BACKGROUND: Hallux valgus (HV) is a triplanar deformity of the first ray including pronation of the first metatarsal with subluxation of the sesamoids. The purpose of this study was to investigate if a first tarsometatarsal fusion (modified Lapidus technique), without preoperative knowledge of pronation measured on weightbearing computed tomographic (CT) scans, changed pronation of the first metatarsal and determine if reduction of the sesamoids was correlated with changes in first metatarsal pronation. METHODS: Thirty-one feet in 31 patients with HV who underwent a modified Lapidus procedure had preoperative and at least 5-month postoperative weightbearing CT scans and radiographs. Differences in preoperative and postoperative pronation of the first metatarsal using a 3-dimensional computer-aided design, HV angle, and intermetatarsal angle (IMA) were calculated using Wilcoxon signed-rank tests. After dividing patients into groups based on sesamoid station, Kruskal-Wallis H tests were used to compare first metatarsal pronation between the groups. RESULTS: The mean preoperative and postoperative pronation of the first metatarsal was 29.0 degrees (range 15.8-51.1, SD 8.7) and 20.2 degrees (range 10.4-32.6, SD 5.4), respectively, which was a mean change in pronation of the first ray of -8.8 degrees (P < .001). There was no difference in pronation of the first ray when stratified by postoperative sesamoid position (P > .250). The average preoperative and postoperative IMA was 16.7 degrees (SD 3.2) and 8.8 degrees (SD 2.8), which demonstrated a significant change (P < .001). CONCLUSIONS: The modified Lapidus procedure was an effective tool to change pronation of the first ray. Reduction of the sesamoids was not associated with postoperative first metatarsal pronation. LEVEL OF EVIDENCE: Level IV, case series.
BACKGROUND:Hallux valgus (HV) is a triplanar deformity of the first ray including pronation of the first metatarsal with subluxation of the sesamoids. The purpose of this study was to investigate if a first tarsometatarsal fusion (modified Lapidus technique), without preoperative knowledge of pronation measured on weightbearing computed tomographic (CT) scans, changed pronation of the first metatarsal and determine if reduction of the sesamoids was correlated with changes in first metatarsal pronation. METHODS: Thirty-one feet in 31 patients with HV who underwent a modified Lapidus procedure had preoperative and at least 5-month postoperative weightbearing CT scans and radiographs. Differences in preoperative and postoperative pronation of the first metatarsal using a 3-dimensional computer-aided design, HV angle, and intermetatarsal angle (IMA) were calculated using Wilcoxon signed-rank tests. After dividing patients into groups based on sesamoid station, Kruskal-Wallis H tests were used to compare first metatarsal pronation between the groups. RESULTS: The mean preoperative and postoperative pronation of the first metatarsal was 29.0 degrees (range 15.8-51.1, SD 8.7) and 20.2 degrees (range 10.4-32.6, SD 5.4), respectively, which was a mean change in pronation of the first ray of -8.8 degrees (P < .001). There was no difference in pronation of the first ray when stratified by postoperative sesamoid position (P > .250). The average preoperative and postoperative IMA was 16.7 degrees (SD 3.2) and 8.8 degrees (SD 2.8), which demonstrated a significant change (P < .001). CONCLUSIONS: The modified Lapidus procedure was an effective tool to change pronation of the first ray. Reduction of the sesamoids was not associated with postoperative first metatarsal pronation. LEVEL OF EVIDENCE: Level IV, case series.
Entities:
Keywords:
first metatarsal pronation; first tarsometatarsal fusion; hallux valgus; weightbearing CT scan
Authors: Sergio Tejero; David González-Martín; Alfonso Martínez-Franco; Fernando Jiménez-Diaz; Gabriel Gijón-Nogueron; Mario Herrera-Pérez Journal: Arch Orthop Trauma Surg Date: 2022-03-11 Impact factor: 3.067
Authors: Jeremy Y Chan; Naudereh Noori; Stephanie Chen; Glenn B Pfeffer; Timothy P Charlton; David B Thordarson Journal: Foot Ankle Orthop Date: 2020-10-14
Authors: Tonya W An; Robert Fuller; Lavan Rajan; Agnes Cororaton; Matthew W Conti; Jonathan T Deland; Scott J Ellis Journal: Foot Ankle Orthop Date: 2022-09-30