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Radiological characteristics and anatomical risk factors in the evaluation of hallux valgus in chinese adults.

Xu H, Jin K, Fu Z, Ma M, Liu Z, An S, Jiang B - Chin. Med. J. (2015)

Bottom Line: We found positive correlations between the HVA and IMA (r = 0.279, P < 0.01) and HVA and PASA (r = 0.358, P < 0.01), but not for IMA and PASA (P > 0.05).Using this grouping, HVA was significant higher in the rounded shape (19.92°) than in a flat shape (17.66°).The medial eminence in the moderate and severe groups was significantly larger than that in the mild group; moderate and severe groups were not significantly different.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedics, Peking University People's Hospital, Beijing 100044, China.

ABSTRACT

Background: There are no unified theories as to the anatomical changes that occur with hallux valgus, we investigated the radiological characteristics and anatomical risk factors for hallux valgus deformity in Chinese adults.

Methods: We reviewed 141 patients with hallux valgus (206 feet; 15 males, 126 females; mean age, 58.5 years). These patients attended Peking University People's Hospital from April 2008 to March 2014. All feet had intact radiological data, obtained using the Centricity RIS/PACS system. We measured hallux valgus angle (HVA), 1-2 intermetatarsal angle (IMA), proximal articular set angle (PASA), distal articular set angle, hallux interphalangeal angle, metatarsocuneiform angle, size of the medial eminence of the distal first metatarsal, tibial sesamoid position, and joint congruity of the first metatarsophalangeal joint (MTPJ).

Results: We found positive correlations between the HVA and IMA (r = 0.279, P < 0.01) and HVA and PASA (r = 0.358, P < 0.01), but not for IMA and PASA (P > 0.05). Feet were divided into three groups based on HVA severity. IMA (P < 0.05) and PASA (P < 0.05) in the mild group were significantly lower than that in the moderate and severe groups, with no significant difference determined for IMA or PASA between the moderate and severe groups (P > 0.05). Feet were then grouped based on the shape of the first metatarsal head. Using this grouping, HVA was significant higher in the rounded shape (19.92°) than in a flat shape (17.66°). The size of the medial eminence of the distal first metatarsal was positively correlated with HVA (r = 0.185, P < 0.01). The medial eminence in the moderate and severe groups was significantly larger than that in the mild group; moderate and severe groups were not significantly different.

Conclusions: PASA enlargement is an adaptive change during early hallux valgus formation, and decompensation leads to subdislocation in the first MTPJ. A rounded first metatarsal head would thus predispose a foot to hallux valgus. Furthermore, bone proliferation at the medial eminence may also lead to early hallux valgus development.

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The hallux valgus angle is formed by the longitudinal axis of the first metatarsal and the longitudinal axis of the proximal phalanx (a). The intermetatarsal angle is the angle between the extension longitudinal axis of the first and second metatarsals (b). The interphalangeal angle is the angle between the longitudinal axis of the proximal phalange and the longitudinal axis of the distal phalange (c). The proximal articular set angle (PASA) is determined as follows: first, a line is drawn between the medial and lateral points of the articular surface. This is followed by drawing a vertical line through the center. This line and the longitudinal axis of the first metatarsal form the PASA (d). The distal articular set angle defines the relationship of the proximal articular surface of the proximal phalange to the longitudinal axis of the proximal phalange (e). The medial eminence is measured by drawing a line along the medial diaphyseal border of the first metatarsal. A perpendicular line is then drawn at the widest extent of the medial eminence (f). Metatarsocuneiform angle is formed by the intersection of the longitudinal axes of the first metatarsals and the proximal articular surface of the first metatarsal. Image is a weight-bearing AP view of the foot (g).
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Figure 1: The hallux valgus angle is formed by the longitudinal axis of the first metatarsal and the longitudinal axis of the proximal phalanx (a). The intermetatarsal angle is the angle between the extension longitudinal axis of the first and second metatarsals (b). The interphalangeal angle is the angle between the longitudinal axis of the proximal phalange and the longitudinal axis of the distal phalange (c). The proximal articular set angle (PASA) is determined as follows: first, a line is drawn between the medial and lateral points of the articular surface. This is followed by drawing a vertical line through the center. This line and the longitudinal axis of the first metatarsal form the PASA (d). The distal articular set angle defines the relationship of the proximal articular surface of the proximal phalange to the longitudinal axis of the proximal phalange (e). The medial eminence is measured by drawing a line along the medial diaphyseal border of the first metatarsal. A perpendicular line is then drawn at the widest extent of the medial eminence (f). Metatarsocuneiform angle is formed by the intersection of the longitudinal axes of the first metatarsals and the proximal articular surface of the first metatarsal. Image is a weight-bearing AP view of the foot (g).

Mentions: The HVA is formed by the longitudinal axis of the first metatarsal and the longitudinal axis of the proximal phalanx [Figure 1a]. The longitudinal axis of the first metatarsal connects the middle point of the medial and lateral cortices of the proximal and distal first metatarsals. The longitudinal axis of the proximal phalange is similarly drawn. Normally, the HVA is no more than 15°, and when increased, it typifies a hallux valgus deformity.


Radiological characteristics and anatomical risk factors in the evaluation of hallux valgus in chinese adults.

Xu H, Jin K, Fu Z, Ma M, Liu Z, An S, Jiang B - Chin. Med. J. (2015)

The hallux valgus angle is formed by the longitudinal axis of the first metatarsal and the longitudinal axis of the proximal phalanx (a). The intermetatarsal angle is the angle between the extension longitudinal axis of the first and second metatarsals (b). The interphalangeal angle is the angle between the longitudinal axis of the proximal phalange and the longitudinal axis of the distal phalange (c). The proximal articular set angle (PASA) is determined as follows: first, a line is drawn between the medial and lateral points of the articular surface. This is followed by drawing a vertical line through the center. This line and the longitudinal axis of the first metatarsal form the PASA (d). The distal articular set angle defines the relationship of the proximal articular surface of the proximal phalange to the longitudinal axis of the proximal phalange (e). The medial eminence is measured by drawing a line along the medial diaphyseal border of the first metatarsal. A perpendicular line is then drawn at the widest extent of the medial eminence (f). Metatarsocuneiform angle is formed by the intersection of the longitudinal axes of the first metatarsals and the proximal articular surface of the first metatarsal. Image is a weight-bearing AP view of the foot (g).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4837819&req=5

Figure 1: The hallux valgus angle is formed by the longitudinal axis of the first metatarsal and the longitudinal axis of the proximal phalanx (a). The intermetatarsal angle is the angle between the extension longitudinal axis of the first and second metatarsals (b). The interphalangeal angle is the angle between the longitudinal axis of the proximal phalange and the longitudinal axis of the distal phalange (c). The proximal articular set angle (PASA) is determined as follows: first, a line is drawn between the medial and lateral points of the articular surface. This is followed by drawing a vertical line through the center. This line and the longitudinal axis of the first metatarsal form the PASA (d). The distal articular set angle defines the relationship of the proximal articular surface of the proximal phalange to the longitudinal axis of the proximal phalange (e). The medial eminence is measured by drawing a line along the medial diaphyseal border of the first metatarsal. A perpendicular line is then drawn at the widest extent of the medial eminence (f). Metatarsocuneiform angle is formed by the intersection of the longitudinal axes of the first metatarsals and the proximal articular surface of the first metatarsal. Image is a weight-bearing AP view of the foot (g).
Mentions: The HVA is formed by the longitudinal axis of the first metatarsal and the longitudinal axis of the proximal phalanx [Figure 1a]. The longitudinal axis of the first metatarsal connects the middle point of the medial and lateral cortices of the proximal and distal first metatarsals. The longitudinal axis of the proximal phalange is similarly drawn. Normally, the HVA is no more than 15°, and when increased, it typifies a hallux valgus deformity.

Bottom Line: We found positive correlations between the HVA and IMA (r = 0.279, P < 0.01) and HVA and PASA (r = 0.358, P < 0.01), but not for IMA and PASA (P > 0.05).Using this grouping, HVA was significant higher in the rounded shape (19.92°) than in a flat shape (17.66°).The medial eminence in the moderate and severe groups was significantly larger than that in the mild group; moderate and severe groups were not significantly different.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedics, Peking University People's Hospital, Beijing 100044, China.

ABSTRACT

Background: There are no unified theories as to the anatomical changes that occur with hallux valgus, we investigated the radiological characteristics and anatomical risk factors for hallux valgus deformity in Chinese adults.

Methods: We reviewed 141 patients with hallux valgus (206 feet; 15 males, 126 females; mean age, 58.5 years). These patients attended Peking University People's Hospital from April 2008 to March 2014. All feet had intact radiological data, obtained using the Centricity RIS/PACS system. We measured hallux valgus angle (HVA), 1-2 intermetatarsal angle (IMA), proximal articular set angle (PASA), distal articular set angle, hallux interphalangeal angle, metatarsocuneiform angle, size of the medial eminence of the distal first metatarsal, tibial sesamoid position, and joint congruity of the first metatarsophalangeal joint (MTPJ).

Results: We found positive correlations between the HVA and IMA (r = 0.279, P < 0.01) and HVA and PASA (r = 0.358, P < 0.01), but not for IMA and PASA (P > 0.05). Feet were divided into three groups based on HVA severity. IMA (P < 0.05) and PASA (P < 0.05) in the mild group were significantly lower than that in the moderate and severe groups, with no significant difference determined for IMA or PASA between the moderate and severe groups (P > 0.05). Feet were then grouped based on the shape of the first metatarsal head. Using this grouping, HVA was significant higher in the rounded shape (19.92°) than in a flat shape (17.66°). The size of the medial eminence of the distal first metatarsal was positively correlated with HVA (r = 0.185, P < 0.01). The medial eminence in the moderate and severe groups was significantly larger than that in the mild group; moderate and severe groups were not significantly different.

Conclusions: PASA enlargement is an adaptive change during early hallux valgus formation, and decompensation leads to subdislocation in the first MTPJ. A rounded first metatarsal head would thus predispose a foot to hallux valgus. Furthermore, bone proliferation at the medial eminence may also lead to early hallux valgus development.

Show MeSH
Related in: MedlinePlus