First-Ray Radiographic Changes After Flexible Adult Acquired Flatfoot Deformity Correction

Wang, Chien-Shun; Tzeng, Yun-Hsuan; Yang, Tsuey Ching; Lin, Chun‐Cheng; Chang, Ming-Chau; Chiang, Chao-Ching

doi:10.1177/10711007211034516

Cited by 8 publications

(8 citation statements)

References 31 publications

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“…Limitations of this study primarily stem from the relatively short follow-up period post-surgery, which is nonetheless consistent with similar studies by Wang and Matsumoto [4,5]. Additionally, after 6 months, patients were able to resume high-impact sports, suggesting that the clinical condition was sufficiently stabilized for a radiological evaluation.…”

Section: Limitationssupporting

confidence: 57%

“…Previous investigations in adults have shown varying outcomes regarding radiographic changes in the first ray following deformity correction surgery [4,5]. Wang et al examined patients with Adult Acquired Flatfoot Deformity (AAFD) who underwent soft tissue and bony procedures, including medializing calcaneal osteotomy and Cotton osteotomy [5]. They hypothesized that following AAFD surgery, reduction in HVA may occur due to first metatarsal bone supination.…”

Section: Discussionmentioning

confidence: 99%

“…Given the influence of the subtalar joint on the midfoot and forefoot, it is plausible that correcting flatfoot deformity may result in changes in forefoot parameters, particularly at the first ray. While previous studies in adults have investigated radiographic changes in the first ray following flatfoot deformity correction [4,5], with controversial results, no similar investigations have been conducted in pediatric patients with flexible flatfoot.…”

Section: Introductionmentioning

confidence: 99%

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Do First Ray-Related Angles Change Following Subtalar Arthroereisis in Pediatric Patients? A Radiographic Study

Mazzotti,

Langone,

Zielli

et al. 2024

Preprint

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Introduction: Subtalar Arthroereisis (STA) is a surgical intervention for pediatric flexible flatfoot (PFF), primarily targeting hindfoot alignment by limiting excessive subtalar eversion. However, its effects on forefoot parameters remain underexplored. This study aims to investigate radiological changes following STA in pediatric patients. Materials and Methods: A retrospective analysis was conducted on consecutive patients treated with STA for PFF. First ray-related angles, including Hallux Valgus Angle (HVA) and Inter-Metatarsal Angle (IMA), alongside hindfoot radiological parameters such as Meary, Calcaneal Pitch, and Costa Bartani angles, were assessed. Subgroup analysis by gender was performed, and correlations between demographic and pre-operative radiological parameters were examined. Results: Forty-one patients (81 feet) with a mean age of 11.6 years were included, with a mean follow-up duration of 6.4 months. No significant differences were observed in first ray-related an-gles pre- and post-operatively, with mean IMA changing from 7.97° to 7.18° and mean HV angles from 9.51° to 8.66°. Noteworthy improvements were seen in flat foot angles, including Meary, Calcaneal Pitch, and Costa Bartani angles, postoperatively. Age subgroup analysis revealed similar trends in IMA and HVA changes between Group A (operated before peak growth) and Group B (operated later). Higher preoperative angles tended to improve, while lower preoperative IMA and HVA tended to worsen postoperatively, all remaining within normal ranges. Conclusion: STA showed positive radiological outcomes for PFF treatment, while negligible changes in first ray-related angles were observed. Age subgroup analysis indicated similar trends regardless of operation timing. Higher preoperative angles tended to improve, while lower preoperative angles tended to worsen postoperatively, despite all falling within non-pathological ranges. Further re-search is warranted to confirm this correlation.

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Section: Limitationssupporting

confidence: 57%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Do First Ray-Related Angles Change Following Subtalar Arthroereisis in Pediatric Patients? A Radiographic Study

Mazzotti,

Langone,

Zielli

et al. 2024

Preprint

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“…Recent studies showed that presence of progressive collapsing foot deformities (PCFDs), which is a condition frequently associated with HV, can strongly influence the medial column coronal plane alignment. 1,12,14 Therefore, this must be taken into account when assessing the origin of the pronation of the M1 head.…”

Section: Introductionmentioning

confidence: 99%

Coronal Plane Rotation of the Medial Column in Hallux Valgus: A Retrospective Case-Control Study

et al. 2022

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Background: We previously reported an increase in pronation of the first metatarsal (M1) head relative to the ground in hallux valgus (HV) patients compared to controls. Still, the origin and location of this hyperpronation along the medial column is unknown. Recent studies showed that presence of progressive collapsing foot deformities (PCFDs), which is a condition frequently associated with HV, can strongly influence the medial column coronal plane alignment. The objective of this study was to assess the coronal rotation of the medial column bones in HV feet, HV feet with radiologic markers of PCFD, and controls. We hypothesized that hyperpronation in HV will originate from a combination of M1 intrinsic torsion and first tarsometatarsal joint malposition. Methods: The same cohort of 36 HV and 20 controls matched on age, gender, and body mass index was used. Previously, a validation of the measurements was carried out through a cadaveric study. Using these metrics, we assessed the coronal plane rotation of the navicular, medial cuneiform, and the M1 at its base and head with respect to the ground using weightbearing CT images. We measured the Meary angle and the calcaneal moment arm in our 36 HV subjects. We subdivided our cohort into an HV group and a potential PCFD HV group according to these measurements. Comparisons on medial column bones coronal rotation were performed between HV, PCFD HV, and control groups. Results: Twenty-two HV cases were included in the HV group and 14 in the PCFD HV group. Both groups presented an increase in pronation of the first metatarsal head relative to the ground when compared to the control group ( P < .001). Comparing HV and controls showed an 8.3 degrees increase in pronation of M1 intrinsic torsion ( P < .001) and a 4.7 degrees pronated malposition of the first tarsometatarsal joint ( P = .02) in HV. A 9.7 degrees supinated malposition of the first naviculocuneiform joint ( P < .001) was also observed in HV. Comparing PCFD HV and controls showed a significant increase in pronation of the navicular (respectively, 17.2 ± 5.4 and 12.3 ± 3.4 degrees, P = .007) and a 5.5 degrees increase in pronation of M1 intrinsic torsion ( P = .02) in PCFD HV, without malposition of the first tarsometatarsal and naviculocuneiform joints. Conclusion: Hyperpronation of the M1 head relative to the ground originated from both increases in pronation of M1 intrinsic torsion and first tarsometatarsal joint malposition in HV, although partially counterbalanced by a supinated malposition of the first naviculocuneiform joint. On the other hand, PCFD HV patients showed a generalized pronated position throughout the medial column from the navicular to the M1 head and may be related to the midfoot and hindfoot deformities frequently present in PCFD. Level of Evidence: Level III, retrospective comparative study.

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“…We appreciate the interest and comments by Del Vecchio et al in their Letter to the Editor regarding our recently published article. 4…”

mentioning

confidence: 99%

Response to “Letter Regarding: First-Ray Radiographic Changes After Flexible Adult Acquired Flatfoot Deformity Correction”

Wang¹,

Chiang²,

Tzeng³

et al. 2022

Foot Ankle Int.

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First-Ray Radiographic Changes After Flexible Adult Acquired Flatfoot Deformity Correction

Cited by 8 publications

References 31 publications

Do First Ray-Related Angles Change Following Subtalar Arthroereisis in Pediatric Patients? A Radiographic Study

Do First Ray-Related Angles Change Following Subtalar Arthroereisis in Pediatric Patients? A Radiographic Study

Coronal Plane Rotation of the Medial Column in Hallux Valgus: A Retrospective Case-Control Study

Response to “Letter Regarding: First-Ray Radiographic Changes After Flexible Adult Acquired Flatfoot Deformity Correction”

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