Spring ligament insufficiency and hallux valgus as an independent risk factors for first ray instability

Pasapula, Chandra; Al‐Sukaini, Ahmad; Band, Hisham; Fawi, Hassan; Cutts, Steven

doi:10.1016/j.foot.2021.101818

Cited by 6 publications

(2 citation statements)

References 29 publications

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“…Besides the variations of surgical techniques, the intrinsic features of HV, such as spring ligament insufficiency [ 70 ], first ray hypermobility [ 71 ], hypermobility due to malpractice in amateur ballet dancers [ 72 ], generalized ligament laxity [ 73 ], medial column instability, and posterior tibial tendon dysfunction [ 74 ], may have contributed to clinical heterogeneity as well. Moreover, HV was often compounded with other foot problems that were infeasible to isolate [ 59 , 75 ], such as flatfoot [ 76 ], plantar fasciitis [ 77 ], transfer metatarsalgia [ 18 ], and claw toes [ 78 ].…”

Section: Discussionmentioning

confidence: 99%

Forefoot Function after Hallux Valgus Surgery: A Systematic Review and Meta-Analysis on Plantar Load Measurement

Wong

Cheung

Zhao

et al. 2023

JCM

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While hallux valgus (HV) surgeries are useful for correcting skeletal alignment problems, their effects on plantar load, which reflects forefoot functions, are less understood. The objective of this study is to conduct a systematic review and meta-analysis on the plantar load change after HV surgeries. A systematic search of Web of Science, Scopus, PubMed, CENTRAL, EMBASE, and CINAHL was performed. Studies that assessed the pre- and post-operative plantar pressure of HV patients undergoing surgeries and reported load-related parameters over the hallux, medial metatarsal, and/or central metatarsal regions were included. Studies were appraised by using the modified NIH quality assessment tool for before-after study. Studies suitable for meta-analysis were pooled with the random-effects model, using the standardized mean difference of the before-after parameters as an effect measure. Twenty-six studies containing 857 HV patients and 973 feet were included for the systematic review. Meta-analysis was conducted on 20 of them, and most studies did not favor HV surgeries. Overall, HV surgeries reduced the plantar load over the hallux region (SMD −0.71, 95% CI, −1.15 to −0.26), indicating that forefoot function worsened after surgeries. For the other five outcomes, the overall estimates were not statistically significant, indicating that surgeries did not improve them either. There was substantial heterogeneity among the studies, which in most cases could not be resolved by pre-planned subgroup analyses by surgical classification, year of publication, median age of patients, and length of follow-up. Sensitivity analysis removing lower-quality studies showed that the load integrals (impulse) over the central metatarsal region significantly increased (SMD 0.27, 95% CI, 0 to 0.53), indicating that surgeries increased the risk of transfer metatarsalgia. There is no solid evidence that HV surgeries could improve forefoot functions from a biomechanical point perspective. Currently available evidence even suggests that surgeries might reduce the plantar load over the hallux and adversely affect push-off function. The reasons behind and the effectiveness of alternative surgical methods warrant further investigation.

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Section: Discussionmentioning

confidence: 99%

Forefoot Function after Hallux Valgus Surgery: A Systematic Review and Meta-Analysis on Plantar Load Measurement

Wong

Cheung

Zhao

et al. 2023

JCM

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“…Coughlin et al 2 showed how the instability measured with the Klaue device improved after a metatarsal osteotomy, stating that instability is secondary to the deformity and not a joint instability itself (it is a consequence and not the cause). Pasapula et al 12 recently showed how there appears to exist some relationship (independent risk factors) between hallux valgus, spring ligament insufficiency, and first-ray instability, thus suggesting a multi- ligament compromise in hallux valgus. The previous findings could make us suggest that some importance can be given to different joints in the medial column other than only the first tarsometatarsal one, when addressing hallux valgus pathology.…”

Section: Discussionmentioning

confidence: 99%

Biomechanical Cadaveric Evaluation of the Role of Medial Column Instability in Hallux Valgus Deformity

Wagner

Pacheco

et al. 2022

Foot Ankle Int.

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Background: Medial column instability is a frequent finding in patients with flatfeet and hallux valgus, within others. The etiology of hallux valgus is multifactorial, and medial ray axial rotation has been mentioned as having an individual role. Our objective was to design a novel cadaveric foot model where we could re-create through progressive medial column ligament damage some components of a hallux valgus deformity. Methods: Ten fresh-frozen lower leg specimens were used, and fluorescent markers were attached in a multisegment foot model. Constant axial load and cyclic tibial rotation (to simulate foot pronation) were applied, including pull on the flexor hallucis longus tendon (FHL). We first damaged the intercuneiform (C1-C2) ligaments, second the naviculocuneiform (NC) ligaments, and third the first tarsometatarsal ligaments, leaving the plantar ligaments unharmed. Bony axial and coronal alignment was measured after each ligament damage. Statistical analysis was performed. Results: A significant increase in pronation of multiple segments was observed after sectioning the NC ligaments. Damaging the tarsometatarsal ligament generated small supination and varus changes mainly in the medial ray. No significant change was observed in axial or frontal plane alignment after damaging the C1-C2 ligaments. The FHL pull exerted a small valgus change in segments of the first ray. Discussion: In this biomechanical cadaveric model, the naviculocuneiform joint was the most important one responsible for pronation of the medial column. Bone pronation occurs along the whole medial column, not isolated to a certain joint. Flexor hallucis longus pull appears to play some role in frontal plane alignment, but not in bone rotation. This model will be of great help to further study medial column instability as one of the factors influencing medial column pronation and its relevance in pathologies like hallux valgus. Clinical Relevance: This cadaveric model suggests a possible influence of medial column instability in first metatarsal pronation. With a thorough understanding of a condition’s origin, better treatment strategies can be developed.

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Injuries to the Spring Ligament

Richie

2022

Clinics in Podiatric Medicine and Surgery

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Spring ligament insufficiency and hallux valgus as an independent risk factors for first ray instability

Cited by 6 publications

References 29 publications

Forefoot Function after Hallux Valgus Surgery: A Systematic Review and Meta-Analysis on Plantar Load Measurement

Forefoot Function after Hallux Valgus Surgery: A Systematic Review and Meta-Analysis on Plantar Load Measurement

Biomechanical Cadaveric Evaluation of the Role of Medial Column Instability in Hallux Valgus Deformity

Injuries to the Spring Ligament

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