Effect of First Ray Insufficiency and Metatarsal Index on Metatarsalgia in Hallux Valgus

Abstract

Category: Midfoot/Forefoot Introduction/Purpose: There are two concepts that tried to explain the etiology of metatarsalgia in hallux valgus patients: First, the one that states that as the magnitude of hallux valgus increases, there is a mechanical overload of the lesser metatarsals. Second, that an increased relative lesser metatarsal length is a factor in the development of metatarsalgia. However there is no current evidence that these facts predisposes for primary metatarsalgia. The purpose of the study was to evaluate the factors associated with metatarsalgia in hallux valgus patients. Methods: A cross-sectional study of 121 consecutive adult patients with non-arthritic hallux valgus was carried out. Binary logistic regression was performed to identify the effect of the clinical and demographic factors on the occurrence of metatarsalgia. Results: One hundred twenty one patients (184 feet) with hallux valgus were analyzed. The median weight was 65 Kg (IQR 58 – 72). Metatarsalgia was present in 84 (45.6%) feet. The binary logistic regression showed that lesser toe deformity (OR 2.6 IC95% 0.2-0.5), gastrocnemius shortening (OR 5.8 IC95% 2.8-12.3), metatarsal index (OR 0.3 IC95% 0.2-0.5) and weight (OR 2.5 IC95% 1.2-5.3) were significantly associated. Conclusion: Metatarsalgia occurs in almost a half of hallux valgus patients. It has a multifactorial etiology. Our finding questions the common theory that both the magnitude of hallux valgus deformity and an increased length of a lesser metatarsal by themselves, predisposes for primary metatarsalgia. Metatarsalgia was associated with Achilles shortening, excessive weight and associated lesser toe deformity. These factors should be addressed in order to treat this disorder adequately.

Association of Abnormal Metatarsal Parabola With Second Metatarsophalangeal Joint Plantar Plate Pathology

“…After all, a long second metatarsal will not, by itself, be sufficient to produce a tear. Rather, most tears will depend on the interplay of both suboptimal genetics (eg, foot structure and function) 27 and hazardous environmental conditions (eg, activity and shoe gear). Future work may explore the potential interactive effects of metatarsal length and these other factors (e.g., tight Achilles tendon, cavus foot type, high-heeled shoe gear).…”

Proximal Gastrocnemius Release in the Treatment of Mechanical Metatarsalgia

“…The relationship between the first and second metatarsal showed that 27 patients had index minus formula (if first metatarsal was shorter than second), 5 index plus (first metatarsal longer than second), and 20 index plus-minus (first and second metatarsal of equal length). 34…”

“…The relationship between the first and second metatarsal showed that 27 patients had index minus formula (if first metatarsal was shorter than second), 5 index plus (first metatarsal longer than second), and 20 index plusminus (first and second metatarsal of equal length). 34 Groups were divided according to type of mechanical metatarsalgia. Sixteen cases (20.5%) had metatarsalgia of the second and third rocker, 44 (56.4%) had metatarsalgia of second rocker, and 18 (23.1%) metatarsalgia of third rocker (Table 1).…”

Estudo radiográfico axial do antepé para a avaliação do alinhamento da cabeça dos metatarsais no plano coronal

“…Dentro do grupo com metatarsalgia encontramos um subgrupo com hálux valgo (31%), achado compatível com a literatura, que mostra uma forte associação entre essas duas patologias 30,58,65 . Porém a repercussão da deformidade em valgo do hálux na disposição das cabeças dos metatarsais com carga no plano coronal não é clara.…”

“…Muito se discute sobre a associação do hálux valgo com a instabilidade da 1ª articulação tarsometatarsal nos planos sagital e coronal, inclusive uma relação de causalidade entre a deformidade e a instabilidade, mas ainda não há consenso entre os autores [53][54][55][56]60,65,72,73 .…”