Nacime Salomão Barbachan Mansur1,2, Matthieu Lalevee1,3, Eli Schmidt1, Kevin Dibbern1, Pablo Wagner4, Emilio Wagner4, Caio Augusto de Souza Nery2, Cesar de Cesar Netto5. 1. Department of Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa (UIOWA), 200 Hawkins Dr, John PappaJohn Pavillion (JPP), Iowa City, IA, 52242-0000, USA. 2. Department of Orthopedics and Traumatology, Escola Paulista de Medicina, UNIFESP, São Paulo, Brazil. 3. Department of Orthopaedic Surgery, Rouen University Hospital, Rouen, France. 4. Foot and Ankle Unit, Orthopedic and Traumatology Department, Clinica Alemana, Vitacura, Chile. 5. Department of Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa (UIOWA), 200 Hawkins Dr, John PappaJohn Pavillion (JPP), Iowa City, IA, 52242-0000, USA. cesar-netto@uiowa.edu.
Abstract
PURPOSE: To verify if indirect radiographic signs of first metatarsal pronation, determined by the head round sign, correspond to weight-bearing computed tomography (WBCT) measurements. METHODS: In this case-control retrospective study, we analyzed 26 hallux valgus (HV) feet and 20 controls through conventional radiograph (CR) and WBCT images. Two blinded orthopaedic foot and ankle surgeons performed the measurements. Pronation classification (head roundness), head diameter (HD), traditional HV angles, arthritis, sesamoid positioning, and first metatarsal rotation angle (MRA) (alpha angle) were evaluated. Comparisons were performed by Student's T-test and a multivariate regression was executed. P-values less than 0.05 were considered significant. RESULTS: Mean values were higher in HV patients than controls when evaluating MRA (11.51 [9.42-13.60] to 4.23 [1.84-6.62], 95%CI), HD (22.35 [21.52-23.18] to 21.01 [20.07-21.96]), and sesamoid rotation angle (SRA) (26.72 [24.09-29.34] to 4.56 [1.63-7.50]). The MRA had a low influence in head roundness classification (R2: 0.15). Changes in the pronation classification were explained chiefly by the sesamoid station (SS) (R2: 0.37), where stations 4 to 7 were found to be strong predictors of roundness classifications 2 and 3. CONCLUSION: Indirect signs of metatarsal pronation, determined by the head round sign, correlate weakly with the alpha angle measured in WBCT. The presence of arthritis and sesamoids displacement might modify the perception of first head roundness. The influence of MRA in the classification was low, where SS from 4 to 7 was strong predictors of a higher pronation classification.
PURPOSE: To verify if indirect radiographic signs of first metatarsal pronation, determined by the head round sign, correspond to weight-bearing computed tomography (WBCT) measurements. METHODS: In this case-control retrospective study, we analyzed 26 hallux valgus (HV) feet and 20 controls through conventional radiograph (CR) and WBCT images. Two blinded orthopaedic foot and ankle surgeons performed the measurements. Pronation classification (head roundness), head diameter (HD), traditional HV angles, arthritis, sesamoid positioning, and first metatarsal rotation angle (MRA) (alpha angle) were evaluated. Comparisons were performed by Student's T-test and a multivariate regression was executed. P-values less than 0.05 were considered significant. RESULTS: Mean values were higher in HV patients than controls when evaluating MRA (11.51 [9.42-13.60] to 4.23 [1.84-6.62], 95%CI), HD (22.35 [21.52-23.18] to 21.01 [20.07-21.96]), and sesamoid rotation angle (SRA) (26.72 [24.09-29.34] to 4.56 [1.63-7.50]). The MRA had a low influence in head roundness classification (R2: 0.15). Changes in the pronation classification were explained chiefly by the sesamoid station (SS) (R2: 0.37), where stations 4 to 7 were found to be strong predictors of roundness classifications 2 and 3. CONCLUSION: Indirect signs of metatarsal pronation, determined by the head round sign, correlate weakly with the alpha angle measured in WBCT. The presence of arthritis and sesamoids displacement might modify the perception of first head roundness. The influence of MRA in the classification was low, where SS from 4 to 7 was strong predictors of a higher pronation classification.
Authors: Eduardo Pedrini Cruz; Felipe Victora Wagner; Carlo Henning; José Antônio Veiga Sanhudo; Fernando Pagnussato; Carlos Roberto Galia Journal: J Foot Ankle Surg Date: 2019-11 Impact factor: 1.286
Authors: Matthieu Lalevée; Kevin Dibbern; Nacime Salomao Barbachan Mansur; Jennifer Walt; Hee Young Lee; Jean-Yves Coillard; Charles L Saltzman; Cesar de Cesar Netto Journal: Clin Orthop Relat Res Date: 2022-06-07 Impact factor: 4.755