Kent State University College of Podiatric Medicine, 6000 Rockside Woods Blvd, Independence, OH 44131, USA.
Kent State University College of Podiatric Medicine, 6000 Rockside Woods Blvd, Independence, OH 44131, USA.
Foot (Edinb). 2023 Dec;57:101965. doi: 10.1016/j.foot.2023.101965. Epub 2023 Feb 2.
Recently first tarsometatarsal arthrodesis for hallux abducto valgus (HAV) has been advocated as the sole procedure to correct the multiplanar components of the deformity. However, recent debate suggests other factors such as rearfoot pronation and metatarsal torsion affect frontal plane metatarsal eversion and sesamoid positioning. Using weight-bearing CT, 12 feet (12 subjects) with HAV deformities were placed in positions of maximum rearfoot pronation and supination in order to study the effects on metatarsal eversion, sesamoid rotation/displacement, and secondarily the influence of first metatarsal torsion. Sesamoid displacement was quantified by the novel use of the sesamoid displacement angle.
Although first metatarsal eversion was nearly double in the pronated versus supinated foot, the difference was not statistically significant. Therefore, the bulk of first metatarsal eversion was not secondary to rearfoot eversion. Conversely, a significant positive correlation was found between metatarsal torsion and metatarsal head eversion angles in both supinated and pronated foot positions, with the strongest correlation with rearfoot pronation. Finally, significant increases in sesamoid displacement angles were noted with pronation.
The findings of the present study support the contention that multiple factors are associated with frontal plane first metatarsal eversion and sesamoid displacement. Weight-bearing CT scanning can be used to effectively evaluate the frontal plane components in HAV deformities. The sesamoid displacement angle appears to be a useful adjunct to evaluating the hallucal sesamoids. For surgical correction of the deformity, consideration should be given to pre-operative weight-bearing CT evaluation of the foot. This can illuminate the effects of rearfoot/medial column pronation and the potential influence of metatarsal torsion on the frontal plane components of this triplane deformity. In this way the potential for post-operative HAV recurrence can be minimized.
最近，第一跖跗关节融合术被用于治疗拇趾外翻（HAV），被认为是纠正畸形的多平面成分的唯一方法。然而，最近的争论表明，其他因素，如后足旋前和跖骨扭转，会影响额状面跖骨外展和籽骨的位置。通过负重 CT，对 12 例（12 例）HAV 畸形患者的后足最大旋前和旋后位置进行了研究，以研究其对跖骨外展、籽骨旋转/移位的影响，并进一步研究第一跖骨扭转的影响。籽骨位移通过新颖的籽骨位移角来量化。
尽管在旋前位与旋后位相比，第一跖骨外展几乎增加了一倍，但差异无统计学意义。因此，第一跖骨外展的大部分并不是继发于后足外展。相反，在旋后位和旋前位，均发现跖骨扭转与跖骨头外展角度之间存在显著的正相关，与后足旋前的相关性最强。最后，随着旋前，籽骨的位移角度显著增加。
本研究的结果支持以下观点，即多个因素与额状面第一跖骨外展和籽骨移位有关。负重 CT 扫描可用于有效评估 HAV 畸形的额状面成分。籽骨位移角似乎是评估足趾籽骨的有用辅助方法。对于畸形的手术矫正，应考虑在术前进行负重 CT 足部评估。这可以阐明后足/内侧柱旋前的影响，以及跖骨扭转对这种三平面畸形额状面成分的潜在影响。通过这种方式，可以最大限度地减少术后 HAV 复发的可能性。
