Correlation between indirect radiographic parameters of first metatarsal rotation in hallux valgus and values on weight-bearing computed tomography

Mansur, Nacime Salomão Barbachan; Lalevée, Matthieu; Schmidt, Eli; Dibbern, Kevin; Wagner, Pablo; Wagner, Emilio; Nery, Caio

doi:10.1007/s00264-021-05136-9

Cited by 14 publications

(6 citation statements)

References 34 publications

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“…Steadman et al 9 reported that the normal rotation of the distal aspect of M1 in relation to the ground in control patients is around 2 (±4) degrees of pronation. Mansur et al 7 more recently reported similar values of normality for distal M1 pronation using WBCT, of around 4.2 degrees in controls and 11.5 degrees in HVD patients. More importantly, the authors called attention to the inaccuracy of conventional 2D anteroposterior radiographic assessment in predicting M1 pronation based on the roundness of the lateral aspect of the M1 head.…”

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confidence: 71%

From 2D to 3D: Understanding Hallux Valgus Deformity

Netto

2023

Foot Ankle Int.

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confidence: 71%

From 2D to 3D: Understanding Hallux Valgus Deformity

Netto

2023

Foot Ankle Int.

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“…Nevertheless, a recent study questioned the reliability of the round sign in predicting metatarsal pronation. 18 The authors found a low correlation ( R 2 : 0.15) between the round sign and first metatarsal pronation as measured on weightbearing CT scans. They explained their findings by categorization errors of the round sign because of the superposition of the sesamoids with the lateral edge of the metatarsal head and the presence of first MTPJ arthritis.…”

Section: Discussionmentioning

confidence: 91%

Effect of the Reversed L-Shaped Osteotomy on the Round Sign: Not All Hallux Valgus Deformities May Need Proximal Derotation to Correct the Radiographic Appearance of Metatarsal Pronation

Weigelt

Wild

Winkler

et al. 2022

Foot & Ankle Orthopaedics

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Background: Metatarsal pronation has been claimed to be a risk factor for hallux valgus recurrence. A rounded shape of the lateral aspect of the first metatarsal head has been identified as a sign of persistent metatarsal pronation after hallux valgus correction. This study investigated the derotational effect of a reversed L-shaped (ReveL) osteotomy combined with a lateral release to correct metatarsal pronation. The primary hypothesis was that most cases showing a positive round sign are corrected by rebalancing the metatarsal-sesamoid complex. We further assumed that the inability to correct the round sign might be a risk factor for hallux valgus recurrence. Methods: We retrospectively evaluated 266 cases treated with a ReveL osteotomy for hallux valgus deformity. The radiologic measurements were performed on weightbearing foot radiographs preoperatively, at an early follow-up (median, 6.2 weeks), and the most recent follow-up (median, 13 months). Univariate and multivariate logistic regression analyses identified risk factors for hallux valgus recurrence (hallux valgus angle [HVA] ≥ 20 degrees). Results: A preoperative positive radiographic round sign was present in 40.2% of the cases, of which 58.9% turned negative after the ReveL osteotomy ( P < .001). Hallux valgus recurred in 8.6%. Risk factors for recurrence were a preoperative HVA >30 degrees (odds ratio [OR] = 5.3, P < .001), metatarsus adductus (OR = 4.0, P = .004), preoperative positive round sign (OR = 3.3, P = .02), postoperative HVA >15 degrees (OR = 74.9; P < .001), and postoperative positive round sign (OR = 5.3, P = .008). Cases with a positive round sign at the most recent follow-up had a significantly higher recurrence rate than those with a negative round sign (22.7% vs 5.9%, P < .001). Conclusion: The ReveL osteotomy corrected a positive round sign in 58.9%, suggesting that not all hallux valgus deformities may need proximal derotation to negate the radiographic appearance of the round sign. A positive round sign was found to be an independent risk factor for hallux valgus recurrence. Further 3-dimensional analyses are necessary to better understand the effects and limitations of distal translational osteotomies to correct metatarsal pronation. Level of Evidence: Level IV, case series.

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“…WBCT provides a more comprehensive illustration of the deformity than standard radiographs, thus allowing a better understanding of the relative positioning of the bones of the first and second rays (1,2,4) . This semi-automated technique may also reduce the potential for misinterpreting standard radiographs (6) .…”

Section: Introductionmentioning

confidence: 99%

Automated three-dimensional distance and coverage mapping of hallux valgus: a case-control study

et al. 2022

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Objective: To develop distance-mapping and coverage-mapping algorithms to assess metatarsophalangeal and metatarsal-sesamoid joint interaction in hallux valgus patients, comparing them to a control group. Methods: A total of 9 hallux valgus patients (mean age 37.1 y; 6 F/3 M) and 5 controls (mean age 39 y; 4 F/1 M) underwent weight-bearing computed tomography. Specific software was used to obtain bone segmentation images of the first and second metatarsals, the first and second proximal phalanxes, and the tibial and fibular sesamoids. Joint interaction based on distance mapping and coverage mapping of the first and second metatarsophalangeal joints and the metatarsal-sesamoid joints were calculated. The surfaces of the metatarsophalangeal joints were divided in a 2-by-2 grid using the principal axes to provide a more detailed analysis. P-values <0.05 were considered significant. Results: Coverage maps of hallux valgus and control patients revealed marked lateral and dorsal displacement in joint interaction of the first metatarsophalangeal joint, including decreased joint coverage of the medial facet of the joint. When comparing first metatarsophalangeal joint coverage, hallux valgus patients had significantly lower coverage of the dorsomedial quadrant (77%, p=0.0002) than controls, as well as significantly higher coverage of the plantarlateral (182%, p=0.005) and dorsolateral quadrants (44.9%, p=0.035). Conclusions: In this case-control study, we developed a distance and coverage map weight-bearing computed tomography algorithm to objectively assess 3D joint interaction, joint coverage, and subluxation in hallux valgus deformity. We observed significantly greater first and second metatarsophalangeal joint subluxation in hallux valgus patients than controls. Level of Evidence III; Case Control Study.

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Correlation between indirect radiographic parameters of first metatarsal rotation in hallux valgus and values on weight-bearing computed tomography

Cited by 14 publications

References 34 publications

From 2D to 3D: Understanding Hallux Valgus Deformity

From 2D to 3D: Understanding Hallux Valgus Deformity

Effect of the Reversed L-Shaped Osteotomy on the Round Sign: Not All Hallux Valgus Deformities May Need Proximal Derotation to Correct the Radiographic Appearance of Metatarsal Pronation

Automated three-dimensional distance and coverage mapping of hallux valgus: a case-control study

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