Journal article
Correlation of first metatarsal sagittal alignment with clinical and functional outcomes following the Lapidus procedure
Foot and ankle surgery, Vol.28(4), pp.438-444
06/2022
DOI: 10.1016/j.fas.2021.08.009
PMID: 34474967
Abstract
•The use of the Lapidus procedure to correct hallux valgus requires control of first metatarsal (M1) sagittal alignment to avoid its dorsiflexion.•Variation of M1 sagittal alignment is related to clinical and functional outcomes, with excessive dorsiflexion leading to decreased results.•Variation in the M1 sagittal alignment of up to 3.2 degrees of dorsiflexion is associated with significant clinical and functional improvements.
The purpose of this study was to evaluate the effect of the variation of the first metatarsal (M1) sagittal alignment after the Lapidus procedure (LP) on clinical and functional outcomes, and transfer metatarsalgia.
Twenty-nine patients who underwent a LP, with a mean follow-up of 20 months, were reviewed. Radiographic, clinical and functional measurements were compared. Clinical and functional questionnaires applied were the visual analogue scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) scale, lower extremity functional scale (LEFS) and SF-12, which is divided in physical (PCS-12) and mental-health (MCS-12) scales. Radiographic analysis of M1 sagittal alignment was based on the first metatarsal declination angle (FMDA) and Meary Angle (MA). Intermetatarsal angle (IMA) and hallux valgus angle (HVA) were also measured.
FMDA, IMA and HVA showed significant variation, but MA did not. Clinical and functional improvements were observed, except in MCS-12. No patient developed transfer metatarsalgia. A direct correlation was found between Δ-FMDA with Δ-PCS-12 and Δ-LEFS, meaning that excessive M1 dorsiflexion as measured by FMDA led to a decrease in PCS-12 and LEFS. Patients with Δ-FMDA of up to 3.2° of dorsiflexion were those who had significant improvements.
Dorsiflexion of M1 can lead to decreased outcomes as measured by PCS-12 and LEFS. However, satisfactory outcomes can be obtained even with some dorsal deviation of the M1.
IV, retrospective case series.
Details
- Title: Subtitle
- Correlation of first metatarsal sagittal alignment with clinical and functional outcomes following the Lapidus procedure
- Creators
- Danilo Ryuko Cândido Nishikawa - Hospital Alemão Oswaldo CruzFernando Aires Duarte - Department of Orthopaedics, Foot and Ankle Surgery, Clínica de Ortopedia e Traumatologia Ortocity, 526, Brigadeiro Gavião Peixoto Street, Lapa, CEP: 05078-000 São Paulo, SP, BrazilGuilherme Honda Saito - AdmaCesar de Cesar Netto - University of IowaBruno Rodrigues de Miranda - Department of Orthopaedics, Foot and Ankle Surgery, Hospital do Servidor Público Municipal de São Paulo (HSPM), 60, Castro Alves Street, Aclimação, CEP: 01532-000 São Paulo, SP, BrazilMarcelo Pires Prado - Hospital Israelita Albert Einstein
- Resource Type
- Journal article
- Publication Details
- Foot and ankle surgery, Vol.28(4), pp.438-444
- Publisher
- Elsevier Ltd
- DOI
- 10.1016/j.fas.2021.08.009
- PMID
- 34474967
- ISSN
- 1268-7731
- eISSN
- 1460-9584
- Language
- English
- Date published
- 06/2022
- Academic Unit
- Orthopedics and Rehabilitation
- Record Identifier
- 9984304697502771
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