Observed Changes in Radiographic Measurements of the First Ray after Frontal and Transverse Plane Rotation of the Hallux: Does the Hallux Drive the Metatarsal in a Bunion Deformity?

Quantitative Analysis of the Degree of Frontal Rotation Required to Anatomically Align the First Metatarsal Phalangeal Joint During Modified Tarsal-Metatarsal Arthrodesis Without Capsular Balancing

“…This result is consistent with the studies by Inman (20), Talbot and Saltzman (21), and Dayton et al (13,14), which showed a pronated metatarsal will increase the sesamoid position on anteroposterior radiographs. In conjunction with the work by Okuda et al (6,12,18) and Grode and McCarthy (1), we advance the idea that the sesamoid position, lateral rounding of the metatarsal head, and the appearance of a medial eminence are effective indicators of the rotational position in the assessment, correction, and follow-up of patients with bunion deformities.…”

“…They also hypothesized that the sesamoid position might be related to the amount of rotation (18). Dayton et al (13,14), in a series of cadaveric studies, showed that lateral roundness of the metatarsal head and sesamoid position are a product of metatarsal eversion or pronation. In addition, Dayton et al (13,14) showed that the hallux could be a driver of this positional change in the metatarsal.…”

“…Dayton et al (13,14), in a series of cadaveric studies, showed that lateral roundness of the metatarsal head and sesamoid position are a product of metatarsal eversion or pronation. In addition, Dayton et al (13,14) showed that the hallux could be a driver of this positional change in the metatarsal. DiDomenico et al (8) described using this ligamentotaxis to directionally drive the metatarsal in the same direction as the rotating hallux to correct the rotational component of a bunion when performing Lapidus arthrodesis.…”

Can the Syndesmosis Procedure Prevent Metatarsus Primus Varus and Hallux Valgus Deformity Recurrence? A 5-Year Prospective Study

“…HV deformity has several possible underlying causative factors such as an increased distal metatarsal articular angle, HV interphalangeus, and axial deformity of the first metatarsal (29,30). However, MPV deformity is still considered the most consistent factor, and its importance is reflected by its mandatory correction in all surgical techniques and that it is one of the most recognized measurements for operative success.…”

Hallux Valgus

“…The first ray should be assessed for range of motion, ligamentous laxity or contractures, and passive correction of the deformity, including internal rotation of the hallux to allow for assessment of the reducibility of the first ray in the frontal plane. 21 The first MTP joint should be fully evaluated for any skin changes, pain, crepitus, or decreased motion consistent with arthritic changes. It is important to evaluate for any other concomitant processes including hammertoe deformity, pes planus, equinus of the Achilles complex, or first ray hypermobility.…”