Introduction: The role of first ray sagittal mobility (FRSM) in the etiology and treatment of hallux valgus (HV) remains controversial. The manual clinical test of FRSM performed during the physical examination of HV is completely subjective. Our objective was to compare individuals with and without HV using a previously described manual device validated to evaluate FRSM and to assess the correlation between FRSM and HV severity and between FRSM and the degree of foot flatness. Methods: Thirty-seven feet with HV and 35 control feet were compared using a Eulji Medical Center (EMC)-like manual device. The HV grade was measured using the HV angle (HVA), and the degree of foot flatness was measured using Meary’s angle. Results: FRSM in controls: 6.31 mm; in cases: 8.97 mm, p<0.001, with a difference between controls and cases of 2.66 mm. HVA in controls: 8.75°; in cases: 23.74°, p<0.001. Correlation between FRSM and HVA in controls: r=-0.09, p=0.63; in cases: r=-0.08, p=0.63. Correlation between FRSM and Meary’s angle in controls: r=-0.04, p=0.83; in cases: r=-0.02, p=0.89. The 90th percentile in controls was 8 mm. Conclusion: The individuals with HV had greater FRSM than the controls, and the mean difference was 2.66 mm; a previous study using a Klaue device showed a similar difference of 3.62 mm. There was no correlation between HV severity and FRSM; that is, the more severe cases of HV did not show greater mobility. Therefore, more severe cases will not have a greater likelihood of tarsometatarsal arthrodesis based on the FRSM. There was no correlation between FRSM and foot flatness (Meary’s angle); that is, the FRSM did not increase with foot flatness. The 90th percentile in controls was 8 mm; in other words, 10% of individuals without HV have mobility equal to or greater than 8 mm.
Introduction: The relationship between the inclination of the first metatarsocuneiform joint (FMCJ) in the anteroposterior (AP) plane and the hallux valgus (HV) deformity is controversial. The objectives of our study are to assess whether the FMCJ inclination in the AP plane affects the presence and severity of HV and first ray sagittal mobility (FRSM). Methods: In this study, 35 control feet (22 patients) and 37 feet with HV (25 patients) were evaluated. Hallux valgus was graded using the HV angle (HVA), and the inclination of the FMCJ in the AP plane was assessed using the method described by Hardy and Clapham. The radiographs were taken as described by Maestro, in 2 institutions. The FRSM was measured using an Eulji Medical Center (EMC)-like manual device (previously described and validated). Results: HVA, in controls: 8.75°; in cases: 23.74°, p<0.001. FMCJ inclination in the AP plane, in controls: 8.60°; in cases: 13.33°, p=0.001. Correlation between the FMCJ inclination in the AP plane and the HVA, in controls: r=0.24, p=0.16; in cases: r=-0.01, p=0.98. Correlation between the FMCJ inclination in the AP and the FRM, in controls: r=-0.16, p=0.37; in cases: r=-0.10, p=0.55. Conclusion: The inclination of the FMCJ in the AP plane was greater in the patients with HV, indicating that a larger slope of the FMCJ can be a risk factor for HV. There was no association between FMCJ inclination and the severity of HV. There was no association between FMCJ inclination and FRSM; therefore, we cannot define the mobility or even the hypermobility of the FMCJ based on the FMCJ with the largest inclination in the AP plane. Performing the radiographic examinations at the same institutions kept the protocol constant, thereby decreasing measurement errors.
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