Journal article
Coronal Plane Rotation of the Medial Column in Hallux Valgus: A Retrospective Case-Control Study
Foot & ankle international, Vol.43(8), pp.107110072210918-1048
05/02/2022
DOI: 10.1177/10711007221091810
Abstract
Background:
We previously reported an increase in pronation of the first metatarsal (M1) head relative to the ground in hallux valgus (HV) patients compared to controls. Still, the origin and location of this hyperpronation along the medial column is unknown. Recent studies showed that presence of progressive collapsing foot deformities (PCFDs), which is a condition frequently associated with HV, can strongly influence the medial column coronal plane alignment. The objective of this study was to assess the coronal rotation of the medial column bones in HV feet, HV feet with radiologic markers of PCFD, and controls. We hypothesized that hyperpronation in HV will originate from a combination of M1 intrinsic torsion and first tarsometatarsal joint malposition.
Methods:
The same cohort of 36 HV and 20 controls matched on age, gender, and body mass index was used. Previously, a validation of the measurements was carried out through a cadaveric study. Using these metrics, we assessed the coronal plane rotation of the navicular, medial cuneiform, and the M1 at its base and head with respect to the ground using weightbearing CT images. We measured the Meary angle and the calcaneal moment arm in our 36 HV subjects. We subdivided our cohort into an HV group and a potential PCFD HV group according to these measurements. Comparisons on medial column bones coronal rotation were performed between HV, PCFD HV, and control groups.
Results:
Twenty-two HV cases were included in the HV group and 14 in the PCFD HV group. Both groups presented an increase in pronation of the first metatarsal head relative to the ground when compared to the control group ( P < .001). Comparing HV and controls showed an 8.3 degrees increase in pronation of M1 intrinsic torsion ( P < .001) and a 4.7 degrees pronated malposition of the first tarsometatarsal joint ( P = .02) in HV. A 9.7 degrees supinated malposition of the first naviculocuneiform joint ( P < .001) was also observed in HV. Comparing PCFD HV and controls showed a significant increase in pronation of the navicular (respectively, 17.2 ± 5.4 and 12.3 ± 3.4 degrees, P = .007) and a 5.5 degrees increase in pronation of M1 intrinsic torsion ( P = .02) in PCFD HV, without malposition of the first tarsometatarsal and naviculocuneiform joints.
Conclusion:
Hyperpronation of the M1 head relative to the ground originated from both increases in pronation of M1 intrinsic torsion and first tarsometatarsal joint malposition in HV, although partially counterbalanced by a supinated malposition of the first naviculocuneiform joint. On the other hand, PCFD HV patients showed a generalized pronated position throughout the medial column from the navicular to the M1 head and may be related to the midfoot and hindfoot deformities frequently present in PCFD.
Level of Evidence:
Level III, retrospective comparative study.
Details
- Title: Subtitle
- Coronal Plane Rotation of the Medial Column in Hallux Valgus: A Retrospective Case-Control Study
- Creators
- Matthieu Lalevée - Roy J. and Lucille A. Carver College of MedicineNacime Salomao Barbachan Mansur - Department of Orthopedics and Rehabilitation, University of Iowa, Carver College of Medicine, Iowa City, IA, USA, Department of Orthopedics and Traumatology, Federal University of Sao Paulo, Paulista School of Medicine, Sao Paulo, SP, BrazilKevin Dibbern - Department of Orthopedics and Rehabilitation, University of Iowa, Carver College of Medicine, Iowa City, IA, USAHunter Briggs - Roy J. and Lucille A. Carver College of MedicineConnor J. Maly - Roy J. and Lucille A. Carver College of MedicineKepler Alencar Mendes de Carvalho - Department of Orthopedics and Rehabilitation, University of Iowa, Carver College of Medicine, Iowa City, IA, USAFrançois Lintz - Ramsay Santé Clinique De L'union, Centre de Chirurgie de la Cheville et du Pied. Boulevard Ratalens, Saint-Jean, France.Cesar de Cesar Netto - Roy J. and Lucille A. Carver College of Medicine
- Resource Type
- Journal article
- Publication Details
- Foot & ankle international, Vol.43(8), pp.107110072210918-1048
- DOI
- 10.1177/10711007221091810
- ISSN
- 1071-1007
- eISSN
- 1944-7876
- Language
- English
- Date published
- 05/02/2022
- Academic Unit
- Orthopedics and Rehabilitation
- Record Identifier
- 9984304684102771
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