Department of Orthopaedic Surgery, Akiota Hospital, 236, Shimotonogouchi, Akiota-chou, Yamagata-gun, Hiroshima, 731-3622, Japan.
Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
J Orthop Sci. 2024 Sep;29(5):1265-1269. doi: 10.1016/j.jos.2023.09.010. Epub 2023 Oct 16.
Studies have shown that the first metatarsal contributes to hallux valgus. The proximal phalanx, another factor that defines the hallux valgus angle, also contributes to the development of hallux valgus. There have been no reports on the use of computed tomography to evaluate bone morphology of the proximal phalanx. The purpose of this study was to analyze the morphology and deformity of the proximal phalanx and its relationship to hallux valgus using computed tomography, and to consider the indications for proximal phalanx surgery in hallux valgus.
Patients who consulted at our clinic for foot and ankle disorders and underwent both weight-bearing radiography and computed tomography between May 2019 and March 2022 were included in the study. The hallux valgus angle, sesamoid subluxation, first metatarsal length, proximal phalanx length, metatarsal-proximal phalanx ratio, proximal phalanx valgus angle, metatarsal-proximal phalanx angle, proximal phalanx rotation angle, and distal phalanx-proximal phalanx angle were measured. These parameters were compared between the hallux valgus and control groups. In the hallux valgus group, the hallux valgus and proximal phalanx valgus angles were measured and compared using weight-bearing radiographs.
A total of 83 feet in 65 patients were diagnosed with hallux valgus (hallux valgus group; mean age of 68.0 ± 13.8 years) and 30 feet in 22 patients without hallux valgus (control group; mean age of 67.0 ± 25.8 years) were included in the study. The proximal phalanx length, metatarsal-proximal phalanx ratio and angle, and distal phalanx-proximal phalanx angle were significantly greater in the hallux valgus group than in the control group. However, the proximal phalanx valgus and rotation angles were not significantly different between the groups.
Since there was no significant difference in the proximal phalanx morphology, except length, between the hallux valgus and control groups, the indications for osteotomy of the proximal phalanx should be carefully considered.
研究表明第一跖骨参与了拇外翻的形成。近节趾骨，另一个定义拇外翻角度的因素，也有助于拇外翻的发展。目前还没有关于使用计算机断层扫描来评估近节趾骨骨形态的报道。本研究旨在通过计算机断层扫描分析近节趾骨的形态和畸形及其与拇外翻的关系，并考虑拇外翻近节趾骨手术的适应证。
本研究纳入了 2019 年 5 月至 2022 年 3 月期间因足踝疾病在我院就诊并同时接受负重位 X 线摄影和计算机断层扫描检查的患者。测量拇外翻角、籽骨半脱位、第一跖骨长度、近节趾骨长度、跖骨-近节趾骨比、近节趾骨外翻角、跖骨-近节趾骨角、近节趾骨旋转角和远节趾骨-近节趾骨角。比较拇外翻组和对照组之间的这些参数。在拇外翻组中，通过负重位 X 线片测量并比较拇外翻角和近节趾骨外翻角。
共有 65 例患者的 83 只足被诊断为拇外翻（拇外翻组；平均年龄 68.0±13.8 岁），22 例患者的 30 只足无拇外翻（对照组；平均年龄 67.0±25.8 岁）被纳入研究。拇外翻组的近节趾骨长度、跖骨-近节趾骨比和角度以及远节趾骨-近节趾骨角均显著大于对照组。然而，两组之间的近节趾骨外翻角和旋转角没有显著差异。
由于除了长度之外，拇外翻组和对照组之间的近节趾骨形态没有显著差异，因此应仔细考虑近节趾骨切开术的适应证。
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