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. 2023 Feb 1;13(1):1815.
doi: 10.1038/s41598-023-28469-4.

Investigation on the site of coronal deformities in Hallux valgus

Rachel Xiaoyu Wei  1   2 , Violet Man-Chi Ko  1 , Elvis Chun-Sing Chui  1 , Bruma Sai-Chuen Fu  1 , Vivian Wing-Yin Hung  1 , Patrick Shu-Hang Yung  1 , Samuel Ka-Kin Ling  3
Affiliations

Investigation on the site of coronal deformities in Hallux valgus

Rachel Xiaoyu Wei et al. Sci Rep. .

Abstract

Hallux valgus (HV) is a common foot deformity that is more prevalent in females, characterised by abnormal adduction of the first metatarsal (MT) and valgus deviation of the phalanx on the transverse plane. Increasing evidence indicates that HV is more than a 2D deformity but a 3D one with rotational malalignment. Pronation deformity is seen during clinical examination for HV patients, but the exact origin of this rotational deformity is still unknown. Some attribute it to first tarsometatarsal (TMT) joint rotation, while others attribute it to intra-metatarsal bony torsion. In addition, the correlation between the rotational and transverse plane deformity is inconclusive. Identifying the origin of the rotational deformity will help surgeons choose the optimal surgical procedure while also enhancing our understanding of the pathophysiology of HV. This study aims to (1) develop an objective method for measuring the first MT torsion and first TMT joint rotation; (2) investigate the exact location of the coronal deformity in HV; (3) investigate the relationship between the severity of deformity on the transverse and coronal planes as well as the correlation between deformity severity and foot function/symptoms in HV. Age-matched females with and without HV were recruited at the Foot and Ankle Clinic of the Department of Orthopaedics and Traumatology. Computed tomography was conducted for all subjects with additional weight-bearing dorsal-plantar X-ray examination for HV subjects. Demographic information of all subjects was recorded, with symptoms and functions related to HV evaluated. The intra-class correlation was used to explore the relationship between deformities on different planes and the deformity severity and functional outcomes, respectively. An Independent t-test was used to compare joint rotation and bone torsion degrees. TMT joint rotation is significantly correlated with foot function. HV patients had more TMT joint rotation but not MT torsion compared to normal controls. No relationship was found between the coronal rotation and the 1,2-intermetatarsal angle (IMA) or Hallux valgus angle (HVA) on the transverse plane. Our results indicate that coronal deformities in HV may originate from TMT joint rotation. In addition, the severity of the TMT joint coronal rotation correlates with worse foot function; thus, multi-plane assessment and examination will be necessary for more precise surgical correction.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
The wedge was put at the end of the splint to support the foot.
Figure 2
Figure 2
The subject’s foot was immobilised in the splint with two bandages.
Figure 3
Figure 3
The middle one-third of the whole articular surface of the MT head was marked and extracted from the view of the distal pole.
Figure 4
Figure 4
The cylinder was created by the least-square method and the axis of this fitting cylinder represented the position of the distal end of the first MT.
Figure 5
Figure 5
(A) A fitting cylinder of the diaphysis was created. (B) A cross-section beneath the articular surface was extracted. (C) Vector B was created by connecting the most superior and inferior point.
Figure 6
Figure 6
(A) A fitting plane was created based on the highlighted articular surface. (B) Vector C was created by connecting the two most lateral points on the cross-section.
Figure 7
Figure 7
The definition of first MT torsion angle and TMT joint rotation angle.
See this image and copyright information in PMC

References

    1. Nix S, Smith M, Vicenzino B. Prevalence of hallux valgus in the general population: A systematic review and meta-analysis. J. Foot Ankle Res. 2010;3:21. doi: 10.1186/1757-1146-3-21. - DOI - PMC - PubMed
    1. Coughlin MJ, Jones CP. Hallux valgus: Demographics, etiology, and radiographic assessment. Foot Ankle Int. 2007;28:759–777. doi: 10.3113/FAI.2007.0759. - DOI - PubMed
    1. Hurn SE, Matthews BG, Munteanu SE, Menz HB. Effectiveness of nonsurgical interventions for hallux valgus: A systematic review and meta-analysis. Arthritis Care Res. (Hoboken) 2021;74:1676–1688. doi: 10.1002/acr.24603. - DOI - PubMed
    1. Heineman N, Liu G, Pacicco T, Dessouky R, Wukich DK, Chhabra A. Clinical and imaging assessment and treatment of hallux valgus. Acta Radiol. 2020;61:56–66. doi: 10.1177/0284185119847675. - DOI - PubMed
    1. Coughlin, M. J., Mann, R. A., Saltzman, C. L. Surgery of the Foot and Ankle. (Mosby St. Louis, 1999).