Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Mar 18;10(1):24730114251325854.
doi: 10.1177/24730114251325854. eCollection 2025 Jan.

A Hallux Valgus Surgical Planning Survey Using WBCT-based 3D Printing

François Lintz  1   2 , Enrico Pozzessere  2 , Wolfram Grün  2   3   4 , Antoine Acker  2   5 , Erik Jesús Huánuco Casas  2   6 , Eric Ferkel  7 , Cesar de Cesar Netto  2
Affiliations

A Hallux Valgus Surgical Planning Survey Using WBCT-based 3D Printing

François Lintz et al. Foot Ankle Orthop. .

Abstract

Background: Recent literature highlights the importance of treating hallux valgus (HV) as a 3-dimensional (3D) deformity. Although 3D printing may enhance visualization of the multiplanar aspects of HV, its influence on surgical planning remains unclear. This study assessed changes in surgical plans when surgeons sequentially reviewed 2D radiographs, 3D weightbearing computed tomography (WBCT), and 3D-printed models, hypothesizing that 3D printing would have the greatest impact.

Methods: A single HV case (a 40-year-old woman, intermetatarsal angle [IMA] 21 degrees, HV angle [HVA] 47 degrees) was evaluated by 30 surgeons in a masked, stepwise manner. Surgical plans were recorded at each stage. Surgeons rated the influence of WBCT and 3D printing using a 5-point Likert scale. A follow-up survey examined the effect of these technologies on correction amplitudes.

Results: The participants were mostly early career surgeons (median age 35.5 years, 2 years in practice). WBCT was accessible to 43.3% and used in 30% of HV cases, whereas 3D printing was accessible to 23.3% and used in 6.6%. Changes in the treatment algorithm occurred in 30% of cases after WBCT and in 43.3% after 3D printing. Significant differences (P < .05) were observed for the Lapicotton procedure between radiography and WBCT, and between WBCT and 3D printing. Surgeons performing <50 HV cases annually or with >70% Foot and Ankle specialization were more influenced by WBCT. Follow-up data (n = 23) indicated that WBCT and 3D printing influenced correction amplitudes, particularly for pronation and distal metatarsal articular angle (DMAA), more than for the IMA.

Discussion: Both WBCT and 3D printing influenced surgical planning, mostly explained by changes in first ray tarsometatarsal procedures. The rotational components (pronation and DMAA) were perceived as the most significantly affected. Future studies should explore cost-effectiveness, patient outcomes, and the utility of combining WBCT and 3D printing in other deformities requiring multiplanar corrections.Level of Evidence: Level IV, cross-sectional survey.

Keywords: 3D-printing; cone beam; hallux valgus; weightbearing computed tomography.

PubMed Disclaimer

Conflict of interest statement

The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: François Lintz, MD, PhD, reports disclosures from Paragon28 (consultant, shareholder), CurvebeamAI (consultant, shareholder), Newclip Technics (consultant, royalties), Podonov (consultant, royalties), LINNOV (founder, shareholder), Followinvest (shareholder), and International WBCT Society (cofounder, past president). Antoine Acker, MD, reports disclosures from CurvebeamAI (shareholder). Eric Ferkel, MD, reports disclosures from Ossio, Arthrex, Smith & Nephew, Medartis (consulting fees, royalties), International Bone Research Association (IBRA), American Academy of Orthopaedic Surgeons (AAOS) (support for attending meetings), and AAOS, American Orthopaedic Society for Sports Medicine (AOSSM), American Orthopaedic Foot & Ankle Society (AOFAS), Arthroscopy Association of North America (AANA) leadership roles. Cesar de Cesar Netto, MD, PhD, reports disclosures from Paragon28 (consultant, medical advisory board, royalties), CurvebeamAI (consultant, shareholder), Ossio (consultant), Zimmer (consultant), Stryker (consultant), International WBCT Society (cofounder, President), Exactech (consultant), Arthrex (consultant), Tayco Brace (shareholder), Extremity Medical (consultant), AOFAS committee member, and Foot Ankle Clinics (editor in chief). Disclosure forms for all authors are available online.

Figures

Visual Abstract
Visual Abstract
This is a visual representation of the abstract.
Figure 1.
Figure 1.
An example of first metatarsophalangeal joint congruity evaluation pre (left) and post (right) correction using a 3D-printed model.
Figure 2.
Figure 2.
Plain radiographic dorsal-plantar view of the case.
Figure 3.
Figure 3.
Weightbearing computed tomography coronal slice showing first metatarsal pronation and subluxation of the sesamoid complex.
Figure 4.
Figure 4.
(A) Result of 3D printing showing a coronal view of the first column. (B) Result of 3D printing showing an anteroposterior view of the first column.
Figure 5.
Figure 5.
Distribution of initial treatment algorithm after presentation of conventional radiographic material.
Figure 6.
Figure 6.
(A) Pooled histogram of weightbearing computed tomography (WBCT) influence on algorithms based on experience with hallux valgus (HV). (B) Normalized pooled histogram of WBCT influence on algorithms based on surgeon specialization.
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. 3D-Printing Surgical Planning Study. https://forms.gle/1DpH9J6MFbpUprLU8
    1. 3D-Printing Surgical Planning Survey. https://forms.gle/Tk1KAvaQgpTpq1Hg6
    1. Alemayehu DG, Zhang Z, Tahir E, Gateau D, Zhang DF, Ma X. Preoperative planning using 3D printing technology in orthopedic surgery. Biomed Res Int. 2021;2021:7940242. doi:10.1155/2021/7940242 - DOI - PMC - PubMed
    1. Alexander NB, Sarfani S, Strickland CD, et al.. Cost analysis and reimbursement of weightbearing computed tomography. Foot Ankle Orthop. 2023;8(1):24730114231164143. doi:10.1177/24730114231164143 - DOI - PMC - PubMed
    1. Bhandari M, Swiontkowski MF, Einhorn TA, et al.. Interobserver agreement in the application of levels of evidence to scientific papers in the American volume of the Journal of Bone and Joint Surgery. J Bone Joint Surg Am. 2004;86(8):1717-1720. doi:10.2106/00004623-200408000-00016 - DOI - PubMed

LinkOut - more resources