• 1.

    Coughlin MJ & Anderson RB: “Hallux Valgus,” in Mann's Surgery of the Foot and Ankle , 9th Ed, edited by Coughlin, MJ, Saltzman, CL & Anderson, RB p 155, Saunders, Philadelphia, 2014.

    • Search Google Scholar
    • Export Citation
  • 2.

    Roddy E, Zhang W & Doherty M: Prevalence and associations of hallux valgus in a primary care population. Arthritis Rheum 59 : 857, 2008.

    • Crossref
    • Web of Science
    • Search Google Scholar
    • Export Citation
  • 3.

    Nix S, Smith M & Vicenzino B: Prevalence of hallux valgus in the general population: a systematic review and meta-analysis. J Foot Ankle Res 3 : 21, 2010.

    • Crossref
    • PubMed
    • Web of Science
    • Search Google Scholar
    • Export Citation
  • 4.

    Perera A, Mason L & Stephens M: The pathogenesis of hallux valgus. J Bone Joint Surg Am 93 : 1650, 2011.

    • Crossref
    • PubMed
    • Web of Science
    • Search Google Scholar
    • Export Citation
  • 5.

    Scranton PE Jr, & Rutkowski R: Anatomic variations in the first ray: part I. Anatomic aspects related to bunion surgery. Clin Orthop Rel Res 151 : 244, 1980.

    • Search Google Scholar
    • Export Citation
  • 6.

    Grode SE & McCarthy DJ: The anatomical implications of hallux abducto valgus: a cryomicrotomic study. JAPA 70 : 539, 1980.

  • 7.

    Mizuno S, Sima Y & Yamazaki K: Detorsion osteotomy of the first metatarsal bone in hallux valgus. J Jpn Orthop Assoc 30 : 105, 1956.

  • 8.

    Talbot KD & Saltzman CL: Assessing sesamoid subluxation: how good is the AP radiograph? Foot Ankle Int 19 : 547, 1998.

  • 9.

    Kim Y, Kim SK & Young KW et al.: A new measure of tibial sesamoid position in hallux valgus in relation to coronal rotation of the first metatarsal in CT scans. Foot Ankle Int 36 : 944, 2015.

    • Crossref
    • PubMed
    • Web of Science
    • Search Google Scholar
    • Export Citation
  • 10.

    Inman VT: Hallux valgus: a review of etiologic factors. Orthop Clin North Am 5 : 59, 1974.

  • 11.

    Kay DB, Njus G & Parrish W et al.: Basilar crescentic osteotomy: a three-dimensional computer simulation. Orthop Clin North Am 20 : 571, 1989.

  • 12.

    Kuwano T, Nagamine R & Sakaki K et al.: New radiographic analysis of sesamoid rotation in hallux valgus: comparison with conventional evaluation methods. Foot Ankle Int 23 : 811, 2002.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13.

    Lee KM, Ahn S & Chung CY et al.: Reliability and relationship of radiographic measurements in hallux valgus. Clin Orthop Relat Res 470 : 2613, 2012.

  • 14.

    Choi YR, Lee SJ & Kim JH et al.: Effect of metatarsal osteotomy and open lateral soft tissue procedure on sesamoid position: radiological assessment. J Orthop Surg Res 13 : 11, 2018.

    • Crossref
    • PubMed
    • Web of Science
    • Search Google Scholar
    • Export Citation
  • 15.

    Dayton P & Feilmeier M: Comparison of tibial sesamoid position on anteroposterior and axial radiographs before and after triplane tarsal metatarsal joint arthrodesis. J Foot Ankle Surg 56 : 1041, 2017.

    • Crossref
    • PubMed
    • Web of Science
    • Search Google Scholar
    • Export Citation
  • 16.

    Dayton P, Feilmeier M & Kauwe M et al.: Relationship of frontal plane rotation of first metatarsal to proximal articular set angle and hallux alignment in patients undergoing tarsal metatarsal arthrodesis for hallux abducto valgus: a case series and critical review of the literature. J Foot Ankle Surg 52 : 348, 2013.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17.

    Yildirim Y, Çabukoglu C & Erol B et al.: Effect of metatarsophalangeal joint position on the reliability of the tangential sesamoid view in determining sesamoid position. Foot Ankle Int 26 : 247, 2005.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18.

    Aper RL, Saltzman CL & Brown TD: The effect of hallux sesamoid resection on the effective moment of the flexor hallucis brevis. Foot Ankle Int 15 : 462, 1994.

  • 19.

    Hicks JH: The mechanics of the foot: part I. The joints. J Anat 87 : 345, 1953.

  • 20.

    Welck MJ, Singh D & Cullen N et al.: Evaluation of the 1st metatarso-sesamoid joint using standing CT: the Stanmore classification. Foot Ankle Surg 24 : 314, 2018.

    • Crossref
    • PubMed
    • Web of Science
    • Search Google Scholar
    • Export Citation

Inaccuracy of Forefoot Axial Radiographs in Determining the Coronal Plane Angle of Sesamoid Rotation in Adult Hallux Valgus Deformity: A Study Using Weightbearing Computed Tomography

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Background

Hallux abducto valgus is a triplane deformity with recent attention given to the significance of correcting the coronal plane component. This study explored the accuracy of the forefoot axial (FFA) study as a standard radiographic assessment method compared with weightbearing computed tomography (CT).

Methods

Twelve feet with hallux abducto valgus from 12 individuals were included in this study. Three images of the affected foot were taken: FFA radiograph and weightbearing CT with the foot in maximum pronation (pronated CT) and maximum supination (supinated CT). Five investigators determined the sesamoid rotation angles (SRAs) from each of the images. The measurements from a single investigator were used to compare the SRA means from each of the image types, and those from all five investigators were used to determine reliability.

Results

The mean ± SD SRA was 22.1° ± 7.6° for pronated CT, 10.5° ± 5.0° for supinated CT, and 12.2° ± 9.4° for FFA images. The mean SRA from the pronated CT was significantly greater than the supinated CT (P < .001) and FFA (P < .005) SRAs. There were no significant differences in mean SRA between the FFA and supinated CT images (P > .99). Results indicated high reliability in measurements among investigators.

Conclusions

Using weightbearing CT, these findings indicate that the sesamoids significantly alter their position in the coronal plane, as determined by the SRA, with changes in weightbearing subtalar joint position. Moreover, the affected foot positioning required for determining the SRA from the FFA radiograph seems to significantly underestimate the true SRA. Thus, use of this image in surgical hallux abducto valgus planning is called into question.

Division of Pre-Clinical Sciences, Kent State University College of Podiatric Medicine, Independence, OH.

Division of Foot and Ankle Surgery and Biomechanics, Kent State University College of Podiatric Medicine, Independence, OH.

University Hospitals Regional Hospitals, Richmond Heights, OH. Dr. Bakhaj is now with Western Podiatry, California.

St. Francis Hospital and Medical Center, Hartford, CT.

Kent State University College of Podiatric Medicine, Independence, OH. Dr. Nutter is now with Scripps Mercy, San Diego, CA.

Division of Podiatric and General Medicine, Kent State University College of Podiatric Medicine, Independence, OH.