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Distribution, prevalence, and impact on the metatarsosesamoid complex of first metatarsal pronation in hallux valgus.

Publication ,  Journal Article
Lalevée, M; de Carvalho, KAM; Barbachan Mansur, NS; Kim, KC; McGettigan, L; Dibbern, K; Easley, M; de Cesar Netto, C
Published in: Foot Ankle Surg
August 2023

BACKGROUND: Previous simulated weight-bearing CT (WBCT) studies classifying first metatarsal (M1) pronation suggested a high prevalence of M1 hyper-pronation in hallux valgus (HV). These findings have prompted a marked increase in M1 supination in HV surgical correction. No subsequent study confirms these M1 pronation values, and two recent WBCT investigations suggest lower normative M1 pronation values. The objectives of our WBCT study were to (1) determine M1 pronation distribution in HV, (2) define the hyperpronation prevalence compared to preexisting normative values, and (3) assess the relationship of M1 pronation to the metatarso-sesamoid complex. We hypothesized that the M1 head pronation distribution would be high in HV. METHODS: We retrospectively identified 88 consecutive feet with HV in our WBCT dataset and measured M1 pronation with the Metatarsal Pronation (MPA) and α angles. Similarly, using two previously published methods defining the pathologic pronation threshold, we assessed our cohort's M1 hyper-pronation prevalence, specifically (1) the upper value of the 95% confidence interval (CI95) and (2) adding two standard deviations at the mean normative value (2 SD). Sesamoid station (grading) was assessed on the coronal plane. RESULTS: The mean MPA was 11.4+/-7.4 degrees and the α angle was 16.2+/-7.4 degrees. According to the CI95 method, 69/88 HV (78.4%) were hyperpronated using the MPA, and 81/88 HV (92%) using the α angle. According to the 2 SD method, 17/88 HV (19.3%) were hyperpronated using the MPA, and 20/88 HV (22.7%) using the α angle. There was a significant difference in MPA among sesamoid gradings (p = 0.025), with a paradoxical decrease in MPA when metatarsosesamoid subluxation was increased. CONCLUSION: M1 head pronation distribution in HV was higher than in normative values, but threshold change demonstrated contradictory hyper-pronation prevalences (85% to 20%), calling into question the previously reported high prevalence of M1 hyper-pronation in HV. An increase in sesamoid subluxation was associated with a paradoxical decrease in M1 head pronation in our study. We suggest that a greater understanding of the impact of HV M1 pronation is warranted before routine M1 surgical supination is recommended for patients with HV. LEVEL OF EVIDENCE: Level III, retrospective cohort study.

Duke Scholars

Published In

Foot Ankle Surg

DOI

EISSN

1460-9584

Publication Date

August 2023

Volume

29

Issue

6

Start / End Page

488 / 496

Location

France

Related Subject Headings

  • Retrospective Studies
  • Pronation
  • Prevalence
  • Orthopedics
  • Metatarsal Bones
  • Humans
  • Hallux Valgus
  • Bunion
  • 3202 Clinical sciences
  • 1103 Clinical Sciences
 

Citation

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Lalevée, M., de Carvalho, K. A. M., Barbachan Mansur, N. S., Kim, K. C., McGettigan, L., Dibbern, K., … de Cesar Netto, C. (2023). Distribution, prevalence, and impact on the metatarsosesamoid complex of first metatarsal pronation in hallux valgus. Foot Ankle Surg, 29(6), 488–496. https://doi.org/10.1016/j.fas.2023.06.003
Lalevée, Matthieu, Kepler Alencar Mendes de Carvalho, Nacime Salomao Barbachan Mansur, Ki Chun Kim, Lily McGettigan, Kevin Dibbern, Mark Easley, and Cesar de Cesar Netto. “Distribution, prevalence, and impact on the metatarsosesamoid complex of first metatarsal pronation in hallux valgus.Foot Ankle Surg 29, no. 6 (August 2023): 488–96. https://doi.org/10.1016/j.fas.2023.06.003.
Lalevée M, de Carvalho KAM, Barbachan Mansur NS, Kim KC, McGettigan L, Dibbern K, et al. Distribution, prevalence, and impact on the metatarsosesamoid complex of first metatarsal pronation in hallux valgus. Foot Ankle Surg. 2023 Aug;29(6):488–96.
Lalevée, Matthieu, et al. “Distribution, prevalence, and impact on the metatarsosesamoid complex of first metatarsal pronation in hallux valgus.Foot Ankle Surg, vol. 29, no. 6, Aug. 2023, pp. 488–96. Pubmed, doi:10.1016/j.fas.2023.06.003.
Lalevée M, de Carvalho KAM, Barbachan Mansur NS, Kim KC, McGettigan L, Dibbern K, Easley M, de Cesar Netto C. Distribution, prevalence, and impact on the metatarsosesamoid complex of first metatarsal pronation in hallux valgus. Foot Ankle Surg. 2023 Aug;29(6):488–496.
Journal cover image

Published In

Foot Ankle Surg

DOI

EISSN

1460-9584

Publication Date

August 2023

Volume

29

Issue

6

Start / End Page

488 / 496

Location

France

Related Subject Headings

  • Retrospective Studies
  • Pronation
  • Prevalence
  • Orthopedics
  • Metatarsal Bones
  • Humans
  • Hallux Valgus
  • Bunion
  • 3202 Clinical sciences
  • 1103 Clinical Sciences