Multiplanar instability of the first tarsometatarsal joint in hallux valgus and hallux rigidus patients: a case-control study.
First TMT joint
First ray hypermobility
Hallux rigidus
Hallux valgus
Multiplanar instability
WBCT
Weightbearing CT
Journal
International orthopaedics
ISSN: 1432-5195
Titre abrégé: Int Orthop
Pays: Germany
ID NLM: 7705431
Informations de publication
Date de publication:
02 2022
02 2022
Historique:
received:
13
07
2021
accepted:
20
08
2021
pubmed:
2
9
2021
medline:
11
3
2022
entrez:
1
9
2021
Statut:
ppublish
Résumé
Hypermobility of the first ray has been considered associated with various forefoot diseases including hallux valgus (HV) and hallux rigidus (HR). Weightbearing CT scan can be a reliable method for analysis of the first tarsometatarsal (TMT) joint in axial, sagittal, and coronal planes. Our objective was to comparatively investigate signs of instability of the first TMT joint on weightbearing CT between three groups (control, HV, and HR). In this single-centre, retrospective, case-control study, 27 HV patients (30 feet; mean age 54.2 years), 26 HR patients (30 feet; mean age 56.6 years), and 30 controls (30 feet; mean age; 43 years) were enrolled. Measurements of signs of instability were performed in multiplanes including first TMT angle, dorsal translation of the first metatarsal (M1) at the first TMT joint, plantar distance between the medial cuneiform (C1) and M1 in sagittal plane, hallux valgus angle (HVA), intermetatarsal angle (IMA) in axial plane, rotational profiles of C1 and M1 in coronal plane. Analysis of variance (ANOVA) test and chi-square test were performed to compare each parameter between the three groups. Interobserver reliabilities were assessed using interclass correlation coefficients (ICCs). The HV group had significantly increased first TMT angle (0.23° in controls, 1.15° in HV, 0.19° in HR, p < 0.001), HVA (7.52°, 33.50°, 11.21°, p < 0.001), IMA (9.46°, 16.98°, 11.87°, p < 0.001), C1-M1 angle (22.44°, 29.46°, 23.74°, p < 0.001), and rotational profile of the distal M1 (7.06°, 17.88°, 9.85°, p < 0.001) compared with the control and HR groups. Dorsal translation of M1 (23% in controls, 63% in HV, 70% in HR, p < 0.001) was frequently found in the HV and HR groups with significantly increased plantar distance (0.37 mm, 1.14 mm, 1.46 mm, p < 0.001) compared with controls. Multiplanar instability of the first TMT joint was confirmed using weightbearing CT in HV and HR groups compared with controls. HV group demonstrated instability mainly in sagittal and axial planes; HR group had sagittal instability predominantly. Our measurement of rotational instability at the first TMT joint was not able to detect differences between groups. A surgical correction of the instability at the first TMT joint can be an option to address HV and HR. First ray hypermobility at the first TMT joint is an important consideration when addressing HV and HR, a surgical correction of the instability at the first TMT joint should be taken in consideration as an option.
Sections du résumé
BACKGROUND
Hypermobility of the first ray has been considered associated with various forefoot diseases including hallux valgus (HV) and hallux rigidus (HR). Weightbearing CT scan can be a reliable method for analysis of the first tarsometatarsal (TMT) joint in axial, sagittal, and coronal planes. Our objective was to comparatively investigate signs of instability of the first TMT joint on weightbearing CT between three groups (control, HV, and HR).
METHODS
In this single-centre, retrospective, case-control study, 27 HV patients (30 feet; mean age 54.2 years), 26 HR patients (30 feet; mean age 56.6 years), and 30 controls (30 feet; mean age; 43 years) were enrolled. Measurements of signs of instability were performed in multiplanes including first TMT angle, dorsal translation of the first metatarsal (M1) at the first TMT joint, plantar distance between the medial cuneiform (C1) and M1 in sagittal plane, hallux valgus angle (HVA), intermetatarsal angle (IMA) in axial plane, rotational profiles of C1 and M1 in coronal plane. Analysis of variance (ANOVA) test and chi-square test were performed to compare each parameter between the three groups. Interobserver reliabilities were assessed using interclass correlation coefficients (ICCs).
RESULTS
The HV group had significantly increased first TMT angle (0.23° in controls, 1.15° in HV, 0.19° in HR, p < 0.001), HVA (7.52°, 33.50°, 11.21°, p < 0.001), IMA (9.46°, 16.98°, 11.87°, p < 0.001), C1-M1 angle (22.44°, 29.46°, 23.74°, p < 0.001), and rotational profile of the distal M1 (7.06°, 17.88°, 9.85°, p < 0.001) compared with the control and HR groups. Dorsal translation of M1 (23% in controls, 63% in HV, 70% in HR, p < 0.001) was frequently found in the HV and HR groups with significantly increased plantar distance (0.37 mm, 1.14 mm, 1.46 mm, p < 0.001) compared with controls.
CONCLUSIONS
Multiplanar instability of the first TMT joint was confirmed using weightbearing CT in HV and HR groups compared with controls. HV group demonstrated instability mainly in sagittal and axial planes; HR group had sagittal instability predominantly. Our measurement of rotational instability at the first TMT joint was not able to detect differences between groups. A surgical correction of the instability at the first TMT joint can be an option to address HV and HR.
CLINICAL RELEVANCE
First ray hypermobility at the first TMT joint is an important consideration when addressing HV and HR, a surgical correction of the instability at the first TMT joint should be taken in consideration as an option.
Identifiants
pubmed: 34468786
doi: 10.1007/s00264-021-05198-9
pii: 10.1007/s00264-021-05198-9
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
255-263Informations de copyright
© 2021. SICOT aisbl.
Références
Smyth NA, Aiyer AA (2018) Introduction: why are there so many different surgeries for hallux valgus? Foot Ankle Clin 23:171–182
doi: 10.1016/j.fcl.2018.01.001
Coughlin MJ, Jones CP (2007) Hallux valgus and first ray mobility: a prospective study. JBJS 89:1887–1898
doi: 10.2106/00004623-200709000-00001
Easley ME, Trnka H-J (2007) Current concepts review: hallux valgus part 1: pathomechanics, clinical assessment, and nonoperative management. Foot Ankle Int 28:654–659
doi: 10.3113/FAI.2007.0654
Kimura T, Kubota M, Suzuki N, Hattori A, Saito M (2020) Weightbearing computed tomography and 3-dimensional analysis of mobility changes of the first ray after proximal oblique osteotomy for hallux valgus. Foot & Ankle International:1071100720962471
Kimura T, Kubota M, Suzuki N, Hattori A, Marumo K (2018) Comparison of intercuneiform 1–2 joint mobility between hallux valgus and normal feet using weightbearing computed tomography and 3-dimensional analysis. Foot Ankle Int 39:355–360
doi: 10.1177/1071100717744174
Kimura T, Kubota M, Taguchi T, Suzuki N, Hattori A, Marumo K (2017) Evaluation of first-ray mobility in patients with hallux valgus using weight-bearing CT and a 3-D analysis system: a comparison with normal feet. JBJS 99:247–255
doi: 10.2106/JBJS.16.00542
Santrock RD, Smith B (2018) Hallux valgus deformity and treatment: a three-dimensional approach: modified technique for Lapidus procedure. Foot Ankle Clin 23:281–295
doi: 10.1016/j.fcl.2018.02.001
King DM, Toolan BC (2004) Associated deformities and hypermobility in hallux valgus: an investigation with weightbearing radiographs. Foot Ankle Int 25:251–255
doi: 10.1177/107110070402500410
Klaue K, Hansen ST, Masquelet AC (1994) Clinical, quantitative assessment of first tarsometatarsal mobility in the sagittal plane and its relation to hallux valgus deformity. Foot Ankle Int 15:9–13
doi: 10.1177/107110079401500103
Faber F, Van Kampen P, Bloembergen M (2013) Long-term results of the Hohmann and Lapidus procedure for the correction of hallux valgus: a prospective, randomised trial with eight-to 11-year follow-up involving 101 feet. The bone & joint journal 95:1222–1226
doi: 10.1302/0301-620X.95B9.31560
Faber FW, Kleinrensink G-J, Mulder PG, Verhaar JA (2001) Mobility of the first tarsometatarsal joint in hallux valgus patients: a radiographic analysis. Foot Ankle Int 22:965–969
doi: 10.1177/107110070102201207
Faber FW, Kleinrensink G-J, Verhoog MW, Vijn AH, Snijders CJ, Mulder PG, Verhaar JA (1999) Mobility of the first tarsometatarsal joint in relation to hallux valgus deformity: anatomical and biomechanical aspects. Foot Ankle Int 20:651–656
doi: 10.1177/107110079902001007
Doty JF, Harris WT (2018) Hallux valgus deformity and treatment: a three-dimensional approach. Foot Ankle Clin 23:271–280
doi: 10.1016/j.fcl.2018.01.007
Doty JF, Coughlin MJ, Hirose C, Stevens F, Schutt S, Kennedy M, Grebing B, Smith B, Cooper T, Golanó P (2014) First metatarsocuneiform joint mobility: radiographic, anatomic, and clinical characteristics of the articular surface. Foot Ankle Int 35:504–511
doi: 10.1177/1071100714524556
Doty JF, Coughlin MJ (2013) Hallux valgus and hypermobility of the first ray: facts and fiction. Int Orthop 37:1655–1660
doi: 10.1007/s00264-013-1977-3
Coughlin MJ, Saltzman CL, Nunley JA (2002) Angular measurements in the evaluation of hallux valgus deformities: a report of the ad hoc committee of the American Orthopaedic Foot & Ankle Society on angular measurements. Foot Ankle Int 23:68–74
doi: 10.1177/107110070202300114
Coughlin MJ, Freund E (2001) The reliability of angular measurements in hallux valgus deformities. Foot Ankle Int 22:369–379
doi: 10.1177/107110070102200503
Kim Y, Kim JS, Young KW, Naraghi R, Cho HK, Lee SY (2015) A new measure of tibial sesamoid position in hallux valgus in relation to the coronal rotation of the first metatarsal in CT scans. Foot Ankle Int 36:944–952
doi: 10.1177/1071100715576994
Glasoe WM, Allen MK, Saltzman CL, Ludewig PM, Sublett SH (2002) Comparison of two methods used to assess first-ray mobility. Foot Ankle Int 23:248–252
doi: 10.1177/107110070202300310
Lee KT, Young K (2001) Measurement of first-ray mobility in normal vs. hallux valgus patients. Foot Ankle Int 22:960–964
doi: 10.1177/107110070102201206
Glasoe WM, Nuckley DJ, Ludewig PM (2010) Hallux valgus and the first metatarsal arch segment: a theoretical biomechanical perspective. Phys Ther 90:110–120
doi: 10.2522/ptj.20080298
Campbell B, Miller MC, Williams L, Conti SF (2018) Pilot study of a 3-dimensional method for analysis of pronation of the first metatarsal of hallux valgus patients. Foot Ankle Int 39:1449–1456
doi: 10.1177/1071100718793391
Barg A, Bailey T, Richter M, de Cesar NC, Lintz F, Burssens A, Phisitkul P, Hanrahan CJ, Saltzman CL (2018) Weightbearing computed tomography of the foot and ankle: emerging technology topical review. Foot Ankle Int 39:376–386
doi: 10.1177/1071100717740330
Richter M, Seidl B, Zech S, Hahn S (2014) PedCAT for 3D-imaging in standing position allows for more accurate bone position (angle) measurement than radiographs or CT. Foot Ankle Surg 20:201–207
doi: 10.1016/j.fas.2014.04.004
Godoy-Santos AL, Cesar Netto CD (2018) Weight-bearing computed tomography of the foot and ankle: an update and future directions. Acta Ortopedica Brasileira 26:135–139
doi: 10.1590/1413-785220182602188482
Mahmoud K, Metikala S, Mehta SD, Fryhofer GW, Farber DC, Prat D (2021) The role of weightbearing computed tomography scan in hallux valgus. Foot Ankle Int 42:287–293
doi: 10.1177/1071100720962398
Lintz F, Welck M, Bernasconi A, Thornton J, Cullen NP, Singh D, Goldberg A (2017) 3D biometrics for hindfoot alignment using weightbearing CT. Foot Ankle Int 38:684–689
doi: 10.1177/1071100717690806
Engel E, Erlick N, Krems I (1983) A simplified metatarsus adductus angle. J Am Podiatr Med Assoc 73:620–628
doi: 10.7547/87507315-73-12-620
de Cesar Netto C (2020) Flexible adult-acquired flatfoot deformity: comparison between weight bearing and non-weight bearing measurements using cone beam computed tomography. In: Weight bearing cone beam computed tomography (WBCT) in the foot and ankle. Springer. pp. 181–198.
Ferri M, Scharfenberger AV, Goplen G, Daniels TR, Pearce D (2008) Weightbearing CT scan of severe flexible pes planus deformities. Foot Ankle Int 29:199–204
doi: 10.3113/FAI.2008.0199
de Cesar NC, Richter M (2020) Use of advanced weightbearing imaging in evaluation of hallux valgus. Foot Ankle Clin 25:31–45
doi: 10.1016/j.fcl.2019.10.001
Steadman J, Barg A, Saltzman CL (2021) First metatarsal rotation in hallux valgus deformity. Foot & Ankle International:1071100721997149
Welck M, Singh D, Cullen N, Goldberg A (2018) Evaluation of the 1st metatarso-sesamoid joint using standing CT—the Stanmore classification. Foot Ankle Surg 24:314–319
doi: 10.1016/j.fas.2017.03.005
Koo TK, Li MY (2016) A guideline of selecting and reporting intraclass correlation coefficients for reliability research. J Chiropr Med 15:155–163. https://doi.org/10.1016/j.jcm.2016.02.012
doi: 10.1016/j.jcm.2016.02.012
pubmed: 27330520
pmcid: 4913118
Geng X, Wang C, Ma X, Wang X, Huang J, Zhang C, Xu J, Yang J (2015) Mobility of the first metatarsal-cuneiform joint in patients with and without hallux valgus: in vivo three-dimensional analysis using computerized tomography scan. J Orthop Surg Res 10:1–7
doi: 10.1186/s13018-015-0289-2
Collan L, Kankare JA, Mattila K (2013) The biomechanics of the first metatarsal bone in hallux valgus: a preliminary study utilizing a weight bearing extremity CT. Foot Ankle Surg 19:155–161
doi: 10.1016/j.fas.2013.01.003
Cruz EP, Wagner FV, Henning C, Sanhudo JAV, Pagnussato F, Galia CR (2019) Does hallux valgus exhibit a deformity inherent to the first metatarsal bone? J Foot Ankle Surg 58:1210–1214
doi: 10.1053/j.jfas.2018.09.031
Randich JR, John KJ, Gomez K, Bush WJ (2020) Frontal plane rotation of the first ray in hallux valgus using standing CT. The Journal of Foot and Ankle Surgery
Conti MS, Willett JF, Garfinkel JH, Miller MC, Costigliola SV, Elliott AJ, Conti SF, Ellis SJ (2020) Effect of the modified Lapidus procedure on pronation of the first ray in hallux valgus. Foot Ankle Int 41:125–132
doi: 10.1177/1071100719883325
Schmid T, Krause F (2014) The modified Lapidus fusion. Foot Ankle Clin 19:223–233
doi: 10.1016/j.fcl.2014.02.005