Does metatarsus primus elevatus really exist in hallux rigidus? A weightbearing CT case–control study

Lee, Hee Young; Mansur, Nacime Salomão Barbachan; Lalevée, Matthieu; Maly, Connor; Iehl, Caleb; Hembree, Walter C; Godoy‐Santos, Alexandre Leme

doi:10.1007/s00402-021-04168-5

Cited by 6 publications

(11 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Multiplanar weight-bearing CT has already proven its superiority in assessing subtalar joint subluxation [29][30][31][32], and subfibular impingement [16,33]. Adding a weight-bearing CT assessment in our readings may improve the reliability of this class [18,[34][35][36][37][38]. In the original PCFD publication [13], it is also unclear whether the presence of sinus tarsi impingement should be considered as peritalar subluxation (Class D) or midfoot abduction (Class B) sign.…”

Section: Discussionmentioning

confidence: 99%

A comparison between the Bluman et al. and the progressive collapsing foot deformity classifications for flatfeet assessment

Lalevée

Mansur

Lee

et al. 2021

Arch Orthop Trauma Surg

Self Cite

View full text Add to dashboard Cite

Introduction Bluman et al., flatfoot classification is based on posterior tibial tendon (PTT) dysfunction leading to a chronological appearance of several foot deformities. An expert consensus recently proposed a new classification named Progressive Collapsing Foot Deformity (PCFD) in which the focus was shifted to five different independent foot and ankle deformities and their flexibility or rigidity. The aim of this study was to compare Bluman and PCFD classifications. We hypothesize that both classifications will be reliable and that the PCFD classification will allow a larger distribution of the different types of foot deformity. Materials and methodsWe performed a retrospective IRB-approved study including 92 flatfeet. Three foot and ankle surgeons reviewed patient files and radiographs to classify each foot using both classifications. Bluman classification was performed one time as initially described and a second time after removing the Angle of Gissane sclerosis sign. Interobserver reliabilities were determined with Fleiss' kappa values. Results Interobserver reliabilities of Bluman and PCFD classifications were, respectively, substantial 0.67 and moderate 0.55. PCFD Class C and D reliabilities were, respectively, slight 0.07 and fair 0.28. The 276 readings were spread into 10 substages in Bluman and 65 subclasses in PCFD. The progressivity of the Bluman classification prevented the combination of flexible hindfoot valgus (II Bluman, 1A PCFD), midfoot abduction (IIB, 1B) and medial column instability (IIC, 1C) which was frequent in our study (112/276 readings, 40.6%). By removing the Angle of Gissane sclerosis sign from the Bluman classification, the prevalence of stage III decreased from 44.2 to 10.1%. Conclusions Bluman and PCFD classifications were reliable. The PCFD classification showed a larger distribution of different types of flatfeet but Classes C and D need better definition. The progressivity of Bluman classification causes inconsistencies and Gissane angle sclerosis sign is inappropriately used and might lead to incorrect surgical indications.

show abstract

Section: Discussionmentioning

confidence: 99%

A comparison between the Bluman et al. and the progressive collapsing foot deformity classifications for flatfeet assessment

Lalevée

Mansur

Lee

et al. 2021

Arch Orthop Trauma Surg

Self Cite

View full text Add to dashboard Cite

show abstract

“…Along the same line, in a recent case-control study, Lee et al 8 asked whether MPE really exists in hallux rigidus and evaluated if MPE could affect the forefoot spatial relationship in the HR group compared with controls. Using WBCT, they concluded that the group with HR had increased MPE.…”

Section: Discussionmentioning

confidence: 99%

“…Our expectation was based on previous studies that state that patients with HR have increased MPE. 2,3,8 Cheung et al 3 were the first to study the relationship between HR and WBCT measurements. In their study that evaluated foot alignment and MPE in patients with hallux rigidus, they found that patients with HR significantly decreased declination ratios from the first to the second metatarsal, indicating the presence of MPE.…”

Section: Discussionmentioning

confidence: 99%

Section: Ct Imaging and Measurementmentioning

confidence: 99%

“…The distance between the 2 intersection points of the 2 dorsal cortical bones along the vertical line determined the MPE. 2,8 Angular measurements were performed using the Cobb method (Figure 1). 4,8 The semiautomatic 3D measurements were performed using the Disior Bonelogic Foot and Ankle Software (version 2.1; Finland).…”

Section: Ct Imaging and Measurementmentioning

confidence: 99%

See 2 more Smart Citations

The Use of Advanced Semiautomated Bone Segmentation in Hallux Rigidus

Carvalho

Mallavarapu

Ehret

et al. 2022

Foot & Ankle Orthopaedics

Self Cite

View full text Add to dashboard Cite

Background: Weightbearing computed tomography (WBCT) measurements allow evaluation of several anatomical points for a correct clinical-radiographic diagnosis of pathologies, such as hallux rigidus (HR). In addition, a new semiautomatic segmentation software obtains automated 3D measurements from WBCT scan data sets, minimizing errors in reading angular measurements. The study’s objective was (1) to evaluate the reliability of WBCT semiautomatic imaging measures in HR, (2) to evaluate correlation and agreement between manual and semiautomatic measures in the setting of HR, and (3) to compare semiautomatic measurements between pathologic (HR) and standard control groups. Methods: A retrospective study of HR patients was performed including 20 feet with HR. WBCT manual and semiautomatic 3D measurements were performed using the following parameters: (1) first metatarsal-proximal phalanx angle (1stMPP), (2) hallux valgus angle (HVA), (3) first to second intermetatarsal angle (IMA), (4) hallux interphalangeal angle (IPA), (5) first metatarsal length (1stML), (6) second metatarsal length (2ndML), (7) first metatarsal declination angle (1stMD), (8) second metatarsal declination angles (2ndMD), and (9) metatarsus primus elevatus (MPE). The differences between pathologic and control cases were assessed with a Wilcoxon test. Results: Interobserver and intraobserver agreement for manual vs semiautomatic WBCT measurements demonstrated excellent reliability. According to the Pearson coefficient, there was a strong positive linear correlation between both methods for the following parameters evaluated: HVA (ρ = 0.96), IMA (ρ = 0.86), IPA (ρ = 0.89), 1stML (ρ = 0.96), 2ndML (ρ = 0.91), 1stMD (ρ = 0.86), 2ndMD (ρ = 0.95), and MPE (ρ = 0.87). Comparison between the pathologic group with HR and the control (standard) group allowed for the differentiating of the pathologic (HR) from the non-pathologic conditions for MPE (p < 0.05). Conclusion: Semiautomatic measurements are reproducible and comparable to measurements performed manually, showing excellent interobserver and intraobserver agreement. The software used differentiated pathologic from nonpathologic conditions when submitted to semiautomatic MPE measurements. Level of Evidence: Level III, retrospective comparative study.

show abstract

Early results and complication rate of the LapiCotton procedure in the treatment of medial longitudinal arch collapse: a prospective cohort study

Ehret

Walt

Chinelati

et al. 2022

Arch Orthop Trauma Surg

Self Cite

View full text Add to dashboard Cite

Introduction Instability/collapse of the medial column has been associated with many conditions, particularly progressive collapsing foot deformity (PCFD), hallux valgus (HV), and midfoot arthritis (MA). Restoration of first ray length and sagittal plane alignment to restore the foot tripod is essential when treating these deformities. This study aimed to assess early results, healing, and complication rate of a distraction dorsal opening plantarflexion wedge allograft first tarsometatarsal joint fusion (LapiCotton Procedure) in patients with collapse/instability of the medial column. Methods In this prospective cohort study, we included PCFD, HV, and MA patients that underwent a LapiCotton procedure. Fusion site healing was defined by > 50% bone bridging in both interfaces between allograft wedge and host bone using weight-bearing computed tomography (WBCT) after 3 months. First ray collapse radiographic correction and minor and major complications (deep dehiscence, deep infection, and reoperation) were assessed. Results A total of 22 patients (22 feet) were included (11 PCFD, 6 MA, and 5 of HV patients). Mean follow-up was 5.9 months (range 3–12) and median allograft size was 8 mm (range 5–19 mm). Bone healing was observed in 91% of cases. Two minor complications (9%, both superficial dehiscence) and one major complication (4.5%, deep infection) were observed. Statistically significant improvement of the sagittal plane talus-first metatarsal angle was observed, with mean improvement of 9.4° (95% CI 6.7–12.1°; p < 0.0001). Conclusion In this prospective cohort study of 22 patients treated with the LapiCotton procedure for medial longitudinal arch collapse/instability, we observed a low complication rate (9% minor, 4.5% major), high healing rate after 3 months (91%), one clinically stable radiographic non-union (4.5%) and one unstable non-union (4.5%) needing reoperation. Our results demonstrate promising initial results for LapiCotton technique in treating collapse of the medial longitudinal arch in patients with PCFD, MA and HV deformities. Long-term results are needed to confirm these promising results. Level of evidence Level II, prospective cohort study.

show abstract

Does metatarsus primus elevatus really exist in hallux rigidus? A weightbearing CT case–control study

Cited by 6 publications

References 29 publications

A comparison between the Bluman et al. and the progressive collapsing foot deformity classifications for flatfeet assessment

A comparison between the Bluman et al. and the progressive collapsing foot deformity classifications for flatfeet assessment

The Use of Advanced Semiautomated Bone Segmentation in Hallux Rigidus

Early results and complication rate of the LapiCotton procedure in the treatment of medial longitudinal arch collapse: a prospective cohort study

Contact Info

Product

Resources

About