Departamento de Traumatologia, Clinica Alemana-Universidad del Desarrollo, Santiago, Chile.
J Am Acad Orthop Surg Glob Res Rev. 2020 Jun 15;4(6). doi: 10.5435/JAAOSGlobal-D-20-00091. eCollection 2020 Jun.
Hallux valgus deformity is a multiplanar deformity, where the rotational component has been recognized over the past 5 to 10 years and given considerable importance. Years ago, a rounded shape of the lateral edge of the first metatarsal head was identified as an important factor to detect after surgery because a less rounded metatarsal head was associated to less recurrence. More recently, pronation of the metatarsal bone was identified as the cause for the rounded appearance of the metatarsal head, and therefore, supination stress was found to be useful to achieve a better correction of the deformity. Using CT scans, up to 87% of hallux valgus cases have been shown to present with a pronated metatarsal bone, which highlights the multiplanar nature of the deformity. This pronation explained the perceived shape of the metatarsal bone and the malposition of the medial sesamoid bone in radiological studies, which has been associated as one of the most important factors for recurrence after treatment. Treatment options are discussed briefly, including metatarsal osteotomies and tarsometatarsal arthrodesis.
拇外翻畸形是一种多平面畸形，其中旋转成分在过去 5 到 10 年中得到了认可，并受到了相当大的重视。多年前，人们发现第一跖骨头外侧缘的圆形形状是术后检测的一个重要因素，因为较不圆的跖骨头与较低的复发率相关。最近，跖骨的内旋被认为是跖骨头呈圆形的原因，因此，旋前应力被发现对实现畸形的更好矫正很有用。使用 CT 扫描，高达 87%的拇外翻病例显示出跖骨的内旋，这突出了畸形的多平面性质。这种内旋解释了在影像学研究中所感知的跖骨形状和内侧籽骨的错位，这被认为是治疗后复发的最重要因素之一。简要讨论了治疗选择，包括跖骨截骨术和跗跖关节融合术。
