Kukushliev Vasil V, Burton Alex T, Shi Glenn G, Law Brian C, Kraus Jonathan C
Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, USA.
Department of Orthopaedic Surgery, Mayo Clinic, Jacksonville, USA.
Cureus. 2022 Apr 29;14(4):e24607. doi: 10.7759/cureus.24607. eCollection 2022 Apr.
Hallux valgus deformity is the lateral deviation of the metatarsophalangeal (MTP) joint and is the most common pathology of the great toe, affecting 2%-4% of the population. It is commonly believed that the condition progresses over time both in the magnitude of deformity and development of arthritic changes. To our knowledge, there are rare studies describing the rate of deformity progression and the development of arthritic changes. Our aim is to quantify the progression of hallux valgus and associated arthritic changes in an adult population using radiographs.
Patients who are 18 years of age and older (mean age: 61.7 years and range: 18.6-94.2) who presented to our institutions between January 1, 2004, and December 1, 2019, were included. Patients were included in the study if they had hallux valgus on weight-bearing radiographs and two such radiographs at least six months apart. Hallux valgus angle (HVA), intermetatarsal angle (IMA), metatarsophalangeal (MTP) arthritis, tarsometatarsal (TMT) osteoarthritis, Hardy-Clapham sesamoid position, and round sign were collected per patient in the initial and final radiographs. Included cases were first studied together in a whole group. Then, cases were separated into three groups based on the time between initial and final radiographs.
A total of 52 radiographic records for 43 patients were included. HVA and IMA progress with time; however, progression does not follow a direct relationship with the time elapsed between initial and final radiographs (p = 0.92 and p = 0.35, respectively). The progression of TMT osteoarthritis, sesamoid position, and round sign do not show a dependence on the time elapsed (p = 0.20, p = 0.11, and p = 0.42, respectively). An increase of one sesamoid unit position over baseline is associated with a 0.85-degree increase in IMA. A one-unit progression of sesamoid position at baseline raises the odds of MTP osteoarthritis progression at the follow-up visit by 2.14 (OR = 2.14, p = 0.0007, CI = [1.35, 3.83]). A HVA increase of one degree increases the odds of TMT osteoarthritis progression at follow-up by a factor of 1.17 (OR = 1.17, p = 0.0005, CI = [1.07, 1.34]). Patients with MTP arthritis at the initial visit have 3.77 times higher odds of round sign progression on their follow-up visit (OR = 3.77, p = 0.027, CI = [1.16, 13.13]).
Hallux valgus progression can be quantified. Upon their first visit, a patient's hallux valgus parameters can be utilized to demonstrate expected progression. Progression of the deformity and arthritic changes is slow. Nonetheless, the results should be considered by surgeons and patients when developing a treatment plan with patients.
拇外翻畸形是跖趾（MTP）关节的外侧偏移，是大脚趾最常见的病变，影响2%-4%的人群。人们普遍认为，随着时间的推移，这种情况在畸形程度和关节炎变化的发展方面都会进展。据我们所知，很少有研究描述畸形进展的速度和关节炎变化的发展情况。我们的目的是使用X线片量化成年人群中拇外翻及相关关节炎变化的进展情况。
纳入2004年1月1日至2019年12月1日期间到我们机构就诊的18岁及以上患者（平均年龄：61.7岁，范围：18.6-94.2岁）。如果患者在负重X线片上有拇外翻且有两张间隔至少6个月的此类X线片，则纳入研究。在初始和最终X线片中，为每位患者收集拇外翻角（HVA）、跖间角（IMA）、跖趾（MTP）关节炎、跗跖（TMT）骨关节炎、Hardy-Clapham籽骨位置和圆形征。纳入的病例首先在整个组中一起研究。然后，根据初始和最终X线片之间的时间将病例分为三组。
共纳入43例患者的52份X线记录。HVA和IMA随时间进展；然而，进展与初始和最终X线片之间经过的时间没有直接关系（分别为p = 0.92和p = 0.35）。TMT骨关节炎、籽骨位置和圆形征的进展不显示对经过时间的依赖性（分别为p = 0.20、p = 0.11和p = 0.42）。籽骨单位位置比基线增加一个单位与IMA增加0.85度相关。基线时籽骨位置进展一个单位会使随访时MTP骨关节炎进展的几率提高2.14倍（OR = 2.14，p = 0.0007，CI = [1.35, 3.83]）。HVA增加一度会使随访时TMT骨关节炎进展几率提高1.17倍（OR = 1.17，p = 0.0005，CI = [1.07, 1.34]）。初次就诊时患有MTP关节炎的患者在随访时圆形征进展的几率高3.77倍（OR = 3.77，p = 0.027，CI = [1.16, 13.13]）。
拇外翻进展可以量化。在患者首次就诊时，其拇外翻参数可用于证明预期进展。畸形和关节炎变化的进展缓慢。尽管如此，外科医生和患者在与患者制定治疗计划时应考虑这些结果。
