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Multiplanar instability of the first tarsometatarsal joint in hallux valgus and hallux rigidus patients: a case-control study.

Publication ,  Journal Article
Lee, HY; Lalevee, M; Mansur, NSB; Vandelune, CA; Dibbern, KN; Barg, A; Femino, JE; de Cesar Netto, C
Published in: Int Orthop
February 2022

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.

Duke Scholars

Published In

Int Orthop

DOI

EISSN

1432-5195

Publication Date

February 2022

Volume

46

Issue

2

Start / End Page

255 / 263

Location

Germany

Related Subject Headings

  • Retrospective Studies
  • Orthopedics
  • Middle Aged
  • Metatarsal Bones
  • Joint Instability
  • Humans
  • Hallux Valgus
  • Hallux Rigidus
  • Case-Control Studies
  • Adult
 

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Lee, H. Y., Lalevee, M., Mansur, N. S. B., Vandelune, C. A., Dibbern, K. N., Barg, A., … de Cesar Netto, C. (2022). Multiplanar instability of the first tarsometatarsal joint in hallux valgus and hallux rigidus patients: a case-control study. Int Orthop, 46(2), 255–263. https://doi.org/10.1007/s00264-021-05198-9
Lee, Hee Young, Matthieu Lalevee, Nacime Salomao Barbachan Mansur, Christian A. Vandelune, Kevin N. Dibbern, Alexej Barg, John E. Femino, and Cesar de Cesar Netto. “Multiplanar instability of the first tarsometatarsal joint in hallux valgus and hallux rigidus patients: a case-control study.Int Orthop 46, no. 2 (February 2022): 255–63. https://doi.org/10.1007/s00264-021-05198-9.
Lee HY, Lalevee M, Mansur NSB, Vandelune CA, Dibbern KN, Barg A, et al. Multiplanar instability of the first tarsometatarsal joint in hallux valgus and hallux rigidus patients: a case-control study. Int Orthop. 2022 Feb;46(2):255–63.
Lee, Hee Young, et al. “Multiplanar instability of the first tarsometatarsal joint in hallux valgus and hallux rigidus patients: a case-control study.Int Orthop, vol. 46, no. 2, Feb. 2022, pp. 255–63. Pubmed, doi:10.1007/s00264-021-05198-9.
Lee HY, Lalevee M, Mansur NSB, Vandelune CA, Dibbern KN, Barg A, Femino JE, de Cesar Netto C. Multiplanar instability of the first tarsometatarsal joint in hallux valgus and hallux rigidus patients: a case-control study. Int Orthop. 2022 Feb;46(2):255–263.
Journal cover image

Published In

Int Orthop

DOI

EISSN

1432-5195

Publication Date

February 2022

Volume

46

Issue

2

Start / End Page

255 / 263

Location

Germany

Related Subject Headings

  • Retrospective Studies
  • Orthopedics
  • Middle Aged
  • Metatarsal Bones
  • Joint Instability
  • Humans
  • Hallux Valgus
  • Hallux Rigidus
  • Case-Control Studies
  • Adult