Hallux Valgus and the First Metatarsal Arch Segment: A Theoretical Biomechanical Perspective

Abstract

Hallux valgus is a progressive foot deformity characterized by a lateral deviation of the hallux with corresponding medial deviation of the first metatarsal. Late-stage changes may render the hallux painful and without functional utility, leading to impaired gait. Various environmental, genetic, and anatomical predispositions have been suggested, but the exact cause of hallux valgus is unknown. Evidence indicates that conservative intervention for hallux valgus provides relief from symptoms but does not reverse deformity. Part 1 of this perspective article reviews the literature describing the anatomy, pathomechanics, and etiology of hallux valgus. Part 2 expands on the biomechanical initiators of hallux valgus attributed to the first metatarsal. Theory is advanced that collapse of the arch with vertical orientation (tilt) of the first metatarsal axis initiates deformity. To counteract the progression of hallux valgus, we use theory to discuss a possible mechanism by which foot orthoses can bolster the arch and reorient the first metatarsal axis horizontally.

An Imaged-Based Three-Dimensional Study of First Metatarsal Protrusion Distance in Women with and Without Hallux Valgus

“…This advice is also germane for research planning to quantify MPD in patient populations. Additionally, since collapse of the arch is a common predisposition of hallux valgus, 27,30,42 radiographic distortion attributed to arch height may, in part, explain why first metatarsal protrusion has been so consistently recorded on radiographs in the study of hallux valgus. Because this study measured MPD with 3-D methods instead of single-plane radiographs, and recorded the measure in relation to the navicular, which is novel, we cannot know whether these findings are indicative of the cohorts sampled, or a manifestation of the methods.…”

“…[27][28][29][30][31][32] Therefore, measurements of MPD cannot be compared to data acquired by conventional radiographic methods. This limitation is notable, because despite the advancements in 3-D image-based technology, 35,37,38 radiographic evaluations remain the standard in clinical practice.…”

“…[27][28][29][30][31][32] The weightbearing images were acquired from 2008 to 2010. Nineteen of the women had hallux valgus, 29,31,32 as defined by an enlarged hallux angle.…”

Effect of foot posture on foot-specific health-related quality of life

“…Several authors have suggested that the pressure exerted on medial side of the foot and capsule of the irst metatarsophalangeal joint may cause development and progression of HV deformity [12,23]. Therefore, we aimed to determinate how much the amount of navicular drop would affect the HV angular severity and foot-speci ic health related quality of life in this study.…”

Range of motion and pain intensity of the first metatarsophalangeal joint in women with hallux valgus deformation after two-month home exercise programme

“…Resulting from previous there are changes in position of the foot muscles [2,8]. The deformation is considered to be progressive and irreversible [4,10]. According to different sources HV occurs in about 23% of population [7] and is associated with female gender, older age, and pain in other bodily regions [9].…”