Radiographic study of relationship between medial cuneiform obliquity and simple hallux valgus_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

BU Pengfei ¹ , LI Chuan ¹ , MENG Xuhan ¹ , MA Xinyu ² , ZHANG Xiaoyan ¹ , JIANG Jianfei ³ , LI Jun ¹ ,  XU Yongqing ¹

1. Department of Orthopedics, the 920th Hospital of Joint Logistics Support Force of Chinese PLA, Kunming Yunnan, 650118, P. R. China;
2. Department of Anesthesiology, the 920th Hospital of Joint Logistics Support Force of Chinese PLA, Kunming Yunnan, 650118, P. R. China;
3. Gosun Medical Imaging Diagnostic Center, Kunming Yunnan, 650228, P. R. China;

Corresponding author：

XU Yongqing, Email: xuyongqing920@163.com

Keywords：

Hallux valgus; medial cuneiform; weight-bearing X-ray film; radiographic study

DOI：

10.7507/1002-1892.202109053

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Objective To investigate the relationship between hallux valgus and the indicators associated with medial cuneiform obliquity measured on feet weight-bearing anteroposterior X-ray films. Methods Based on the feet weight-bearing anteroposterior X-ray films taken between January 2018 and February 2021 and met the criteria, the hallux valgus angle (HVA), intermetatarsal angle (IMA), metatarsus adductus angle (MAA), metatarsus cuneiform angle (MCA), distal medial cuneiform angle (DMCA), and proximal metatarsal articular angle (PMAA) were measured and the morphology of the first tarsometatarsal (TMT) were recorded. According to the HVA, the X-ray films were divided into normal group (HVA<15°) and hallux valgus group (HVA≥15°). The gender, age, sides, IMA, MAA, MCA, DMCA, PMAA, and the morphology of TMT were compared between groups. The influencing factors of HVA and IMA were analyzed by multivariate linear regression analysis. Results X-ray films of 534 patients (679 feet) met the selection criteria and were included in the study. There were 220 males and 314 females, with an average age of 36 years (mean, 18-82 years). There were 154 cases (168 feet) in the normal group and 403 cases (511 feet) in the hallux valgus group. There were significant differences in gender and age between groups (P<0.05), and no significant difference in the side (P>0.05). The IMA, MAA, and MCA in the hallux valgus group were significantly bigger than those in the normal group (P<0.05); the difference in DMCA between the two groups was not significant (P>0.05). The TMT morphology of the two groups was mainly curved, and the difference in morphology classification was not significant (P>0.05). PMAA measurement showed that there were 3 kinds of metatarsal shapes: adductive metatarsal, neutral metatarsal, and abductive metatarsal, the difference in metatarsal shapes between groups was not significant (P>0.05). The PMAA of abductive metatarsal was significantly bigger in normal group than in hallux valgus group (P<0.05), there was no significant difference in PMAA of adductive metatarsal between groups (P>0.05). Multivariate linear regression analysis showed that age, MCA, and DMCA were the influencing factors of HVA (P<0.05), and age, MAA, MCA, and DMCA were the influencing factors of IMA (P<0.05). Conclusion The medial cuneiform obliquity is relatively constant and the DMCA can not be used as the characteristic angle to quantify hallux valgus. The morphology of TMT has no relationship with hallux valgus, while MAA, MCA, and PMAA are all factors to be considered, and MCA can be used as the characteristic angle to quantify hallux valgus.

Citation： BU Pengfei, LI Chuan, MENG Xuhan, MA Xinyu, ZHANG Xiaoyan, JIANG Jianfei, LI Jun, XU Yongqing. Radiographic study of relationship between medial cuneiform obliquity and simple hallux valgus. Chinese Journal of Reparative and Reconstructive Surgery, 2022, 36(2): 209-214. doi: 10.7507/1002-1892.202109053 Copy

1.	Fraissler L, Konrads C, Hoberg M, et al. Treatment of hallux valgus deformity. EFORT Open Rev, 2016, 1(8): 295-302.
2.	Kaptan AY, Çavuşoğlu AT, Tokgöz MA, et al. Distal oblique metatarsal osteotomy technique in hallux valgus deformity: Clinical and radiological results. Jt Dis Relat Surg, 2020, 31(1): 88-94.
3.	Baca E, Tuy E, Çelen KM. Can radiology reflect patient satisfaction after hallux valgus surgery? Eklem Hastalik Cerrahisi, 2019, 30(3): 241-245.
4.	Lapidus PW. A quarter of a century of experience with the operative correction of the metatarsus varus primus in hallux valgus. Bull Hosp Joint Dis, 1956, 17(2): 404-421.
5.	Sanicola SM, Arnold TB, Osher L. Is the radiographic appearance of the hallucal tarsometatarsal joint representative of its true anatomical structure? J Am Podiatr Med Assoc, 2002, 92(9): 491-498.
6.	Vyas S, Conduah A, Vyas N, et al. The role of the first metarsocuneiform joint in juvenile hallux valgus. J Pediatr Orthop B, 2010, 19(5): 399-402.
7.	Lintz F, Beaudet P, Richardi G, et al. Weight-bearing CT in foot and ankle pathology. Orthop Traumatol Surg Res, 2021, 107(1): 18-21.
8.	Dykyj D, Ateshian GA, Trepal MJ, et al. Articular geometry of the medial tarsometatarsal joint in the foot: comparison of metatarsus primus adductus and metatarsus primus rectus. J Foot Ankle Surg, 2001, 40(6): 357-365.
9.	Hatch DJ, Smith A, Fowler T. Radiographic relevance of the distal medial cuneiform angle in hallux valgus assessment. J Foot Ankle Surg, 2016, 55(1): 85-89.
10.	Hyer CF, Philbin TM, Berlet GC, et al. The obliquity of the first metatarsal base. Foot Ankle Int, 2004, 25(10): 728-732.
11.	Patel K, Hasenstein T, Meyr AJ. Quantitative assessment of the obliquity of the first metatarsal-medial cuneiform articulation. J Foot Ankle Surg, 2019, 58(4): 679-686.
12.	Koury K, Staggers JR, Pinto MC, et al. Radiographic assessment of first tarsometatarsal joint shape and orientation. Foot Ankle Int, 2019, 40(12): 1438-1446.
13.	Heineman N, Liu G, Pacicco T, et al. Clinical and imaging assessment and treatment of hallux valgus. Acta Radiol, 2020, 61(1): 56-66.
14.	Paley Dror. 矫形外科原则. 陈坚, 译. 北京:中国医药科技出版社, 2006: 8-9.
15.	Wu DY, Lam EKF. Radiological evaluation of a preoperative first metatarsal realignment test for metatarsus primus varus and hallux valgus correction by the syndesmosis procedure. Foot Ankle Int, 2020, 41(3): 342-349.
16.	Doty JF, Coughlin MJ, Hirose C, et al. First metatarsocuneiform joint mobility: radiographic, anatomic, and clinical characteristics of the articular surface. Foot Ankle Int, 2014, 35(5): 504-511.
17.	Mason LW, Tanaka H. The first tarsometatarsal joint and its association with hallux valgus. Bone Joint Res, 2012, 1(6): 99-103.
18.	Erduran M, Acar N, Demirkiran ND, et al. The impact of medial cuneiform bone variant measures on the severity of hallux valgus: A radiological study. J Orthop Surg (Hong Kong), 2017, 25(3): 1-6.
19.	张文涛, 黄英, 吴倩平, 等. 拇外翻与第一跖跗关节形态改变. 中国临床康复, 2002, 6(14): 2056-2057.
20.	Kaiser P, Livingston K, Miller PE, et al. Radiographic evaluation of first metatarsal and medial cuneiform morphology in juvenile hallux valgus. Foot Ankle Int, 2018, 39(10): 1223-1228.
21.	Hyer CF, Philbin TM, Berlet GC, et al. The incidence of the intermetatarsal facet of the first metatarsal and its relationship to metatarsus primus varus: a cadaveric study. J Foot Ankle Surg, 2005, 44(3): 200-202.
22.	Manceron A, Cazeau C, Hardy A, et al. Correlation between first tarsometatarsal joint mobility and hallux valgus severity. Int Orthop, 2021, 8(11): 1432-1436.

1. Fraissler L, Konrads C, Hoberg M, et al. Treatment of hallux valgus deformity. EFORT Open Rev, 2016, 1(8): 295-302.
2. Kaptan AY, Çavuşoğlu AT, Tokgöz MA, et al. Distal oblique metatarsal osteotomy technique in hallux valgus deformity: Clinical and radiological results. Jt Dis Relat Surg, 2020, 31(1): 88-94.
3. Baca E, Tuy E, Çelen KM. Can radiology reflect patient satisfaction after hallux valgus surgery? Eklem Hastalik Cerrahisi, 2019, 30(3): 241-245.
4. Lapidus PW. A quarter of a century of experience with the operative correction of the metatarsus varus primus in hallux valgus. Bull Hosp Joint Dis, 1956, 17(2): 404-421.
5. Sanicola SM, Arnold TB, Osher L. Is the radiographic appearance of the hallucal tarsometatarsal joint representative of its true anatomical structure? J Am Podiatr Med Assoc, 2002, 92(9): 491-498.
6. Vyas S, Conduah A, Vyas N, et al. The role of the first metarsocuneiform joint in juvenile hallux valgus. J Pediatr Orthop B, 2010, 19(5): 399-402.
7. Lintz F, Beaudet P, Richardi G, et al. Weight-bearing CT in foot and ankle pathology. Orthop Traumatol Surg Res, 2021, 107(1): 18-21.
8. Dykyj D, Ateshian GA, Trepal MJ, et al. Articular geometry of the medial tarsometatarsal joint in the foot: comparison of metatarsus primus adductus and metatarsus primus rectus. J Foot Ankle Surg, 2001, 40(6): 357-365.
9. Hatch DJ, Smith A, Fowler T. Radiographic relevance of the distal medial cuneiform angle in hallux valgus assessment. J Foot Ankle Surg, 2016, 55(1): 85-89.
10. Hyer CF, Philbin TM, Berlet GC, et al. The obliquity of the first metatarsal base. Foot Ankle Int, 2004, 25(10): 728-732.
11. Patel K, Hasenstein T, Meyr AJ. Quantitative assessment of the obliquity of the first metatarsal-medial cuneiform articulation. J Foot Ankle Surg, 2019, 58(4): 679-686.
12. Koury K, Staggers JR, Pinto MC, et al. Radiographic assessment of first tarsometatarsal joint shape and orientation. Foot Ankle Int, 2019, 40(12): 1438-1446.
13. Heineman N, Liu G, Pacicco T, et al. Clinical and imaging assessment and treatment of hallux valgus. Acta Radiol, 2020, 61(1): 56-66.
14. Paley Dror. 矫形外科原则. 陈坚, 译. 北京:中国医药科技出版社, 2006: 8-9.
15. Wu DY, Lam EKF. Radiological evaluation of a preoperative first metatarsal realignment test for metatarsus primus varus and hallux valgus correction by the syndesmosis procedure. Foot Ankle Int, 2020, 41(3): 342-349.
16. Doty JF, Coughlin MJ, Hirose C, et al. First metatarsocuneiform joint mobility: radiographic, anatomic, and clinical characteristics of the articular surface. Foot Ankle Int, 2014, 35(5): 504-511.
17. Mason LW, Tanaka H. The first tarsometatarsal joint and its association with hallux valgus. Bone Joint Res, 2012, 1(6): 99-103.
18. Erduran M, Acar N, Demirkiran ND, et al. The impact of medial cuneiform bone variant measures on the severity of hallux valgus: A radiological study. J Orthop Surg (Hong Kong), 2017, 25(3): 1-6.
19. 张文涛, 黄英, 吴倩平, 等. 拇外翻与第一跖跗关节形态改变. 中国临床康复, 2002, 6(14): 2056-2057.
20. Kaiser P, Livingston K, Miller PE, et al. Radiographic evaluation of first metatarsal and medial cuneiform morphology in juvenile hallux valgus. Foot Ankle Int, 2018, 39(10): 1223-1228.
21. Hyer CF, Philbin TM, Berlet GC, et al. The incidence of the intermetatarsal facet of the first metatarsal and its relationship to metatarsus primus varus: a cadaveric study. J Foot Ankle Surg, 2005, 44(3): 200-202.
22. Manceron A, Cazeau C, Hardy A, et al. Correlation between first tarsometatarsal joint mobility and hallux valgus severity. Int Orthop, 2021, 8(11): 1432-1436.

Chinese Journal of Reparative and Reconstructive Surgery

Radiographic study of relationship between medial cuneiform obliquity and simple hallux valgus

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