The Windswept Foot: Dealing with Metatarsus Adductus and Toe Valgus

Leucht, Anna-Kathrin; Younger, Alastair; Veljkovic, Andrea; Perera, Anthony

doi:10.1016/j.fcl.2020.05.005

Cited by 6 publications

(4 citation statements)

References 24 publications

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“…1,5 As the angular deformity increases, the sagittal joint instability may subsequently increase for all toes. 24 The present study revealed that DDR and MAA were weakly positively correlated.…”

Section: Discussionmentioning

confidence: 44%

Ultrasonography-Based Quantitative Evaluation of Second Metatarsophalangeal Joint Instability in Female Patients With Hallux Valgus

Shima,

Togei,

Hirai

et al. 2024

Foot Ankle Int.

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Background: Patients with moderate to severe hallux valgus (HV) sometimes exhibit second metatarsophalangeal (MTP) joint dislocation. Second MTP joint instability due to plantar plate (PP) injury has been suggested as one of the causes. However, there have been no reports that quantitatively evaluate this instability. This study aimed to evaluate second MTP joint instability in patients with HV without dislocation via ultrasonography and investigate its relationship with the presence of PP injury or foot form. Methods: Between May 2018 and July 2023, symptomatic female patients with HV without any lesser toe deformity were included in this study. Second MTP joint instability was defined as the dorsal displacement ratio (DDR) of the passively subluxated proximal phalangeal articular surface on the metatarsal head articular surface. The presence of PP injury was assessed using ultrasonography. Foot “form” was determined by measuring standard foot bony angles on weight-bearing foot-ankle radiographs. The relationship between DDR or PP injury and radiographic measurements was investigated. Results: Sixty-four patients (100 feet) were included. The average DDR of the second MTP joint in patients with HV without dislocation was 35.7%. There was an increase in the probability of PP injury, above a cutoff DDR value r of 35.4% (area under the curve = 0.712). The sensitivity, specificity, positive predictive value, and negative predictive value for the presence of PP injury based on this cutoff level were 63.9%, 74.4%, 79.6%, and 56.9%, respectively. Metatarsalgia was reported in 21 feet (21.0%), of which 15 feet (71.4%) showed PP injury. An increase in DDR was weakly associated with increased metatarsus adductus angle and decreased second metatarsal height. Conclusion: In female patients with HV without second MTP dislocation, we found ultrasonographic evidence of second MTP plantar plate injury and joint instability to be a relatively common finding with a high prevalence in those with localized metatarsalgia. Level of Evidence: Level II, development of diagnostic criteria based on consecutive patients.

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Section: Discussionmentioning

confidence: 44%

Ultrasonography-Based Quantitative Evaluation of Second Metatarsophalangeal Joint Instability in Female Patients With Hallux Valgus

Shima,

Togei,

Hirai

et al. 2024

Foot Ankle Int.

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“…Aiyer et al 1 reported a 53% prevalence of lesser toe deformity in severe metatarsus adductus cases. Leucht et al 20 suggest that this rate could be even higher than 53%, particularly in older patients with severe metatarsus adductus. In cases of less severe metatarsus adductus, the manifestation of lesser toe deformity may be less pronounced.…”

Section: Discussionmentioning

confidence: 96%

“…15 The prevalence of metatarsus adductus in patients with hallux valgus has been reported to range between 29% and 35%. 21 Drawing from the clinical experience of Leucht et al, 20 it is observed that more than half of the patients with severe metatarsus adductus exhibit lesser toe deformities. Similarly, Aiyer et al 1 reported that 53% of patients with metatarsus adductus present with lesser toe deformities.…”

Section: Introductionmentioning

confidence: 99%

Improvement of Valgus Deviation of the Lesser Toes of Moderate to Severe Hallux Valgus After Proximal Chevron Metatarsal Osteotomy and Akin Osteotomy

Kang,

Lim,

et al. 2024

Foot Ankle Int.

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Background: This study examines the correction of lesser toe valgus deviation following proximal chevron metatarsal osteotomy (PCMO) and Akin osteotomy in moderate to severe hallux valgus patients, while identifying influencing factors. Method: Among 89 patients (116 feet), those with moderate to severe hallux valgus underwent PCMO and Akin osteotomy. Radiologic assessments included preoperative metatarsus adductus angle (MAA), hallux valgus angle (HVA), intermetatarsal angle (IMA), valgus angles of the second to fourth metatarsophalangeal joints, and hallux valgus recurrence. Assessments included visual analog scale (VAS) pain scores, American Orthopaedic Foot & Ankle Society (AOFAS) scores, and patient satisfaction over an average follow-up of 30.6 ± 21.2 (range, 12-99) months. Results: The mean preoperative HVA of 34.4 degrees decreased to 8.7 degrees at final follow-up. The valgus angles of the second, third, and fourth toes improved by 37.1%, 27%, and 44.5%, respectively. In metatarsus adductus patients, lesser toe valgus angles were significantly higher both preoperatively and at final follow-up. Hallux valgus recurrence patients had higher preoperative and final follow-up IMA and valgus angles in the second and third toes. Nonrecurrence patients showed greater decreases in these angles. A larger HVA correction corresponded to a greater decrease in lesser toe valgus deviation. VAS and AOFAS scores improved significantly at the last follow-up. Conclusion: The study found a significant reduction in the valgus angle of the second, third, and fourth toes after PCMO and Akin osteotomy in moderate to severe hallux valgus cases, without additional surgeries on lesser toes. The lesser toe angular reductions were less pronounced in patients with metatarsus adductus or with hallux valgus recurrence. Level of Evidence: Level IV, case series.

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“…Therefore, bilateral MAs were defined as severe using the following scale: 0° 15°, normal; 16° 19°, mild; 20° 25°, moderate, and >25°, severe. 12 According to the formula, true IMA = IMA + (MAA − 15), 13 true IMAs of the right and left foot were 25°and 27°, respectively. Bilateral tibial sesamoid positions (TSP) were grade 7 using Hardy's classification.…”

Section: Case Reportsmentioning

confidence: 99%

Minimally invasive surgery for severe hallux valgus with severe metatarsus adductus: Case reports

Kurashige¹

2021

Foot & Ankle Surgery: Techniques, Reports & Cases

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Metatarsus adductus is a congenital transverse plane deformity with an incidence of approximately 30% in patients with hallux valgus. Operative treatment of hallux valgus with metatarsus adductus can be clinically challenging, and the recurrence rate of hallux valgus has been reported as two times higher than in patients without metatarsus adductus. Minimally invasive surgery for the correction of hallux valgus is growing in popularity; however, to our knowledge, only one study has been published on minimally invasive surgery for hallux valgus with metatarsus adductus using percutaneous proximal metatarsal osteotomy. We corrected two of three feet using percutaneous distal oblique metatarsal osteotomies for severe metatarsus adductus. Minimally invasive chevron Akin osteotomy was utilized to correct severe hallux valgus. The patient had subluxations in the second and third metatarsophalangeal joints and hammer toe deformities. Therefore, those deformities were concurrently corrected using percutaneous procedures. The patient was allowed immediate full weight bearing postoperatively in a flat rigid shoe for 6 weeks. Radiographic and clinical evaluations were performed pre-and postoperatively. All measurements, except for the lateral first metatarsal inclination angles, were improved postoperatively. Although there were delayed unions in the lesser metatarsals, there were no symptoms and all unions were achieved finally. Minimally invasive surgery including percutaneous distal metatarsal osteotomy effectively corrected severe hallux valgus with severe metatarsus adductus radiologically and clinically.

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The Windswept Foot: Dealing with Metatarsus Adductus and Toe Valgus

Cited by 6 publications

References 24 publications

Ultrasonography-Based Quantitative Evaluation of Second Metatarsophalangeal Joint Instability in Female Patients With Hallux Valgus

Ultrasonography-Based Quantitative Evaluation of Second Metatarsophalangeal Joint Instability in Female Patients With Hallux Valgus

Improvement of Valgus Deviation of the Lesser Toes of Moderate to Severe Hallux Valgus After Proximal Chevron Metatarsal Osteotomy and Akin Osteotomy

Minimally invasive surgery for severe hallux valgus with severe metatarsus adductus: Case reports

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