Relationship Between Hallux Valgus and Pes Planus: Real or Fiction?

Hallux valgus and pes planus: Correlation analysis using deep learning-assisted radiographic angle measurements

BACKGROUND

The relationship between hallux valgus (HV) and pes planus remains unresolved. This study aims to determine the correlation between HV and pes planus using a deep learning (DL) model to measure radiographic angle parameters.

METHODS

In total, radiographs of 212 feet detectable by the DL model were analyzed. HV was evaluated using the hallux valgus and intermetatarsal angles, while pes planus was assessed using the lateral talo-first metatarsal (Meary's) and calcaneal pitch angles. Correlation analyses were performed for each DL model-measured angle parameter. We investigated whether pes planus worsened with increasing severity of HV and vice versa.

RESULTS

All parameters were significantly correlated with each other. Pes planus worsened with increasing severity of HV, and as the severity of pes planus increased, HV also worsened.

CONCLUSION

Utilizing the DL model-assisted radiographic angle measurements, this study established a significant correlation between HV and pes planus.

LEVEL OF EVIDENCE

III.

Relationship Between the Relative Length of the Second Metatarsal and Occurrence of Metatarsalgia in Patients With Hallux Valgus

BACKGROUND

Patients with hallux valgus (HV) may develop metatarsalgia, which is partly attributed to second metatarsal relative length (RL2M). However, no study has analyzed RL2Ms measured by various methods as predictors for metatarsalgia in HV patients. This study aimed to investigate the predictors for metatarsalgia in HV patients and calculate the cutoff values for metatarsalgia in preoperative planning for lesser metatarsal shortening osteotomy.

METHODS

In this retrospective cohort study, 103 female patients (131 feet) with HV were investigated for metatarsalgia (metatarsalgia-positive [MP] group: 55 feet; metatarsalgia-negative [MN] group: 76 feet). The HV angle (HVA) and intermetatarsal angles (IMAs) (1/2 and 1/5), lateral talo-first metatarsal angle, calcaneal pitch angle, first metatarsal-medial cuneiform angle, and first metatarsal lift (LIFT) were measured using weightbearing radiographs. RL2Ms were assessed using the 4 methods described by Morton and Nilsonne (method A), Coughlin (method B), Hardy and Clapham (method C), and Kumano (method D). RL2M (method D) was calculated as the ratio of this distance to the second metatarsal length. These measurements were compared between the groups. Multivariate logistic regression analysis was performed to determine the predictors of developing metatarsalgia. The cutoff values were calculated using receiver operating characteristic curve analysis.

RESULTS

HVA, IMAs (1/2 and 1/5), LIFT, and RL2M (method D) were significantly higher in the MP group than in the MN group. In the multivariate analysis, HVA and RL2M (method D) were independent predictors for metatarsalgia. The cutoff values for HVA and the value and ratio of RL2M (method D) were 37.0 degrees, 13.1 mm, and 18.8%, respectively.

CONCLUSION

HVA and RL2M measured by method D were independently associated with the occurrence of metatarsalgia in HV patients.

Impact of preoperative pes planus on orthopaedic implant removal following first metatarsophalangeal joint arthrodesis: A retrospective analysis

First metatarsophalangeal (MTP) joint fusion is a frequently employed surgical treatment option for hallux rigidus and hallux valgus. Implant-related complications are common, necessitating further investigation into predisposing factors. The altered mechanics of pes planus may influence surgical outcomes; however, its direct impact on implant removal rates post-fusion remains unclear. We retrospectively analyzed the TriNetX US Collaborative Network database to identify patients undergoing first MTP joint arthrodesis by ICD-10 and CPT coding, the data was stratified by preoperative pes planus status. Implant removal rates were compared between pes planus (PP) and non-pes planus (noPP) cohorts. Odds ratios (OR) were calculated to assess associations. Patients in the PP cohort exhibited significantly higher rates of subsequent hardware irritation (OR 1.30, 95 % CI 1.010-1.675), and hardware removal (OR 1.27, 95 % CI 1.007-1.604) compared to patients in the noPP cohort. Our findings highlight patients with preoperative pes planus have significantly increased likelihood of implant irritation, removal, and reoperation following first MTP joint arthrodesis surgery. Biomechanical alterations associated with pes planus likely contribute to accelerated implant wear and compromise fusion stability leading to higher rates of future surgery.

Comparative Analysis of Structural Differences in Progressive Collapsing Foot Deformity With and Without Hallux Valgus

BACKGROUND

Progressive collapsing foot deformity (PCFD) and hallux valgus (HV) are complex 3-dimensional deformities of the foot. This study aimed to investigate structural and alignment differences between PCFD with and without HV using weightbearing computed tomography.

METHODS

Patients with PCFD aged 18 years or older who underwent weightbearing computed tomography were consecutively enrolled. Standard 2-dimensional PCFD and HV parameters were assessed semiautomatically. Foot and ankle offset, forefoot arch angle, and pronation of the medial column bones in the coronal plane, with the ground as a reference, were manually measured. Additionally, the angles from the inferior aspect of subtalar posterior facet of the talus to the ground (subtalar horizontal angle), from the inferior (posterior facet) to superior facets of the talus (infratalar-supratalar angle), and from the inferior (posterior facet) of the talus to the superior facet of the calcaneus (infratalar-supracalcaneal angle) were examined. HV deformity was defined by an HV angle of ≥15 degrees.

RESULTS

Among 72 feet (58 patients) studied, 33 displayed HV, whereas 39 did not. In the coronal plane, the PCFD with HV group showed a higher infratalar-supratalar angle and greater pronation at the first tarsometatarsal joint, first metatarsal bone, and head. The PCFD with HV group also exhibited greater naviculocuneiform joint supination. Generalized estimating equation logistic regression analysis revealed significant associations of HV deformity with the intrinsic rotation of the first metatarsal bone (P < .001), infratalar-supratalar angle (P = .004), and rotation of the first tarsometatarsal joint (P < .001).

CONCLUSION

This study confirmed significant structural and alignment differences between PCFD with and without HV. Notably, the infratalar-supratalar angle, rotation of the first tarsometatarsal joint, and intrinsic rotation of the first metatarsal bone were associated with HV deformity.

LEVEL OF EVIDENCE

Level III, retrospective comparative study.

Outcomes of Simultaneous Correction of Adult Hallux Valgus and Flexible Pes Planus Deformities

BACKGROUND

There is a high correlation between hallux valgus and pes planus deformity. We sought to evaluate the outcomes of simultaneous Scarf osteotomy and extraosseous talotarsal stabilization (EOTTS) for correcting adult hallux valgus with flexible pes planus deformity.

MATERIALS AND METHODS

This retrospective study enrolled patients who had hallux valgus deformity with flexible pes planus and underwent combined Scarf osteotomy and EOTTS from January 2018 to October 2021. The hallux valgus angle (HVA), intermetatarsal angle (IMA), Meary's angle, calcaneal pitch, and lateral talocalcaneal angles were assessed preoperatively and at 1-year follow-up. Clinical outcomes were evaluated using the visual analog scale (VAS) score for pain, the American Orthopaedic Foot and Ankle Society (AOFAS) forefoot score, and the Maryland foot score (MFS). Complications were recorded.

RESULTS

This study included 25 patients, 19 women and 6 men, with a mean age of 44.3 years. The mean follow-up period was 14.6 months. The mean HVA, IMA, Meary's angle, calcaneal pitch, and lateral talocalcaneal angles improved significantly at 1-year follow-up (P<.001). The mean VAS score decreased from 5.8 to 1.0, whereas the mean AOFAS forefoot score and MFS increased from 52.3 to 88.9 and 61.2 to 89.3, respectively, at 1-year follow-up (P<.001). Two patients had arthroereisis implant removal as a consequence of sinus tarsi pain. No other complications were seen during the follow-up.

CONCLUSION

Management of hallux valgus with flexible pes planus deformity with combined Scarf osteotomy and EOTTS can achieve satisfactory clinical and radiologic results with low complication and recurrence rates. [Orthopedics. 2025;48(1):37-43.].

Toe Separators as a Therapeutic Tool in Physiotherapy-A Systematic Review

Background: Deformities of the foot represent a significant clinical problem. Toe separators constitute an available tool used in various forms of conservative treatment, primarily used for the correction of hallux valgus, but also for improvement in the condition of neurological patients, e.g., after a stroke, or to treat dermatological problems. The goal of this systematic review is to critically assess the current scientific literature on the application of toe separators as a therapeutic intervention in physiotherapy. Methods: A systematic search was conducted across several electronic databases, such as PubMed, Science Direct, and Web of Science. The review included randomized controlled trials, quasi-experimental studies, and observational studies that explored the use of toe separators in physiotherapeutic interventions. Two independent reviewers evaluated all search results to determine eligible studies and assess their methodological quality. Results: A total of 1020 studies were found through the database search. Out of these, 10 studies met the inclusion criteria and were incorporated into the review. The sample sizes of the selected studies varied from 9 to 90 participants. In the majority of the studies, the methodological quality was not mentioned, and a frequent lack of information was noted. Based on a literature analysis, separators were primarily used as a tool for the correction of hallux valgus, but there are also promising results for use in neurology and dermatology as well as affecting the lower leg muscles during gait. Conclusions: The use of toe separators can be a valuable tool for the conservative treatment of hallux valgus and the associated deformities. The research so far varies in describing the type, material, and method of the application of the separators. Studies showed a variety of applications as well as variation in the use of materials. Further research is needed to establish the effectiveness of toe separators in foot disorders more precisely.

The causality between rheumatoid arthritis and postural deformities: bidirectional Mendelian randomization study and mediation analysis

Background

To better understand the preventive or therapeutic clinical interventions that may be supported by the association between rheumatoid arthritis (RA) and postural deformities including hallux valgus, flat foot, and scoliosis, this study was conducted using Mendelian randomization (MR) analysis. It aimed to investigate whether RA is causally associated with postural deformities in European populations.

Methods

Summary-level data on RA and postural deformities were obtained from the IEU OpenGWAS project and Finngen database, respectively. LDSC regression analysis was conducted to assess the genetic correlation between these diseases. The inverse variance weighting (IVW) method was employed as the primary approach for two-sample MR analyses to evaluate causality. Supplementary methods included MR-Egger, maximum likelihood, weighted median, and cML-MA. To test for potential horizontal pleiotropy, we performed the MR-Egger intercept test, cML-MA, and secondary analyses after excluding confounders. Additionally, mediation analyses were conducted using two-step MR.

Results

The IVW method revealed RA to be causally associated with hallux valgus (OR 1.132, 95% CI 1.087-1.178, P < 0.001) and flat foot (OR 1.197, 95% CI 1.110-1.291, P < 0.001). Among postural deformities, hallux valgus was causally associated with flat foot (OR 1.823, 95% CI 1.569-2.119, P < 0.001) and scoliosis (OR 1.150, 95% CI 1.027-1.287, P < 0.05). No significant horizontal pleiotropy was detected. Moreover, mediation analyses indicated that hallux valgus mediates the effect of RA on flat foot (mediation effect 0.024, 95% CI 0.005-0.044, P < 0.05), with a mediation proportion of 41.31%.

Conclusion

These findings indicate a potential causal association between genetically predicted RA and both hallux valgus and flat foot. Furthermore, hallux valgus serves as a mediator in the pathway from RA to flat foot. This underscores the importance of early screening and preventive treatment of foot deformities in RA patients. Further research is necessary to determine the applicability of these findings in non-European populations.

Hallux Valgus Deformities: Preferred Surgical Repair Techniques and All-Cause Revision Rates

INTRODUCTION

Hallux valgus is a commonly treated condition by foot and ankle surgeons with more than 200 different described correction techniques. Recurrence rates range from 5% to 50%, with increasing support of the theory that arthrodesis procedures may have a lower recurrence rate than osteotomies. Arthrodesis procedures to the first metatarsophalangeal (MTP) joint or tarsometatarsal (TMT) joint for correction of hallux valgus deformity are becoming more commonly utilized. The purpose of this study is to investigate the surgical incidence and revision rates of hallux valgus deformities corrected by arthrodesis compared to osteotomy in the state of South Carolina.

METHODS

The South Carolina Revenue and Fiscal Affairs Office was queried from 2000 to 2017 to identify all surgically treated hallux valgus deformities. Data extraction included patient demographics, ICD-9 diagnoses, CPT procedure codes, and dates of surgery. A logistic regression model was used for statistical inference.

RESULTS

A total of 22 199 feet had surgical treatment for hallux valgus during this time period, with 20 422 (92.0%), 592 (2.7%), and 1185(5.3%) receiving an osteotomy, arthrodesis, or other procedure at initial treatment, respectively. There was an all-cause revision rate of 5.6% in the osteotomy group and 6.4% in the arthrodesis group. Demographic factors such as female sex, white race, and surgery pre-2010 were associated with higher revision rates. Multiple comorbidities were correlated with higher revision rates such as tobacco use, hypothyroidism, osteoarthritis, recurrent dislocations, hallux rigidus, lesser toe deformities, metatarsus varus, and talipes cavus.

CONCLUSION

Despite the recent increase in arthrodesis procedures for the treatment of hallux valgus deformity, our results suggest that osteotomy procedures are more commonly performed and there is no difference in all-cause revision surgery. However, there are multiple patient demographics and comorbidities that are associated with higher rates of revision surgery and should be considered and discussed during the preoperative planning period.

LEVEL OF EVIDENCE

Level IV.

Individuals with asymptomatic hallux valgus exhibit altered foot kinematics during gait regardless of their foot posture

BACKGROUND

A flatfoot has been believed to be closely associated with the development of hallux valgus; however, the association is still controversial. Abnormal foot kinematics has been identified as a possible risk factor for the development of hallux valgus, but it remains unclear whether foot posture contributes to abnormal foot kinematics. This is the first study to investigate the differences in foot kinematics during gait between individuals with and without hallux valgus, while controlling for foot posture.

METHODS

Twenty-five females with hallux valgus and 25 healthy females aged 18 to 22 were recruited. Foot posture was measured using normalized navicular height truncated and the leg-heel angle. Foot kinematic and kinetic data during gait were recorded by a three-dimensional motion capture system. To investigate the characteristics of foot kinematics in individuals with hallux valgus while controlling for foot posture, we used a propensity score matching method. The matching was obtained by using the 1:1 nearest-neighbor procedure and a caliper width of 0.2.

FINDINGS

Twelve pairs were matched. Individuals with hallux valgus had significantly increased midfoot dorsiflexion from 56% to 80% during stance phase, rearfoot eversion from 53% to 71%, and forefoot abduction from 5% to 29% compared with control.

INTERPRETATION

Individuals with hallux valgus have a flexible foot that cannot suppress the dynamic deformation of the rearfoot and midfoot during gait. To suppress the development of hallux valgus, interventions that aim to prevent dynamic deformations of the rearfoot and midfoot during gait may be necessary, regardless of their static foot posture.

Does the Presence of Asymptomatic Flatfoot Deformity Impact the Clinical and Radiographic Outcomes of the Minimally Invasive Chevron and Akin Bunionectomy?

BACKGROUND

Flatfoot deformity is believed to play a role in hallux valgus development and recurrence. While symptomatic flatfoot deformity can be treated with separate procedures at the time of hallux valgus correction, the question remains whether the patient undergoing correction of a symptomatic hallux valgus deformity should have their asymptomatic flatfoot concurrently addressed. We aimed to investigate whether the presence of asymptomatic flatfoot influences patient-reported and radiographic outcomes of the minimally invasive chevron and Akin bunionectomy.

METHODS

A total of 104 patients were included in this study. Forty-two asymptomatic patients met the radiographic criteria for flatfoot while 62 had a normal arch. Patient-reported outcomes were evaluated and compared between the two groups using validated PROMIS measures preoperatively and at a minimum one-year postoperatively. Radiographic outcomes including hallux valgus angle (HVA), intermetatarsal angle (IMA), Meary's angle, calcaneal pitch (CP), and talonavicular coverage angle (TNCA) were measured and compared preoperatively and minimum six-months postoperatively.

RESULTS

Both groups demonstrated similar preoperative and postoperative PROMIS scores with significant improvements in physical function, pain interference, pain intensity, and global physical health. Preoperatively, HVA was similar between both groups, however the flatfoot group showed a greater IMA, Meary's angle, TNCA, and lower CP. Postoperatively, HVA and IMA were similar between groups, although patients in the flatfoot group retained a significantly greater Meary's angle, TNCA, and lower CP. Both groups showed significant improvements in HVA, IMA, and TNCA.

CONCLUSION

Our study indicates that the minimally invasive chevron and Akin bunionectomy leads to improved clinical and radiographic hallux valgus outcomes without adversely impacting radiographic flatfoot parameters. Therefore, the MIS bunionectomy may be an effective option for hallux valgus correction in patients with mild, asymptomatic flatfoot.

LEVEL OF EVIDENCE

Level III, retrospective cohort.

Correlation Between Traditional Anteroposterior Radiographic Measurements With Lateral Radiographic Measurements Following Triplanar Correction of Hallux Valgus and With Patient-Reported Outcomes From a Prospective Multicenter Trial

Hallux valgus (HV) is a common condition in which the first ray is deformed, leading to pain and altered joint mechanics. A variety of radiographic measurements are used to evaluate HV. Little is known about measurements used in the assessment of HV on lateral radiographs compared to anteroposterior (AP) radiographs. The primary aim of this study was to correlate lateral measurements with AP measurements pre and postoperatively. The secondary aim was to correlate lateral measurements with patient-reported outcome measures (PROMs) pre and postoperatively. One hundred eighty-three patients were initially enrolled in the study. Two fellowship-trained musculoskeletal radiologists independently performed all measurements. On AP radiographs, hallux valgus angle (HVA) and intermetatarsal angle (IMA) were measured. On lateral radiographs, sagittal IMA, Meary's angle, and sagittal first ray length were measured. Measurements were recorded at baseline and 6, 12, and 24 months postoperatively. Intraclass correlation coefficients (ICCs) were used for inter-reader analysis. ICCs were moderate to very strong among readers. There were significant but weak correlations between lateral measurements and AP measurements. For at least 1 timepoint, IMA correlated with sagittal IMA, sagittal first ray length, and Meary's angle. HVA only correlated with sagittal first ray length. These correlations were all weak in magnitude. There were a few significant but weak correlations between the measurements in the study and PROMs. This study showed that sagittal IMA, sagittal first ray length, and Meary's angle are not predictive of AP measurements or patient outcomes and are not useful in preoperative assessment of HV.

Are sesamoids and proximal phalanx of metatarsus primus varus deformity of hallux valgus feet displaced? A radiological study

BACKGROUND

The hallux valgus deformity is made up of misaligned first metatarsal, hallux, and sesamoids. Their angular deformities are well-studied, but not their positional displacements. A few available reports claimed the proximal end of the proximal phalanx and sesamoids were not shifted medially along with the first metatarsal head. However, the general observation is otherwise. This study revisits the issue.

METHODS

A radiological study of 189 feet with and without the hallux valgus deformity was carried out to analyze the first metatarsal, hallux, and sesamoid positional changes in relation to the second metatarsal and among themselves. A total of 194 X-ray images with all relevant measurements that formed the raw database for this study were submitted for online viewing and reference.

RESULTS

There was a statistically significant change in the first metatarsal, hallux, and sesamoid positions of feet with hallux valgus deformity compared to normal feet. All have migrated medially but to different degrees. It was contrary to the past findings of no change in sesamoid and hallux positions.

CONCLUSIONS

We agree with past findings that the metatarsus primus varus deformity is directly related to the failed medial metatarsosesamoid ligament. We also believe in the failure of the deep 1-2 transverse metatarsal ligament responsible for the sesamoid migration.

Foot morphology as a predictor of hallux valgus development in children

An excess of body weight can produce morphological changes in the feet of children. The aim of this study was to assess the morphological differences of the foot in children based on their body mass index and to determine the risk factors for the development of a hallux valgus in childhood and adolescence. One Thousand Six Hundred Seventy-Eight children (5-17 years) were classified as group with obesity, overweight, and normal weight. Lengths, widths, heights and angles of both feet was measured with a 3D scanner. The risk of developing hallux valgus was calculated. Group with overweight and obesity presented longer feet (p = 0.00), wider metatarsals (p = 0.00) and wider heels (p = 0.00). Arch height was lower (p > 0.01) in the group with obesity, and the hallux angle was greater in the group with normal weight (p < 0.05). The relative risk of a lateral hallux deviation increases with age, foot length and heel width (Exp (B) > 1). Children with overweight and obesity had longer and wider feet. The arch height was higher in children with overweight, and lower in children with obesity. Age, foot length, and heel width could be risk factors for the development of hallux valgus, while metatarsal width and arch height could be protective factors. Monitorization of the development and characterization of the foot in childhood as a clinical tool could help professionals to early identify the patients presenting risk factors and prevent future deformities and other biomechanical conditions in adulthood by implementing protecting measures.

Effects of Foot-Toe Orthoses on Moment and Range of Motion of Knee Joint in Individuals with Hallux Valgus

Although various types of hallux valgus (HV) orthoses have been used to manage hallux valgus deformity, few previous studies have determined the biomechanical effects of applying a foot-toe orthosis as a therapeutic intervention for HV deformity on the kinetics and kinematics of the knee joint. Biomechanical variables were collected from 24 patients with HV. A three-dimensional motion capture system and force platforms were used to analyze the kinetic and kinematic variables in HV orthosis conditions during gait. To determine the biomechanical effect of each orthosis for HV on knee kinetic and kinematic values, repeated-measures ANOVA was used. The knee adduction moment was significantly decreased under a hard plastic orthosis (HPO) condition compared to that under a without foot-toe orthosis (WTO) condition (p = 0.004). There was a significant decrease in maximal external rotation of the knee joint in HPO than in WTO at the stance phase during gait (p = 0.021). All of the kinetic and kinematic data showed no significant differences between WTO and soft silicone orthosis conditions (p > 0.05). This study indicates that a stronger foot-toe orthosis, such as HPO, to correct HV deformity has a positive effect on the moment and joint motion occurring in the knee joint during walking. In particular, the application of this type of HV orthosis can reduce knee adduction moments associated with the development and progression of knee OA.

Contributions of age, gender, body mass index, and normalized arch height to hallux valgus: a decision tree approach

BACKGROUND

Hallux valgus (HV) is a common toe deformity with various contributory factors. The interactions between intrinsic risk factors of HV, such as arch height, sex, age, and body mass index (BMI) should be considered. The present study aimed to establish a predictive model for HV using intrinsic factors, such as sex, age, BMI, and arch height based on decision tree (DT) model.

METHODS

This is retrospective study. The study data were based on the fifth Size Korea survey, of the Korea Technology Standard Institute. Among 5,185 patients, 645 were excluded due to unsuitable age or missing data, and 4,540 (males = 2,236 and females = 2,304) were selected for inclusion in the study. Seven variables (i.e., sex, age, BMI, and four normalized arch height variables) were used to develop the prediction model for the presence of HV using a DT model.

RESULTS

The DT model correctly classified 68.79% (95% confidence interval [CI] = 67.25-70.29%) of the training data set (3,633 cases). The predicted presence of HV based on the DT was verified against the testing data set (907 cases) and showed an accuracy of 69.57% (95% CI = 66.46-72.55%).

CONCLUSIONS

The DT model predicted the presence of HV on the basis of sex, age, and normalized arch height. According to our model, women aged over 50 years and those with lower normalized arch height were at high risk of HV.

Associated correction of forefoot alignment with hindfoot fusion for pes planovalgus deformity

BACKGROUND

The present study aimed to investigate changes in hallux alignment after corrective surgery for adult-acquired flatfoot deformity (AAFD).

PATIENTS AND METHODS

The present study retrospectively investigated the changes of hallux alignment in 37 feet (33 patients) which were treated with double or triple arthrodesis of the hindfoot for AAFD between 2015 and 2021 and could be followed up to one year postoperatively.

RESULTS

Hallux valgus (HV) angle significantly decreased by a mean 4.1° among the whole 37 subjects and by a mean 6.6° among the 24 subjects who had a preoperative HV angle of 15° or more. Those who had HV correction (HV angle correction ≥ 5°) demonstrated more near-normal postoperative alignment of the medial longitudinal arch and hindfoot than those without HV correction.

CONCLUSIONS

Hindfoot fusion for AAFD could improve preoperative HV deformity to some degree. HV correction was associated with proper realignment of the midfoot and hindfoot.

LEVEL OF EVIDENCE

Level IV; retrospective case series.

Incidence and Progression of Hallux Valgus: A Prospective Cohort Study

OBJECTIVE

Hallux valgus is a common and disabling condition. The objective of the present study was to identify factors associated with hallux valgus incidence and progression.

METHODS

Participants were from a population-based prospective cohort study, the Clinical Assessment Study of the Foot. All adults ages ≥50 years who were registered at 4 general practices in North Staffordshire, UK, were invited to take part in a postal survey at baseline and at 7-year follow-up, which included health questionnaires and self-assessment of hallux valgus using line drawings.

RESULTS

Complete baseline and follow-up data were available for 1,482 participants (739 women and 743 men, mean ± SD age 62.9 ± 8.1 years), of whom 450 (30.4%) had hallux valgus in at least 1 foot at baseline. Incident hallux valgus was identified in 207 (20.1%) participants (349 [15.4%] feet) and was associated with baseline age, poorer physical health, foot pain, and wearing shoes with a very narrow toe-box shape between the ages of 20 and 29 years. Hallux valgus progression was identified in 497 (33.6%) participants (719 [24.3%] feet) but was not associated with any baseline factors.

CONCLUSION

Incident hallux valgus develops in 1 in 5 adults ages ≥50 years over a 7-year period and is related to age, poorer physical health, foot pain, and previous use of constrictive footwear. Progression occurs in 1 in 3 adults. These findings suggest that changes in first metatarsophalangeal joint alignment may still occur beyond the age of 50 years.

Selected hallmarks of hallux valgus in older women with symptomatic hallux valgus compared to middle-aged women with and without deformation of the forefoot

The aim of the study was to compare the shape of the feet, the mobility of the metatarsophalangeal and interphalangeal joints and the flexibility of the calf muscles in older women with hallux valgus versus middle-aged women with and without this deformation to identify the presence of features which correlate particularly strongly with hallux valgus, and on which prophylaxis and conservative treatment should focus. The study involved 201 women: 92 aged 60-84 years with hallux valgus of both toes, 78 aged 38-59 with hallux valgus of both toes, and 31 aged 38-57 years with correctly shaped feet. The intensity of pain in the foot, the valgus angle of the big toe and fifth toe, the longitudinal and transverse arches of the foot, the symmetry of foot load with body weight, toe joint mobility and muscle flexibility were analysed. Both groups of women with hallux valgus differed from women with normal feet in the height of the transverse arch, the extent of dorsal extension in the first metatarsophalangeal joint and plantar flexion in the first interphalangeal joint. Older women were additionally characterised by reduced plantar flexion in the metatarsophalangeal joint of the big toe, limited flexibility of the soleus and gastrocnemius muscles as well as less pain in the toe area than in the foot itself. The most characteristic changes which were observed in older women with hallux valgus are a limited range of motion in the MTP and IP joints of the big toe, a reduced transverse arch and increased restriction of calf muscle flexibility.

Evaluation of the relationship between hallux valgus and foot measurements in radiographic images of adult female

PURPOSE

In the present study, we aimed to determine the relationship of HV angle with angles and measurements obtained from lateral and anteroposterior (AP) radiological images of the foot in individuals with HV.

METHODS

The present study had a retrospective design, and the participants consisted of 66 female patients between the ages of 19 and 64 who applied to Orthopedics and Traumatology and were diagnosed with Hallux valgus. Metatarsus adductus angle, metatarsus primus adductus angle, hallux valgus angle, hallux interphalangeal angle, metatarsal break angle, first metatarsal protrusion distance, metatarsal width, talocalcaneal angle, AP Meary's angle were measured on AP view and calcaneal inclination angle, talar declination angle, lateral talocalcaneal angle, first metatarsal declination angle, fifth metatarsal declination angle, navicular height, lateral Meary's angle, tibiotalar angle were measured on a lateral radiograph. The IBM SPSS 21.0. program was used for statistical analysis, and the level of significance was taken as p < 0.05.

RESULTS

There were statistically significant differences between the right and left feet in MPA and AMA measurements. The results showed that HV angle (HVA) had a weak relationship with MAA and MW, as well as a moderately positive relationship with MPA. However, it had a moderately negative relationship with AMA and a weak negative relationship with HIPA.

CONCLUSION

We believe that in addition to the HVA angle, MPA and AMA angles should be considered in the diagnosis of HV, especially as the HVA angle is moderately positively correlated with the MPA angle and moderately negatively correlated with the AMA angle.

Impact of pes planus on clinical outcomes of hallux valgus surgery

BACKGROUND

Pes planus is associated with hallux valgus development. This study evaluated the impact of pes planus on clinical outcomes following hallux valgus surgery.

METHODS

191 patients underwent Scarf osteotomy for hallux valgus. Pes planus angles including talonavicular coverage angle, lateral talus-first metatarsal angle (Meary's angle) and lateral talocalcaneal angle were measured. The cohort was stratified into control (0°-4.0°), mild (4.1°-14.9°), moderate (15.0°-30.0°) and severe (> 30.0°) pes planus groups according to Meary's angle. Clinical outcomes were compared at baseline, 6 months and 24 months.

RESULTS

There were 78 controls, 95 mild and 18 moderate cases of pes planus. Meary's angle was independently associated with preoperative hallux valgus angle. Pes planus angles were not associated with pain, AOFAS, SF-36 physical or mental scores. All three groups had similar clinical outcomes and patient satisfaction.

CONCLUSION

Compared to patients with neutral foot arches, those with pes planus presented with more severe hallux valgus deformity but had similar clinical outcomes following surgical correction.

Impact of Asymptomatic Flatfoot on Clinical and Radiographic Outcomes of the Modified Lapidus Procedure in Patients With Hallux Valgus

Background

Patients with hallux valgus commonly present with concomitant flatfoot deformity. First-ray hypermobility, among other biomechanical factors, has been suggested as a potential link between these deformities. However, not all hallux valgus patients exhibit symptoms associated with flatfoot deformity, and the necessity of correcting the asymptomatic flatfoot at the time of hallux valgus correction is unclear. We aimed to investigate the relationship between asymptomatic flatfoot and patient-reported and radiographic outcomes after the Lapidus procedure.

Methods

This study included 142 patients who underwent the Lapidus procedure for hallux valgus at a single institution. Sixty-one patients met radiographic criteria for flatfoot. No patients exhibited symptoms related to flatfoot deformity on review of clinical notes. Preoperative, minimum 1-year postoperative, and change in Patient-Reported Outcomes Measurement Information System (PROMIS) scores between asymptomatic flatfoot and control groups were compared. Radiographic outcomes including hallux valgus angle (HVA), intermetatarsal angle (IMA), Meary angle, talonavicular coverage angle (TNCA), and calcaneal pitch (CP) were compared.

Results

Preoperatively, the flatfoot group had higher BMI 22.6 vs 24.6 (P < .01) and IMA 15.32 vs 14.0 degrees (P < .05). Both groups demonstrated preoperative to postoperative improvement in PROMIS physical function (P < .01), pain interference (P < .001), pain intensity (P < .001), and global physical health (P < .001). There were no preoperative or postoperative differences in PROMIS scores between groups. Postoperatively, there were no differences in HVA or IMA between groups; however, the flatfoot group exhibited greater deformity in Meary angle, TNCA, and CP (all P < .001).

Conclusion

There were no significant postoperative differences in patient-reported outcomes of the Lapidus procedure between patients with and without asymptomatic flatfoot, and both groups achieved similar radiographic correction of their hallux valgus deformity. The Lapidus procedure appears to be a reasonable surgical option for hallux valgus correction in patients with asymptomatic flatfoot deformity.Level of Evidence: Level III, retrospective cohort study.

Is the Planus Foot Type Associated With First Ray Hypermobility?

Background:

Many foot pathologies have been associated with foot type. However, the association of first ray hypermobility remains enigmatic. The purpose of this study was to investigate first ray hypermobility among participants with planus and rectus foot types and its influence on static measures of foot structure.

Methods:

Twenty asymptomatic participants with planus (n = 23 feet) and rectus (n = 17 feet) foot types were enrolled. Several parameters of static foot structure (arch height index, arch height flexibility, first metatarsophalangeal joint flexibility, and first ray mobility) were measured. Participants were further stratified into groups with nonhypermobile (n = 26 feet) and hypermobile (n = 14 feet) first rays. First ray mobility ≥8 mm was used to define “first ray hypermobility”. Generalized estimating equations, best-fit regression lines, and stepwise linear regression were used to identify significant differences and predictors between the study variables

Results:

Overall, 86% of subjects categorized with first ray hypermobility exhibited a planus foot type. Arch height flexibility, weightbearing first ray mobility, and first metatarsophalangeal joint flexibility showed no significant between-group differences. However, weightbearing ray mobility and first metatarsophalangeal joint laxity were associated with partial weightbearing first ray mobility, accounting for 38% of the model variance.

Conclusion:

The planus foot type was found to be associated with first ray hypermobility. Furthermore, weightbearing first ray mobility and first metatarsophalangeal joint laxity were predictive of partial weightbearing first ray mobility, demonstrating an interaction between the translation and rotational mechanics of the first ray.

Clinical Relevance:

Association of first ray hypermobility with foot type and first metatarsophalangeal joint flexibility may help understand the sequela to symptomatic pathologies of the foot.

The short-term effectiveness of Kinesiology Taping on foot biomechanics in patients with hallux valgus

BACKGROUND

Hallux valgus, one of the most common foot disorders, contributes to the formation of pain and changes foot biomechanics.

OBJECTIVE

To assess the impact of Kinesiology Taping (KT) on foot loading during gait in patients with hallux valgus.

METHODS

Forty feet with hallux valgus were examined. Patients wore the KT for a month and the parameters of the foot during gait on a baropodometric platform were measured three times: before taping, immediately after application of taping and after one month's use.

RESULTS

The taping had a statistically significant effect on dynamic foot measurements. The maximum and mean foot load (p< 0.001), foot surface (p< 0.001), ratio of forefoot to hindfoot load (p< 0.01) and the proportions of the lateral and medial foot loading (p< 0.05) all changed. During gait cycle, taping significantly increased the load and surface at the first metatarsal head (p< 0.001) while there was a decrease around the second to fifth (p< 0.001) metatarsal heads.

CONCLUSIONS

Using KT to correct a hallux valgus is a procedure that has an impact on the dynamic parameters of the foot during gait. The use of this method could become an alternative to surgical treatment for those patients, who have any contraindication for surgery.

Triad of foot deformities and its conservative treatment: With a 3D customized insole

The coexisting of three deformities as hallux valgus, flatfoot, and the calcaneal spur is an undefined medical condition, and it may be called triad of foot deformities (TFD) as a definition for a new disease entity. A customized 3D insole prototype was created by postprocessing of MRI data, and printed by 3D printer technology for the purpose of providing effective and innovative treatment for TFD. A 42 years-old female was clinically examined for TFD findings. All radiological measurements were made on the weightbearing anteroposterior and lateral X-rays. The patient underwent the pedogram (RSscan International, footscan©). MRI images were taken for the purpose of 3D scanning that was used for producing the 3D splint for TFD. AOFAS (American Orthopedic Foot and Ankle Society scores) and FHSQ (Foot Health Status Questionnaire) were used for clinical follow-up. MRI images of the patient were imported to Mimics software in order to create a 3D model using image processing. Thus, Patient-Specific 3D customized silicone orthotic insole that was based on 3D printing technology was produced. The one-simple test was used to compare the results of AOFAS and FHSQ scores. The measurements of radiological measurements were given. On the clinical follow-up, AOFAS was FHSQ scores were obtained. There was a significant difference in terms of AOFAS and FHSQ scores (p ≤ 0.05). As a result of our study; our 3D customized insole was produced at the price of approximately 1/3 of the total cost of three standard medical products. The coexisting of these three deformities may be called triad of foot deformities (TFD). The 3D printer technology enables us to access a customized, personalized conservative treatment option for TFD. The conservative treatment of TFD is possible by a single orthotic insole.