Grande-Del-Arco Jessica, Becerro-de-Bengoa-Vallejo Ricardo, Palomo-López Patricia, López-López Daniel, Calvo-Lobo César, Pérez-Boal Eduardo, Losa-Iglesias Marta Elena, Martin-Villa Carlos, Rodriguez-Sanz David
Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, 28040 Madrid, Spain.
University Center of Plasencia, Universidad de Extremadura, 10600 Plasencia, Spain.
Diagnostics (Basel). 2020 Aug 2;10(8):552. doi: 10.3390/diagnostics10080552.
The diagnostic of flat and crest-shaped of first metatarsal heads has been associated as an important risk factor for hallux deformities, such as hallux valgus and hallux rigidus. The rounded form of the first metatarsal head on the dorsoplantar radiograph of the foot has been believed to be associated with the development of hallux valgus. The aim of this study was to clarify the effect of tube angulation on the distortion of first metatarsal head shape, and verify the real shape of the metatarsal head in anatomical dissection after an X-ray has been taken. In this prospective study at Universidad Complutense de Madrid, from December 2016 to June 2019, 103 feet from embalmed cadavers were included. We performed dorsoplantar radiograph tube angulation from 0° until 30° every 5° on all specimens; then, two observers verified the shape of the first metatarsal head in the radiographs and after its anatomic dissection. Kappa statistics and McNemar Bowker tests were used to assess and test for intra and interobserver agreement of metatarsal shape. We calculated the intraobserver agreement, and the results showed that the first metatarsal head is distorted and crested only when the angle of the X-ray beam is at 20° of inclination ( < 0.001). The interobserver agreement showed good agreement at 0°, 5°, 10°, 20°, and 25° and was excellent at 30° ( < 0.001). All of the studies that we identified in the literature state that there are three types of shapes of the first metatarsal head and relate each type of head to the diagnosis of a foot pathology, such as hallux valgus or hallux rigidus. This study demonstrates that there is only the round-shaped form, and not three types of metatarsal head shape. Therefore, no diagnoses related to the shape of the first metatarsal head can be made.
第一跖骨头扁平及嵴状形态的诊断被认为是拇趾畸形（如拇外翻和僵硬性拇趾）的重要危险因素。足部背跖位X线片上第一跖骨头的圆形形态被认为与拇外翻的发生有关。本研究的目的是阐明管角度对第一跖骨头形状变形的影响，并在X线检查后通过解剖验证跖骨头的真实形状。在马德里康普顿斯大学进行的这项前瞻性研究中，纳入了2016年12月至2019年6月来自防腐尸体的103只脚。我们对所有标本进行了从0°到30°、每隔5°的背跖位X线管角度调整；然后，两名观察者在X线片上以及解剖后验证第一跖骨头的形状。使用Kappa统计和McNemar Bowker检验来评估和测试观察者内和观察者间跖骨形状的一致性。我们计算了观察者内一致性，结果显示只有当X线束倾斜角度为20°时，第一跖骨头才会变形并形成嵴状（<0.001）。观察者间一致性在0°、5°、10°、20°和25°时显示出良好的一致性，在30°时为优秀（<0.001）。我们在文献中找到的所有研究都表明第一跖骨头有三种形状，并将每种形状与足部病理学诊断（如拇外翻或僵硬性拇趾）相关联。本研究表明只有圆形形态，而不是三种跖骨头形状。因此，无法根据第一跖骨头的形状进行诊断。
