Mobility of the first metatarsal-cuneiform joint in patients with and without hallux valgus: in vivo three-dimensional analysis using computerized tomography scan

Journal of Orthopaedic Surgery and Research

Junsheng Yang¹  Jian Xu¹  Chao Zhang¹  Jiazhang Huang¹  Xu Wang¹  Xin Ma¹  Chen Wang¹  Xiang Geng¹ 

[1] Department of Orthopedics, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai 200040, China

关键词: Weight-bearing;    Three-dimensional motion;    Hypermobility;    First ray;    Computed tomography;   

Others  :  1227816
DOI  :  10.1186/s13018-015-0289-2

 received in 2015-06-22, accepted in 2015-09-07,  发布年份 2015

【 摘 要 】

Background

Hallux valgus (HV) deformity is closely correlated to the hypermobility of the first metatarsal-cuneiform joint, but adequate understanding of the three-dimentional (3D) mobility of this joint in normal or HV feet is lacking. This study was conducted to investigate the mobility of the first metatarsal-cuneiform joint in multiple planes during body weight-bearing conditions for both normal and HV patients.

Methods

A total of 10 female volunteers (20 feet) and 10 female HV patients (20 feet) participated in this study. Using a custom-made foot-loading device, computerized tomography (CT) scans of each pair of feet were taken under both unloaded and body weight-bearing conditions. 3D models were reconstructed for the first metatarsal and the medial cuneiform. Rotational and translational motions of the first metatarsal-cuneiform joint in multiple planes from unloaded to loaded conditions were quantitatively evaluated by reverse-engineering software.

Results

During body weight-bearing conditions, the first metatarsal-cuneiform joint in HV feet dorsiflexed at an average of 2.91° (standard deviation, SD 1.71) versus 1.18° (SD 0.47) in controls (t = 4.158, P = 0.001); supinated 2.17° (SD 2.28) versus 0.98° (SD 0.81) in controls (t = 2.080, P = 0.045); and internally rotated 2.65° (SD 2.22) versus 0.96° (SD 0.57) in controls (t = 3.114, P = 0.006). Moreover, the joint in HV feet widened significantly compared with the controls (t = 2.256, P = 0.030) and tended to translate more in the dorsal-plantar direction (t = 1.928, P = 0.063); the translation in the medial-lateral direction was not significantly different between the two groups.

Conclusions

During weight-loading process, the first metatarsal-cuneiform joint turns dorsiflexed, supinated, and internally rotated. For HV feet, hypermobility of the first metatarsal-cuneiform joint can be observed in multiple planes. This study promotes further understanding of the physiological and pathological mobility of the first metatarsal-cuneiform joint.

【 授权许可】

   
2015 Geng et al.

【 图 表 】

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【 参考文献 】

• [1]Van Beek C, Greisberg J. Mobility of the first ray: review article. Foot Ankle Int. 2011; 32:917-22.
• [2]Smith BW, Coughlin MJ. The first metatarsocuneiform joint, hypermobility, and hallux valgus: what does it all mean? Foot Ankle Surg. 2008; 14:138-41.
• [3]Faber FW, Van Kampen PM, Bloembergen MW. Long-term results of the Hohmann and Lapidus procedure for the correction of hallux valgus: a prospective, randomised trial with eight- to 11-year follow-up involving 101 feet. Bone Joint J. 2013; 95-B:1222-6.
• [4]Kim JY, Park JS, Hwang SK, Young KW, Sung IH. Mobility changes of the first ray after hallux valgus surgery: clinical results after proximal metatarsal chevron osteotomy and distal soft tissue procedure. Foot Ankle Int. 2008; 29:468-72.
• [5]Roukis TS, Landsman AS. Hypermobility of the first ray: a critical review of the literature. J Foot Ankle Surg. 2003; 42:377-90.
• [6]Klaue K, Hansen ST, Masquelet AC. Clinical, quantitative assessment of first tarsometatarsal mobility in the sagittal plane and its relation to hallux valgus deformity. Foot Ankle Int. 1994; 15:9-13.
• [7]Glasoe WM, Grebing BR, Beck S, Coughlin MJ, Saltzman CL. A comparison of device measures of dorsal first ray mobility. Foot Ankle Int. 2005; 26:957-61.
• [8]Doty JF, Coughlin MJ. Hallux valgus and hypermobility of the first ray: facts and fiction. Int Orthop. 2013; 37:1655-60.
• [9]King DM, Toolan BC. Associated deformities and hypermobility in hallux valgus: an investigation with weightbearing radiographs. Foot Ankle Int. 2004; 25:251-5.
• [10]Faber FW, Kleinrensink GJ, Mulder PG, Verhaar JA. Mobility of the first tarsometatarsal joint in hallux valgus patients: a radiographic analysis. Foot Ankle Int. 2001; 22:965-9.
• [11]Fritz GR, Prieskorn D. First metatarsocuneiform motion: a radiographic and statistical analysis. Foot Ankle Int. 1995; 16:117-23.
• [12]Zhang YJ, Xu J, Wang Y, Lin XJ, Ma X. Correlation between hindfoot joint three-dimensional kinematics and the changes of the medial arch angle in stage II posterior tibial tendon dysfunction flatfoot. Clin Biomech (Bristol, Avon). 2015; 30:153-8.
• [13]Xu J, Zhang Y, Muhammad H, Wang X, Huang J, Zhang C et al.. In vivo three-dimensional analysis of hindfoot kinematics in stage II PTTD flatfoot. J Orthop Sci. 2015; 20:488-97.
• [14]Kido M, Ikoma K, Imai K, Maki M, Takatori R, Tokunaga D et al.. Load response of the tarsal bones in patients with flatfoot deformity: in vivo 3D study. Foot Ankle Int. 2011; 32:1017-22.
• [15]Tanaka Y, Takakura Y, Takaoka T, Akiyama K, Fujii T, Tamai S. Radiographic analysis of hallux valgus in women on weightbearing and nonweightbearing. Clin Orthop Relat Res. 1997; 336:186-94.
• [16]Coughlin MJ, Anderson RB. Hallux valgus: etiology. In: Mann's surgery of the foot and ankle. 9th ed. Coughlin MJ, Saltzman CL, Anderson RB, editors. Saunders Elsevier, Philadelphia; 2014: p.175-6.
• [17]Ferri M, Scharfenberger AV, Goplen G, Daniels TR, Pearce D. Weightbearing CT scan of severe flexible pes planus deformities. Foot Ankle Int. 2008; 29:199-204.
• [18]Takatori R, Tokunaga D, Inoue N, Hase H, Harada T, Suzuki H et al.. In vivo segmental motion of the cervical spine in rheumatoid arthritis patients with atlantoaxial subluxation. Clin Exp Rheumatol. 2008; 26:442-8.
• [19]Beck TW. The importance of a priori sample size estimation in strength and conditioning research. J Strength Cond Res. 2013; 27:2323-37.
• [20]Dietze A, Bahlke U, Martin H, Mittlmeier T. First ray instability in hallux valgus deformity: a radiokinematic and pedobarographic analysis. Foot Ankle Int. 2013; 34:124-30.
• [21]Ouzounian TJ, Shereff MJ. In vitro determination of midfoot motion. Foot Ankle Int. 1989; 10:140-6.
• [22]Faber FW, Kleinrensink GJ, Verhoog MW, Vijn AH, Snijders CJ, Mulder PG et al.. Mobility of the first tarsometatarsal joint in relation to hallux valgus deformity: anatomical and biomechanical aspects. Foot Ankle Int. 1999; 20:651-6.
• [23]Mortier JP, Bernard JL, Maestro M. Axial rotation of the first metatarsal head in a normal population and hallux valgus patients. Orthop Traumatol Surg Res. 2012; 98:677-83.
• [24]Collan L, Kankare JA, Mattila K. The biomechanics of the first metatarsal bone in hallux valgus: a preliminary study utilizing a weight bearing extremity CT. Foot Ankle Surg. 2013; 19:155-61.