in juvenile hallux valgus.
Vyas S, Conduah A, Vyas N, Otsuka NY.
J Pediatr Orthop B. 2010 Sep;19(5):399-402.

Juvenile hallux valgus (JHV) is a relatively common condition in the female adolescent. The etiology of the condition has been attributed to various deformities in the forefoot, ranging from the first metatarsophalangeal joint, the morphology of the distal metatarsal, and the intermetatarsal angle (IMA). There have been very few studies evaluating the first metarsocuneiform (MTC) joint, and the results available vary. The purpose of this study is to more critically evaluate the MTC joint with novel angular measurements as a contributor to JHV. A cohort of 46 feet from 29 patients (average age 14.2 years) with hallux valgus as defined as IMA of greater than 10 degrees were evaluated. The hallux valgus angle, IMA, base of first metatarsal to articular surface of medial cuneiform angle, first metatarsal to cuneiform (1MCA), second metatarsal to cuneiform (2MCA), intrinsic medial cuneiform obliquity angle (COA), distal metatarsal articular angle, and ratio of first cuneiform to second cuneiform length were measured. The same was done for an age-matched control group of 36 normal feet from 25 patients (average age 13.2 years). The two groups were statistically compared. There were several statistically significant differences between the study and control groups. Naturally, the hallux valgus angle and IMA were statistically greater by definition. In addition, the distal metatarsal articular angle and 1MCA were significantly larger in the study group. The magnitude of the 2MCA was found to positively correlate with the magnitude of the IMA. The COA angle was not found to be statistically different. In conclusion, the role of the MTC joint in JHV has been evaluated earlier with varying results. The objective of this study is to critically evaluate the MTC joint with novel angular measurements to delineate its contribution to JHV. One such novel measurement is the 1MCA. The statistically significant increase in 1MCA suggests that a property intrinsic to the articulation between the medial cuneiform and the first metatarsal may be involved in JHV. Another angle, the 2MCA was found to positively correlated with increased IMA, further implicating the MTC joint as a contributor to increased IMA and thus, JHV. Third, the COA was used to define the intrinsic obliquity of the medial cuneiform articular angle. This angle was not found to be statistically different between the study and control groups, suggesting that the morphology of the cuneiform is not involved in JHV.
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NewsBot · Jun 12, 2012

The first tarsometatarsal joint and its association with hallux valgus
L. W. Mason, H. Tanaka
Bone Joint Res June 2012 vol. 1 no. 6 99-103

Introduction The aetiology of hallux valgus is almost certainly multifactoral. The biomechanics of the first ray is a common factor to most. There is very little literature examining the anatomy of the proximal metatarsal articular surface and its relationship to hallux valgus deformity.

Methods We examined 42 feet from 23 specimens in this anatomical dissection study.

Results This analysis revealed three distinct articular subtypes. Type 1 had one single facet, type 2 had two distinct articular facets, and type 3 had three articular facets one of which was a lateral inferior facet elevated from the first. Type 1 joints occurred exclusively in the hallux valgus specimens, while type 3 joints occurred exclusively in normal specimens. Type 2 joints occurred in both hallux valgus and normal specimens. Another consistent finding in regards to the proximal articular surface of the first metatarsal was the lateral plantar prominence. This prominence possessed its own articular surface in type 3 joints and was significantly flatter in specimens with hallux valgus (p < 0.001) and the angle with the joint was significantly more obtuse (p < 0.001).

Conclusions We believe the size and acute angle of this prominence gives structural mechanical impedance to movement at the tarsometatarsal joint and thus improves the stability.
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NewsBot · Sep 4, 2012

Axial rotation of the first metatarsal head in a normal population and hallux valgus patients.
Mortier JP, Bernard JL, Maestro M.
Orthop Traumatol Surg Res. 2012 Aug 28.

HYPOTHESIS:
Does metatarsal pronation exist and, if so, what is its impact?

INTRODUCTION:
Hallux valgus is a deformity associating angulation and a rotational component. The present study sought to investigate the nature and origin of the coronal plane displacement.

MATERIALS AND METHODS:
A prospective single-center radiological and anatomic study was conducted on 100 feet operated on for hallux valgus. Baseline X-ray determined the preoperative position of the 1st metatarsal head in the coronal plane. The range of motion (ROM) of the cuneometatarsal joint in pronation-supination was measured peroperatively. An anatomic study investigated possible diaphyseal torsion.

RESULTS:
Mean radiologic pronation in hallux valgus was 12.7° (range, 0°-40°). Cuneometatarsal rotational ROM was determined by adding peroperative ROM in pronation (mean, 9.3°; range, 0°-30°) and in supination (mean, 8.7°; range, 0°-20°). Intermetatarsal divergence showed no correlation with radiologic pronation or ROM in pronation. Radiologic pronation showed no correlation with peroperative ROM in pronation. Pronation of the metatarsal head was never observed without associated sesamoid pronation; the latter, however, was in some cases observed without the former. Twenty randomly selected metatarsal cadaver specimens from the anatomy laboratory of the University of Nice (France) showed diaphyseal torsion in 80% of cases, with the metatarsal head in neutral position or in supination with respect to the base.

DISCUSSION:
In hallux valgus, 1st ray pronation appears to be systematic, in contrast to the typical supination found in the general population. Metatarsal rotation is always associated with sesamoid rotation, whereas the converse is not the case: displacement of the sesamoids appears to displace the metatarsal head via the metatarsosesamoid ligaments. This "drive-belt" effect, however, varies in its mechanical properties and the transmission is imperfect and likely subject to progressive ligament stretching, so that head rotation does not exactly follow and may even become independent of the sesamoid displacement. Radiologic and clinical rotation thus do not match any longer. The anatomic study showed that, while diaphyseal torsion cannot be ruled out, the metatarsal pronation mainly derives from cuneometatarsal joint rotational instability, the evolution of which does not parallel lateral instability, no correlation being found between degree of varus and rotational instability.

CONCLUSION:
The present study found metatarsal pronation to be associated with hallux valgus, making a preoperative AP view useful; the underlying mechanism was generally cuneometatarsal instability. Although difficult to specify exactly without correlation between radiological and clinical data, any such pronation raises the question of whether replacing the metatarsal head on its sesamoid supports is sufficient to achieve stability in all planes, or whether on the contrary derotation should be associated to metatarsal valgization osteotomy to restore horizontal support.
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Simon Spooner · Sep 5, 2012

http://www.bjj.boneandjoint.org.uk/content/73-B/6/937.full.pdf

NewsBot · Mar 8, 2013

Relationship of Frontal Plane Rotation of First Metatarsal to Proximal Articular Set Angle and Hallux Alignment in Patients Undergoing Tarsometatarsal Arthrodesis for Hallux Abducto Valgus: A Case Series and Critical Review of the Literature
Paul Dayton, DPM, MS, FACFAS, Mindi Feilmeier, DPM, FACFAS, Merrell Kauwe, BS, Jordan Hirschi, BS
Journal of Foot and Ankle Surgery; Article in Press

Rotation of the first metatarsal, as a component of hallux abducto valgus, is rarely discussed and is not addressed as a component of most hallux valgus corrective procedures. We believe frontal plane rotation of the first metatarsal to be an integral component of hallux abducto valgus deformity (the “third plane of deformity”) and believe de-rotation is necessary for complete deformity correction. We observed the change in angular measurements commonly used in the evaluation of hallux valgus deformity in patients who underwent a modified lapidus procedure. We measured the intermetatarsal angle, hallux abductus angle, proximal articular set angle, and tibial sesamoid position on weightbearing radiographs of 25 feet in 24 patients who had undergone tarsal metatarsal corrective arthrodesis and lateral capsular release. Specific attention was given to reduction of the frontal plane rotation of the first metatarsal during correction. Our results showed a change in the angular measurements observed by 4 investigators as follows. The mean change in the intermetatarsal angle was 10.1° (p < .0001). The mean change in the hallux abductus angle was 17.8° (p < .0001). The mean change in the proximal articular set angle was 18.7° (p < .0001). The mean change in the tibial sesamoid position was 3.8 (p < .0001). Also, a consistent valgus, or everted position of the first metatarsal, was noted as a component of the hallux abducto valgus deformity in our patient population and was corrected by varus rotation or inversion of the metatarsal. We also reviewed the current literature related to anatomic changes in the first ray in the patient with hallux valgus deformity and reviewed our hypothesis regarding the reduction in the proximal articular set angle, which we believe to be related to frontal plane rotation of the first metatarsal, resulting in a radiographic artifact.
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NewsBot · Oct 18, 2014

Interpretation of variant morphological patterns in the hallucal cuneometatarsal joint
SCOTT E. BURNETT, D. TROY CASE
Anthropological Science

First cuneometatarsal joints are normally characterized by a single articulating facet. In some cases, however, they may bear some degree of division into two, or even three, distinct facets. Typically, double facets at this joint are interpreted as evidence of partial or complete division of the medial cuneiform earlier in development, though evidence to support this interpretation is limited. The purpose of this study was to examine the relationship between double facets and bipartition by comparing the sex ratio in double-faceted medial cuneiforms from two Euro-American skeletal samples, with the unbalanced sex ratio found in cases of complete bipartition of the medial cuneiform. Upon examination, no statistically significant differences were found in double-facet frequency between females and males, and the sex ratio differed significantly from that seen in known cases of bipartite medial cuneiform. These results suggest that the existence of double facets distally on the medial cuneiform is likely not exclusively indicative of developmental bipartition, a conclusion also supported by reports of divided distal surfaces in non-bipartite medial cuneiforms in some prenatal specimens. Furthermore, medial cuneiforms bearing three facets distally to the first metatarsal sometimes occur, possibly more frequently in individuals of advanced age. Ultimately, understanding distal facet patterns on the medial cuneiform may hold significance for understanding joint mobility and susceptibility to hallux valgus deformity in hominins from both bioarchaeological and paleoanthropological perspectives.
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NewsBot · Sep 8, 2015

Radiographic Relevance of the Distal Medial Cuneiform Angle in Hallux Valgus Assessment
Daniel J. Hatch, DPM, FACFAS, Abigail Smith, DPM, Troy Fowler, DPM, MHA
JFAS; Article in Press

The angle formed by the distal articular facet of the medial cuneiform has been evaluated and discussed by various investigators. However, no consistent method has been available to radiograph and measure this entity. The wide variability of the angle is not conducive to comparative analysis. Additionally, investigators have noted that the angles observed (obliquity) vary greatly because of changes in radiographic angle, foot position, rotation of the first ray, and declination of the first metatarsal. Recognizing that these variables exist, we propose a reproducible assessment using digital radiography and application of deformity of correction principles. Our results have indicated a mean distal medial cuneiform angle of 20.69? in normal feet, 23.51? with moderate hallux valgus, and 20.41? with severe hallux valgus deformity. The radiograph beam was kept at 15? from the coronal plane. An inverse relationship was found between the distal medial cuneiform angle and bunion severity. This was in contrast to our expected hypothesis. The overall angle of the first metatarsal?medial cuneiform did, however, correlate with the severity of the bunion deformity (p < .000). The obliquity values and intermetatarsal angles changed in direct relationship to the radiographic projection angle. This illustrates the importance of using standardized radiographic projection angles. We conclude that the 1-dimensional standard anteroposterior radiograph with assessment of the distal medial cuneiform angle cannot adequately demonstrate the pathologic features of hallux valgus. A better indicator appears to be the first metatarsal?medial cuneiform angle. This pathologic entity is a 3-dimensional one that incorporates the joint morphology of the first ray, triplane osseous positioning, and soft tissue imbalances. Perhaps, 3-dimensional computed tomography imaging will provide better insight into this entity.
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NewsBot · Aug 26, 2017

The impact of medial cuneiform bone variant measures on the severity of hallux valgus: A radiological study
Mehmet Erduran, Nihat Acar, Nihat D Demirkiran, ...
Journal of Orthopaedic Surgery August 23, 2017

Purpose:
The aetiology of hallux valgus (HV) is multifactorial in nature. The first metatarsocuneiform joint obliquity is a well-known factor in the development of the deformity. The purpose of this study is to assess the correlation of different medial cuneiform radiological measures on the severity of HV.

Methods:
Full weight-bearing anteroposterior views of 152 feet with different clinical severity are divided into four groups: without deformity and with mild, moderate and severe deformities. Three medial cuneiform angles were assessed, namely, the first metatarsocuneiform angle (MCA), the first metatarsocuneiform slope angle (MCSA) and the medial cuneiform lateral tilt angle (MCLTA).

Results:
The first MCA average values of groups 1, 2, 3 and 4 were (25.16 ± 5.74°, 27.38 ± 6.14°, 30.27 ± 5.62° and 34.28 ± 6.81°), respectively. Statistical differences were detected between groups (1, 3) and (1, 4) with p values of 0.034 and 0.001, respectively. The average values of the first MCSA of groups 1, 2, 3 and 4 were 19.26 ± 4.97°, 22.54 ± 5.62°, 26.13 ± 6.36° and 32.17 ± 5.85°, respectively. Significant differences were detected between groups (1, 3) and (1, 4) with p values of 0.04 and 0.023, respectively. Average values of the MCLTA of groups 1, 2, 3 and 4 were 80.85 ± 4.49°, 74.56 ± 5.28°, 62.38 ± 6.34° and 58.78 ± 6.25°, respectively. Statistical significances were detected between groups (1, 2), (1, 3) and (1, 4) with p values of 0.026, 0.018 and 0.001, respectively.

Conclusions:
Increasing the medial cuneiform lateral tilt increases the first metatarsocuneiform articulation obliquity demonstrated by the increase in the first MCSA which in term enhances the progression of varus deformity of the first metatarsal bone explained by the increase in the first MCA.
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NewsBot · Sep 21, 2017

Natural progression of radiographic indices in juvenile hallux valgus deformity

NewsBot · Sep 21, 2017

3D analysis of intercuneiform 1–2 joint mobility in normal vs. hallux valgus using weightbearing CT

NewsBot · Dec 9, 2017

Comparison of Intercuneiform 1-2 Joint Mobility Between Hallux Valgus and Normal Feet Using Weightbearing Computed Tomography and 3-Dimensional Analysis
Tadashi Kimura, MD, PhD, Makoto Kubota, MD, PhD, Naoki Suzuki, PhD, ...
Foot & Ankle International December 4, 2017

Background:
An association has been reported between hallux valgus and hypermobility of the first ray, but subluxation of the intercuneiform 1-2 joint was also suspected in some cases. However, dynamics of the intercuneiform 1-2 joint has seldom been investigated. This study used weightbearing computed tomography (CT) and a 3-dimensional (3D) analysis system to evaluate displacement of the intercuneiform 1-2 joint, intercuneiform 2-3 joint, and second cuneonavicular joint due to weightbearing in hallux valgus and normal feet.

Methods:
Patients were 11 women with hallux valgus (mean age, 56 years; mean hallux valgus angle, 43 degrees; mean first-second intermetatarsal angle, 22 degrees) and 11 women with normal feet (mean age, 57 years; mean hallux valgus angle, 14 degrees; mean first-second intermetatarsal angle, 9 degrees). Each patient was placed supine with the lower limbs extended, and CT was performed under nonweightbearing and weightbearing conditions (load equivalent to body weight). 3D models reconstructed from CT images were used to compare displacement of the intermediate cuneiform relative to the medial cuneiform under nonweightbearing and weightbearing conditions.

Results:
Relative to the medial cuneiform, the middle cuneiform was displaced by 0.1 and 0.8 degrees due to dorsiflexion, 0.2 and 1.0 degrees due to inversion, and 0.7 and 0.7 degrees due to abduction in normal feet and feet with hallux valgus, respectively, with the latter having significantly greater dorsiflexion (P = .0067) and inversion (P = .0019). There was no significant intergroup difference at the intercuneiform 2-3 joint and second cuneonavicular joint.

Conclusion:
This study clarified the detailed load-induced displacement of the cuneiform 3-dimensionally. Compared with normal feet, hallux valgus feet had significantly greater mobility of the intercuneiform 1-2 joint, suggesting hypermobility of this joint
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NewsBot · Aug 3, 2018

Radiographic Evaluation of First Metatarsal and Medial Cuneiform Morphology in Juvenile Hallux Valgus
Philip Kaiser, MD, Kristin Livingston, MD, Patricia E. Miller, MS, ...
Foot & Ankle International August 2, 2018

Background:
Operative treatment of juvenile hallux valgus (JHV) has a high recurrence rate. The aim of this study was to better understand the pattern of radiographic deformity.

Methods:
Standing radiographs of 93 feet in 57 patients with JHV, and 50 feet in 36 normal patients were measured. Measurements included: hallux valgus angle (HVA), first metatarsal physis status (open or closed), intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA), Meary’s angle, medial cuneiform angle (MCA), relative first to second metatarsal length ratio (1:2 MT ratio), cuneiform obliquity (CO), and congruency of the metatarsophalangeal joint (MTPJ). JHV groups were defined as normal (HVA 0-15 degrees), mild-moderate (HVA 15-35), or severe (HVA > 35) and were analyzed.

Results:
Seventy of 93 feet (75%) with JHV presented with mild-moderate JHV (average HVA of 26.2 ± 5.6 degrees), and 23 feet (25%, 23/93) presented with severe JHV (average HVA of 41.9 ± 5.3 degrees). Multivariable analysis determined that DMAA (P < .001), MCA (P = .04), and congruency (P < .001) were independently associated with JHV and its severity (normal vs mild-moderate vs severe). Severe JHV cases had larger DMAA (P = .01), larger IMA (P = .01), larger 1:2 MT ratio (P = .02), and were less frequently congruent (P = .03) compared with mild-moderate JHV cases.

Conclusion:
Deformity in JHV was highly correlated with both the proximal and distal morphology of the first metatarsal and medial cuneiform. Severe JHV was associated with increased bony deformity and increased incongruity of the MTPJ. Treatment should be individualized, but JHV treatment algorithms can take this information into account.
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NewsBot · Oct 3, 2018

Pronation of the First Metatarsal in Hallux Valgus Deformity: A Weight Bearing CT Study
Chris Cychosz, MD, Alyssa Johnson, BA, Phinit Phisitkul, MD
AOFAS Annual Meeting 2018 1

Introduction/Purpose: Hallux Valgus is a common condition often resulting in chronic pain and disability. However, the precise
etiology of Hallux Valgus deformity remains poorly understood and likely results from a combination of intrinsic and extrinsic
factors. There is conflicting evidence regarding as to whether hallux valgus deformity is associated with increased pronation of the
first metatarsal. The purpose of this study was to investigate the correlation between hallux valgus and pronation of the first
metatarsal in relation to other structural parameters of the foot.
Methods: Eighty-five consecutive patients with clinically and radiographically diagnosed hallux valgus, pes planus, or cavovarus that
underwent imaging with weightbearing CT between January 2014 and May 2016 were retrospectively enrolled and compared to a
control group consisting of patients who with scans completed for indications unrelated to hallux valgus (e.g. ankle arthritis) and
were determined to have normal foot structure. Using a weightbearing CT axial view, the alpha angle of the first metatarsal was
measured and correlated with other radiographic parameters on plain weightbearing radiographs including Meary’s angle, hallux
valgus angle, intermetatarsal angle, and calcaneal pitch.
Results: There were 39 males and 46 females (91 feet) with a mean age of 47.16 (SD14.89) years and BMI of 32.99 (SD 7.35)
kg/m2 included in this study. Mean pronation of the first metatarsal significantly (p<0.001) different in all group compared to the
control: 15.23 (SD 7.96) in the hallux valgus group, 15.22 (SD 8.56) in the pes planus group, negative 0.23 (SD 5.99) in the
cavovarus group, and 6.98 (SD 5.09) in the control group. There was moderate correlation between meary’s angle, tripod index,
calcaneal pitch, and the alpha angle (negative 0.70, 0.65, negative 0.53, respectively) with a p-value < 0.001. HVA demonstrated
little correlation with the measured alpha angle (0.23), p<0.03.
Conclusion: Patients with hallux valgus deformity demonstrated a significantly higher pronation of the first metatarsal compared
to the control group. However, a greater number of patients in the hallux valgus group had flatfoot deformity and further analysis
revealed a greater correlation between foot type and pronation of the first metatarsal. Weightbearing CT is a reasonable way to
image complex forefoot deformities prior to bunion surgery and it is important to take into account rotation of the first
metatarsal in bunion surgery
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NewsBot · Apr 6, 2019

Quantitative Assessment of the Obliquity of the First Metatarsal-Medial Cuneiform Articulation
Kevin Patel et al
JFAS; Article in Press

The so-called obliquity of the first metatarsal-medial cuneiform articulation has been described as an atavistic trait of human foot morphology, and it is commonly proposed as a relative risk factor for development of the hallux abductovalgus (HAV) deformity. The objectives of this investigation were to 1) provide descriptive normative radiographic data on a series of first metatarsal-medial cuneiform articulations and 2) correlate these findings to other common radiographic parameters used to define the HAV deformity. We measured radiographic parameters including the first intermetatarsal angle, hallux abductus angle, tibial sesamoid position, Engel's angle, and 2 measures of obliquity in the transverse and sagittal planes on a consecutive series of 136 weightbearing foot radiographic projections from subjects without a history of foot/ankle surgery or fracture/dislocation. Measurements were considered as continuous variables, graphically depicted against each other on frequency scatter plots, and analyzed by means of Pearson correlation coefficients. Only 1 bivariate comparison demonstrated a weak negative correlation (Engel's angle versus Obliquity_1 [Pearson –0.259; p = .002]). The results of this investigation did not demonstrate a statistically significant or clinically substantial relationship between the obliquity of the first metatarsal-cuneiform joint and common radiograph parameters of the HAV deformity. Although not specifically studied here, these results might potentially indicate function, as opposed to structure, in the developmental pathogenesis of the HAV deformity.
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NewsBot · Oct 14, 2021

Pronation on Weightbearing Radiographs does not Correlate with Pronation from Weightbearing CT Scans
Tamanna J.Patel et al
Foot and Ankle Surgery; 12 October 2021

Introduction
In hallux valgus (HV), first metatarsal pronation is increasingly recognized as an important aspect of the deformity. The purpose of this study was to compare pronation in HV patients determined from the shape of the lateral head of the first metatarsal on AP weightbearing radiographs with pronation calculated from weightbearing CT (WBCT) scans.

Methods
Patients were included in this study if they had preoperative and 5-month postoperative WBCT scans and corresponding weightbearing AP radiographs of the affected foot. Pronation of the first metatarsal on WBCT scans was measured using a 3D CAD model and the alpha angle and categorized into four groups on radiographs. Association between pronation groups on radiographs and WBCT scans was determined using Spearman correlation coefficients (rs) and by comparing mean WBCT pronation of the first metatarsal between plain radiograph pronation groups.

Results
Agreement between the two observers’ pronation on radiographs was good (k = 0.634) and moderate (k = 0.501), respectively. There was no correlation between radiographic pronation and the 3D CAD model (rs<0.15). Preoperatively, there was weak correlation between the alpha angle and the radiographic pronation groups (rs = 0.371, P = 0.048) although this relationship did not hold postoperatively (rs = 0.330, P = 0.081). There was no difference in mean pronation calculated on WBCT scans between the plain radiographic groups.

Conclusion
Pronation of the first metatarsal measured on weightbearing AP radiographs had moderate interobserver agreement and was only weakly associated with pronation measured from WBCT scans. These results suggest that first metatarsal pronation measured on weightbearing radiographs is not a substitute for pronation measured on WBCT scans.
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NewsBot · Feb 22, 2022

Radiographic study of relationship between medial cuneiform obliquity and simple hallux valgus
Pengfei Bu et al
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2022 Feb 15;36(2):209-214

Objective: To investigate the relationship between hallux valgus and the indicators associated with medial cuneiform obliquity measured on feet weight-bearing anteroposterior X-ray films.

Methods: Based on the feet weight-bearing anteroposterior X-ray films taken between January 2018 and February 2021 and met the criteria, the hallux valgus angle (HVA), intermetatarsal angle (IMA), metatarsus adductus angle (MAA), metatarsus cuneiform angle (MCA), distal medial cuneiform angle (DMCA), and proximal metatarsal articular angle (PMAA) were measured and the morphology of the first tarsometatarsal (TMT) were recorded. According to the HVA, the X-ray films were divided into normal group (HVA<15°) and hallux valgus group (HVA≥15°). The gender, age, sides, IMA, MAA, MCA, DMCA, PMAA, and the morphology of TMT were compared between groups. The influencing factors of HVA and IMA were analyzed by multivariate linear regression analysis.

Results: X-ray films of 534 patients (679 feet) met the selection criteria and were included in the study. There were 220 males and 314 females, with an average age of 36 years (mean, 18-82 years). There were 154 cases (168 feet) in the normal group and 403 cases (511 feet) in the hallux valgus group. There were significant differences in gender and age between groups ( P<0.05), and no significant difference in the side ( P>0.05). The IMA, MAA, and MCA in the hallux valgus group were significantly bigger than those in the normal group ( P<0.05); the difference in DMCA between the two groups was not significant ( P>0.05). The TMT morphology of the two groups was mainly curved, and the difference in morphology classification was not significant ( P>0.05). PMAA measurement showed that there were 3 kinds of metatarsal shapes: adductive metatarsal, neutral metatarsal, and abductive metatarsal, the difference in metatarsal shapes between groups was not significant ( P>0.05). The PMAA of abductive metatarsal was significantly bigger in normal group than in hallux valgus group ( P<0.05), there was no significant difference in PMAA of adductive metatarsal between groups ( P>0.05). Multivariate linear regression analysis showed that age, MCA, and DMCA were the influencing factors of HVA ( P<0.05), and age, MAA, MCA, and DMCA were the influencing factors of IMA ( P<0.05).

Conclusion: The medial cuneiform obliquity is relatively constant and the DMCA can not be used as the characteristic angle to quantify hallux valgus. The morphology of TMT has no relationship with hallux valgus, while MAA, MCA, and PMAA are all factors to be considered, and MCA can be used as the characteristic angle to quantify hallux valgus.
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NewsBot · Jun 5, 2022

Quantitative evaluation of the vertical mobility of the first tarsometatarsal joint during stance phase of gait
Noriaki Maeda et al
Source

We determined how the in vivo mobility of the first tarsometatarsal (TMT) joint can be quantified during gait. Twenty-five healthy participants (12 females) with no history of foot disorders were included. Non-invasive ultrasound (US) with a three-dimensional motion analysis (MA) system was used to evaluate the kinematic characteristics of first TMT joint during stance phase of gait. US probe was positioned longitudinally above the first TMT joint and adjusted to its proximal dorsal prominence. Gait analysis was conducted by the MA system starting with the activation of B-mode US video at 80 frames per second and 60-mm depth for simultaneous capture. During stance phase, the first metatarsal was translated dorsally with respect to the medial cuneiform, returning to a neutral level at toe-off in all subjects. During middle stance phase, the medial cuneiform was stable in males but displaced in the plantar direction in females and was the primary contributor to the differences in sagittal mobility observed between groups. Quantitatively measuring sagittal mobility of the first TMT joint could be useful for the early detection of foot abnormalities. The dynamic characteristics of the medial cuneiform during gait in healthy females may be associated with a high prevalence of hallux valgus.
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NewsBot · Jun 16, 2022

Distributional patterns of subchondral bone density and histopathological features of the first tarsometatarsal joint in hallux valgus feet
Yasunari Ikuta et al
BMC Musculoskelet Disord. 2022 Jun 14;23(1):569

Background: Hypermobility of the first tarsometatarsal (TMT) joint is frequently identified in patients with hallux valgus (HV); however, its association with the development of osteoarthritis in the first TMT joint in such patients remains unknown. The purpose of this study was to clarify the distribution of subchondral bone density of the first TMT joint via computed tomography (CT) using Hounsfield units (HU).

Methods: Patients were divided into three groups: the osteotomy (20 feet; 20 women, mean age: 61.8 years), arthrodesis (23 feet; two men, 21 women, 71.2 years), and control group (patients without HV deformity who had undergone CT scans of the foot; 13 feet; seven men, six women, 29.7 years). The HU ratios were calculated, which were defined as the HU value of each subdivision of the subarticular spongiosa of the first TMT joint [dorsomedial (DM), dorsolateral (DL), plantomedial (PM), and plantolateral (PL)] divided by the HU values of the entire joint surface. The ratios for the osteotomy, arthrodesis, and control groups were compared. The degradation of the articular cartilage in the first TMT joint was histologically graded in the arthrodesis group. Tukey-Kramer multiple comparison analysis was conducted to compare the HU ratios among the three groups, and the histological grade in each subdivision.

Results: The arthrodesis group demonstrated high HU ratios in the DM area of the medial cuneiform, and significantly lower HU ratios in the PL area of the first metatarsal. Lower HU ratios in the DL area were observed in both the osteotomy and the arthrodesis group when compared to that in the medial cuneiform of the control group. The histological evaluation indicated nearly normal articular cartilage for all subdivided areas in both the medial cuneiform and the first metatarsal in patients with severe HV.

Conclusions: Although high subchondral bone density was identified in the DM area of the medial cuneiform in severe HV, only mild degradation was histologically observed in the articular cartilage of the first TMT joint. Our findings suggest that the indications for arthrodesis of the first TMT should be reconsidered based on the severity of the degenerative changes in the first TMT joint
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NewsBot · Jun 28, 2022

Radiographic Assessment of Relationship between Medial Cuneiform Obliquity and Hallux Valgus
Pengfei Bu, MD et al
June 27, 2022

The research results are inconsistent that assessing whether the increased obliquity of the distal articular surface of the medial cuneiform leads to an increase in hallux valgus angle. Thus, this study investigated the relationship between distal medial cuneiform obliquity and hallux valgus by measuring various angles in weight-bearing anteroposterior radiographs of the foot. In total, 679 feet of 538 patients with the radiographs were included in the study. We measured radiographic parameters including hallux valgus angle, 1st-2nd intermetatarsal angle, metatarsus adductus angle, first metatarsus cuneiform angle, distal medial cuneiform angle, and first proximal metatarsal articular angle were measured. The surface morphology (flat or curved) of the first tarsometatarsal joint was also recorded. Our results analysis revealed a weak negative correlation between distal medial cuneiform angle and both hallux valgus angle and 1st-2nd intermetatarsal angle, contrary to our assumption. So we believe that distal medial cuneiform angle was relatively constant and it cannot be used as a characteristic angle for quantifying hallux valgus. first metatarsus cuneiform angle was a characteristic indicator of hallux valgus and was positively correlated with its severity(p < .000), indicating that it can be used to measure the size of hallux valgus. It can also be used as a reference factor for the first metatarsal osteotomy in clinical bunion orthopaedics. First tarsometatarsal joint morphology was unrelated to hallux valgus, whereas metatarsus adductus angle, and first proximal metatarsal articular angle should be considered in hallux valgus.
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NewsBot · Jan 23, 2023

Original article: Relationship between arthritis of the second and third tarsometatarsal joints and incongruity of the first tarsometatarsal joint in patients with hallux valgus
Toshihiro Hosokawa et al
Mod Rheumatol. 2023 Jan 23

Objectives: Hallux valgus is associated with tarsometatarsal arthritis; its pathophysiology remains unknown. Therefore, we aimed to elucidate the relationship between arthritis of the second and third tarsometatarsal joints and incongruity of the first tarsometatarsal joint in the sagittal plane.

Methods: Forty-three patients (64 feet) with hallux valgus who underwent surgery at our hospital were included and divided into two groups: control (without second and third tarsometatarsal joint degeneration) and osteoarthritis (with second and third tarsometatarsal joint degeneration). Intergroup comparisons of the incongruity of the first tarsometatarsal joint in the sagittal plane, age, body mass index, hallux valgus angle, first-second inter-metatarsal angle, metatarsus adductus angle, Meary's angle, and calcaneal pitch angle were performed.

Results: The proportion of patients with incongruity of the first tarsometatarsal joint was significantly higher in the osteoarthritis group than in the control group. Logistic regression analysis identified incongruity of the first tarsometatarsal joint and metatarsus adductus angle as significant related factors for arthritis of the second and third tarsometatarsal joint.

Conclusions: Incongruity of the first tarsometatarsal joint in the sagittal plane was involved in the development of arthritis of the second and third tarsometatarsal joints in patients with hallux valgus.
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NewsBot · Mar 30, 2023

Radiographic Assessment of Relationship Between Medial Cuneiform Obliquity and Hallux Valgus
Pengfei Bu et al
J Foot Ankle Surg. 2022 Jun 28

The research results are inconsistent that assessing whether the increased obliquity of the distal articular surface of the medial cuneiform leads to an increase in hallux valgus angle. Thus, this study investigated the relationship between distal medial cuneiform obliquity and hallux valgus by measuring various angles in weightbearing anteroposterior radiographs of the foot. In total, 679 feet of 538 patients with the radiographs were included in the study. We measured radiographic parameters including hallux valgus angle, first to second intermetatarsal angle, metatarsus adductus angle, first metatarsus cuneiform angle, distal medial cuneiform angle, and first proximal metatarsal articular angle. The surface morphology (flat or curved) of the first tarsometatarsal joint was also recorded. Our results analysis revealed a weak negative correlation between distal medial cuneiform angle and both hallux valgus angle and first to second intermetatarsal angle, contrary to our assumption. So we believe that distal medial cuneiform angle was relatively constant and it cannot be used as a characteristic angle for quantifying hallux valgus. First metatarsus cuneiform angle was a characteristic indicator of hallux valgus and was positively correlated with its severity (p < .000), indicating that it can be used to measure the size of hallux valgus. It can also be used as a reference factor for the first metatarsal osteotomy in clinical bunion orthopedics. First tarsometatarsal joint morphology was unrelated to hallux valgus, whereas metatarsus adductus angle, and first proximal metatarsal articular angle should be considered in hallux valgus.
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NewsBot · Jul 6, 2023

The Role of First Tarsometatarsal Joint Morphology and Instability in the Etiology of Hallux Valgus: A Case-Control Study
Linfeng Ji et al
Foot Ankle Int. 2023 Jul 1

Background: The morphology of foot joints is widely accepted as a significant factor in the development of various foot disorders. Nevertheless, the role of the first tarsometatarsal joint (TMT1) morphology in hallux valgus (HV) remains unclear, and its impact on TMT1 instability has not been fully explored. This study aimed to investigate the TMT1 morphology and its potential correlation with HV and TMT1 instability.

Methods: Weightbearing computed tomography (WBCT) scans of 82 consecutive feet with HV and 79 controls were reviewed in this case-control study. Three-dimensional (3D) models of TMT1 were constructed using Mimics software and WBCT scans. The height of the TMT1 facet (FH) and the superior, middle, and inferior facet width (SFW, MFW, and IFW) were measured on anteroposterior view of the first metatarsal base. On the lateral view, the inferior lateral facet height and angle (ILFH and ILFA) were measured. TMT1 instability was evaluated using the TMT1 angle.

Results: Compared with the control group, the HV group had a significantly wider MFW (9.9 mm in HV, 8.7 mm in control), lower ILFH (1.7 mm in HV, 2.5 mm in control), smaller ILFA (16.3 degrees in HV, 24.5 degrees in control), and larger TMT1 angle (1.9 degrees in HV, 0.9 degrees in control) (all P < .05). No significant differences were found between the 2 groups in FH, SFW, and IFW (all P > .05). The study identified 4 types of TMT1 morphology: continuous-flat, separated-flat, continuous-protruded, and separated-protruded. The continuous-flat type possessed significantly larger HVA, IMA, and TMT1 angles compared with other types (all P < .001).

Conclusion: This study indicates a potential association between TMT1 morphology and the severity of HV and identifies 4 TMT1 types. Notably, the continuous-flat type is found to be associated with more severe HV and TMT1 instability.
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NewsBot · Aug 3, 2023

Influence of the shape of the first metatarsal cuneiform joint on the development of hallux valgus deformity
Mirko Sovilj et al
BMC Musculoskelet Disord. 2023 Jul 4;24(1):548. doi: 10.1186/s12891-023-06668-4.

Objective: To examine the presence of certain shapes of the first metatarsal-cuneiform joint (MTC) joint in feet with hallux valgus (HV) deformity. To determine whether the anatomical orientation of this joint affects the size of the hallux valgus angle (HVA) and the first intermetatarsal angle (IMA) and whether it contributes to the dynamics of the developmental course of HV deformity.

Methods: The shape of the first MTC joint was determined on a sample of 315 feet with HV deformity. The influence of the shape of this joint on the values of HVA and IMA was explored. The relation between the position of the tibial sesamoid and the size of HVA and IMA as well as the dynamics of the development of this deformity depending on the shape of the first MTC joint, was examined.

Results: The oblique shape of the first MTC joint was found in 165 (52.4%) feet, the transverse in 145 (46%), and the convex shape was registered in five feet (1.6%). In the oblique shape of this joint, a moderate and severe degree of HV deformity is predominant, while in the transverse shape a mild degree dominates. A statistically significant dependence of HVA on the shape of the first MTC joint was found (Sig. = 0.010), while the dependence of IMA did not show statistical significance (Sig. = 0.105). HVA values follow the position of the tibial sesamoid in both shapes of the MTC joint while the size of the IMA in the transverse shape does not follow the change of the position of this sesamoid.

Conclusion: The oblique shape of the first MTC joint is associated with the more severe form of HV deformity and its faster developmental course. In the analyzed sample, it was shown that HVA is higher in the oblique shape of the MTC joint and significantly depends on the anatomical orientation of this joint. Furthermore, IMA has a higher value in the oblique shape compared to transverse but this dependence is not statistically significant. The analysis showed that the oblique shape of the first MTC joint contributes to the development of HV deformity.
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