A New Measure of Tibial Sesamoid Position in Hallux Valgus in Relation to the Coronal Rotation of the First Metatarsal in CT Scans

Abstract

Level III, retrospective comparative study.

Quantitative Analysis of the Degree of Frontal Rotation Required to Anatomically Align the First Metatarsal Phalangeal Joint During Modified Tarsal-Metatarsal Arthrodesis Without Capsular Balancing

“…The mean value of supination correction of the first metatarsal needed to achieve clinical and radiographic alignment of the first MTPJ without soft tissue balancing in our series was very close to the mean metatarsal pronation found in feet with bunions reported in a recent partial weightbearing computed tomography study (16). That computed tomography study reported a mean pronated position of the first metatarsal in a bunion deformity of 21.9 , significantly different from that of their normal control subjects (16). Our results have indicated that a frontal plane correction of an average of 22.1 of supination of the first metatarsal, concurrently with transverse plane IMA correction, reduces the deformity nearly completely at the first MTPJ according to the observation of sesamoid position and joint congruency.…”

“…3). The mean value of supination correction of the first metatarsal needed to achieve clinical and radiographic alignment of the first MTPJ without soft tissue balancing in our series was very close to the mean metatarsal pronation found in feet with bunions reported in a recent partial weightbearing computed tomography study (16). That computed tomography study reported a mean pronated position of the first metatarsal in a bunion deformity of 21.9 , significantly different from that of their normal control subjects (16).…”

Effect of natural full weight‐bearing during standing on the rotation of the first metatarsal bone

“…In the present study, we focused on the first metatarsal (1MT) bone, because lesions of many foot diseases are typically located in 1MT, such as the hallux valgus, hallux rigidus, and hallucal sesamoid disorders. Several studies have reported that the 1MT in hallux valgus patients showed pronation under weight‐bearing (Eustace et al, ; Eustace et al, ; Saltzman et al, ; Okuda et al, ; Collan et al, ; Kim et al, ; Kimura et al, ). These clinical studies suggest that pronation of the 1MT is a key pathology in the hallux valgus; however, there has been no evidence whether pronation of the 1MT occurs in asymptomatic feet due to natural weight‐bearing.…”

“…Weight-bearing radiography of the foot is an established and important method of assessment in clinical practice (Eustace et al, 1993;Eustace et al, 1994;Okuda et al, 2007); however, the two-dimensional (2D) analysis using radiography limits the evaluation of the morphological changes of the foot due to weight-bearing because of the foot's complex three-dimensional (3D) structure. To overcome this limitation, CT imaging has been used to analyze the morphological change of the foot under weight-bearing conditions (Collan et al, 2013;Tuominen et al, 2013;Carrino et al, 2014;Kim et al, 2015;Kimura et al, 2017;Watanabe et al, 2017;Barg et al, 2018). In previous studies, CT images were obtained with upright cone-beam CT scanners (Collan et al, 2013;Tuominen et al, 2013;Carrino et al, 2014) or with a conventional CT scanner under simulated weight in a prone position (Kim et al, 2015;Kimura et al, 2017;Watanabe et al, 2017).…”

Rotational Osteotomy for Hallux Valgus. A New Technique for Primary and Revision Cases

“…But there is another deformity not frequently discussed: the first-ray axial malrotation. Up to 87% of HV cases present with a metatarsal internal rotation, shown by an internally malrotated hallux (on clinical examination), visible metatarsal head condyles on a foot anteroposterior x-ray and by laterally subluxated sesamoids as seen on x-rays 6. Interestingly, in this same study, up to 25% of the cases with HV deformity presented with a pronated first metatarsal bone and with no sesamoid subluxation on computed tomographic scan, and no correlation was found between the metatarsal pronation and the HV or intermetatarsal (IMTT) angle.…”