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The Shape of the Lateral Edge of the First Metatarsal Head as a Risk Factor for Recurrence of Hallux Valgus
Ryuzo Okuda, Mitsuo Kino****a, To****o Yasuda, Tsuyoshi Jotoku, Naoshi Kitano, and Hiroaki Shima The Journal of Bone and Joint Surgery (American). 2007;89:2163-2172.
Quote:
Background: The relationship between the shape of the first metatarsal head and hallux valgus deformity remains controversial. The purpose of the present study was to retrospectively analyze differences in the radiographic appearance of the shape of the lateral edge of the first metatarsal head between women with normal feet and those with hallux valgus and to clarify the relationship between the shape of the lateral edge and the postoperative recurrence of hallux valgus deformity.
Methods: Dorsoplantar weight-bearing radiographs of sixty normal feet in women (the control group) and sixty feet in women with hallux valgus (the hallux valgus group) were reviewed. The feet in the hallux valgus group were treated with a proximal metatarsal osteotomy, and the radiographs of those feet were assessed preoperatively, at the time of early follow-up (mean, 3.4 months), and at the time of the most recent follow-up (mean, forty-eight months). The shape of the lateral edge, which was defined as consisting of the articular and lateral surfaces of the first metatarsal head, was examined. The shape of the lateral edge was classified as one of three types: round (type R), angular (type A), and intermediate (type I). We defined the round sign as being positive when the shape of the lateral edge was classified as type R.
Results: Prior to surgery, the prevalence of the type-R shape was significantly greater in the hallux valgus group than it was in the control group (78.3% compared with 1.7%; p < 0.0001) and the prevalence of type-A shape was significantly lower in the hallux valgus group than in the control group (3.3% compared with 81.7%; p < 0.0001). In the hallux valgus group, the prevalence of the type-R shape at the time of the early follow-up after surgery was significantly lower than that before surgery (p < 0.0001). Feet with a positive round sign at the time of the early follow-up had a greater risk of having recurrence of the hallux valgus deformity at the time of the most recent follow-up than did those without a round sign at the time of the early follow-up (odds ratio, 12.71; 95% confidence interval, 3.21 to 50.36).
Conclusions: There is a significant relationship between a round-shaped lateral edge of the first metatarsal head and hallux valgus, and a positive round sign after a proximal first metatarsal osteotomy can be a risk factor for the recurrence of hallux valgus.
Have you read the paper? The method of measuring the edge of the metatarsal head is actually quite novel (it's not just "round" versus "square"). Furthermore, the paper is focused on recurrence of HV, and was therefore prospective (ie: prior to, and approx 3 months following surgery).
Have you read the paper? The method of measuring the edge of the metatarsal head is actually quite novel (it's not just "round" versus "square"). Furthermore, the paper is focused on recurrence of HV, and was therefore prospective (ie: prior to, and approx 3 months following surgery).
Cheers,
Hylton
Not read this. I have read the majority of the others on the subject. Similar methodological problems. This does not prove causation. Think sagittal groove.
__________________ Science is the antidote to the poison of enthusiasm and superstition
OBJECTIVE: To determine the population prevalence and examine factors associated with hallux valgus in a primary care population.
METHODS: A questionnaire was mailed to all adults age >30 years registered with 2 general practices. Validated instruments assessed self-reported hallux valgus, nodal osteoarthritis, and knee pain. The questionnaire also asked about big toe pain, joint replacement, and history of osteoarthritis and rheumatoid arthritis. Hallux valgus prevalence was calculated and standardized by the source population in terms of age, sex, knee pain, osteoarthritis, and rheumatoid arthritis. A nested case-control study was undertaken and age-sex adjusted odds ratios (ORs) were calculated between hallux valgus and age, sex, body mass index, nodal osteoarthritis, knee pain, big toe pain, joint replacement, self-reported osteoarthritis, and self-reported rheumatoid arthritis, using a binary logistic regression model.
RESULTS: A total of 13,684 questionnaires were mailed and 4,249 (32%) responses were received. The standardized prevalence of hallux valgus was 28.4%. Hallux valgus was associated with age (adjusted OR 1.61 per decade; 95% confidence interval [95% CI] 1.52-1.69), female sex (adjusted OR 2.64; 95% CI 2.26-3.08), nodal osteoarthritis (adjusted OR 1.66; 95% CI 1.26-2.17), knee pain (adjusted OR 1.96; 95% CI 1.65-2.32), big toe pain (adjusted OR 3.28; 95% CI 2.48-4.33), self-reported osteoarthritis (adjusted OR 1.41; 95% CI 1.15-1.72), and self-reported rheumatoid arthritis (adjusted OR 2.04; 95% CI 1.43-2.91).
CONCLUSION: Hallux valgus is prevalent in the community and is associated with age, female sex, and components of generalized osteoarthritis such as nodal osteoarthritis, knee pain, big toe pain, and self-reported osteoarthritis.
Length of the first metatarsal and hallux in hallux valgus in the initial stage.
Munuera PV, Polo J, Rebollo J. Int Orthop. 2008 Aug;32(4):489-95.
Quote:
The aim of this study was to confirm whether the length of the first metatarsal and the length of the hallux are greater than normal in the initial phase of the hallux valgus deformity. In a sample of 152 radiographs (98 of normal feet and 54 of incipient hallux valgus feet), the length of the first metatarsal and the hallux was measured according to methods previously described. Comparisons were made between normal and hallux valgus feet, and between male and female feet. The results show significant differences between the two groups in the first metatarsal (P<0.0001) and hallux (P<0.001). In the male feet, these differences are more marked (when comparing the length of the hallux between the female hallux valgus feet and the female normal feet, P>0.05). This indicates that in men with hallux valgus, the excess in length of the first metatarso-digital segment is greater than in women that develop this deformity, at least in its initial phase. According to these results, the size of the first metatarso-digital segment could be involved in the development of the hallux valgus deformity.
Factors associated with hallux valgus in a population-based study of older women and men: the MOBILIZE Boston Study.
Nguyen US, Hillstrom HJ, Li W, Dufour AB, Kiel DP, Procter-Gray E, Gagnon MM, Hannan MT. Osteoarthritis Cartilage. 2009 Sep 1. [Epub ahead of print]
Quote:
OBJECTIVE: To examine potential risk factors for hallux valgus in community-dwelling elders.
METHOD: Data from 600 MOBILIZE Boston Study participants (386 women and 214 men) were analyzed. Hallux valgus was defined as >15 degrees angular deviation of the hallux with respect to the first metatarsal bone toward the lesser toes. Associations of hallux valgus with age, body mass index (BMI), race, education, pes planus, foot pain, and in women, history of high heel shoe use, were assessed using sex-specific Poisson regression with robust variance estimation for risk ratios (RR) and 95% confidence intervals (CI).
RESULTS: Hallux valgus was present in 58% of women and 25% of men. Higher BMI was inversely associated with presence of hallux valgus in women (P trend=0.001), with the strongest inverse association observed in those with BMI of 30.0 or more compared to those with normal BMI (RR=0.7, 95% CI: 0.5, 0.9). Women, who usually wore high-heeled shoes during ages 20-64 years compared to those who did not, had increased likelihood of hallux valgus (RR=1.2, 95% CI: 1.0, 1.5). Among men, those with BMI between 25.0 and 29.9 had increased likelihood of hallux valgus compared to those with normal BMI (RR=1.9, 95% CI: 1.0, 3.5). Men with pes planus were more likely to have hallux valgus (RR=2.1, 95% CI: 1.3, 3.3) compared to men without pes planus.
CONCLUSION: In women, hallux valgus was associated with lower BMI and high heel use during ages 20-64, while in men, associations were observed with higher BMI and pes planus. Our results suggest that the etiologic mechanisms for hallux valgus may differ between men and women.
Risk factors for hallux valgus
Linear Mode
