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Correlation between indirect radiographic parameters of first metatarsal rotation in hallux valgus and values on weight-bearing computed tomography

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Abstract

Purpose

To verify if indirect radiographic signs of first metatarsal pronation, determined by the head round sign, correspond to weight-bearing computed tomography (WBCT) measurements.

Methods

In this case–control retrospective study, we analyzed 26 hallux valgus (HV) feet and 20 controls through conventional radiograph (CR) and WBCT images. Two blinded orthopaedic foot and ankle surgeons performed the measurements. Pronation classification (head roundness), head diameter (HD), traditional HV angles, arthritis, sesamoid positioning, and first metatarsal rotation angle (MRA) (alpha angle) were evaluated. Comparisons were performed by Student’s T-test and a multivariate regression was executed. P-values less than 0.05 were considered significant.

Results

Mean values were higher in HV patients than controls when evaluating MRA (11.51 [9.42–13.60] to 4.23 [1.84–6.62], 95%CI), HD (22.35 [21.52–23.18] to 21.01 [20.07–21.96]), and sesamoid rotation angle (SRA) (26.72 [24.09–29.34] to 4.56 [1.63–7.50]). The MRA had a low influence in head roundness classification (R2: 0.15). Changes in the pronation classification were explained chiefly by the sesamoid station (SS) (R2: 0.37), where stations 4 to 7 were found to be strong predictors of roundness classifications 2 and 3.

Conclusion

Indirect signs of metatarsal pronation, determined by the head round sign, correlate weakly with the alpha angle measured in WBCT. The presence of arthritis and sesamoids displacement might modify the perception of first head roundness. The influence of MRA in the classification was low, where SS from 4 to 7 was strong predictors of a higher pronation classification.

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Authors and Affiliations

  1. Department of Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa (UIOWA), 200 Hawkins Dr, John PappaJohn Pavillion (JPP), Iowa City, IA, 52242-0000, USA

    Nacime Salomão Barbachan Mansur, Matthieu Lalevee, Eli Schmidt, Kevin Dibbern & Cesar de Cesar Netto

  2. Department of Orthopedics and Traumatology, Escola Paulista de Medicina, UNIFESP, São Paulo, Brazil

    Nacime Salomão Barbachan Mansur & Caio Augusto de Souza Nery

  3. Department of Orthopaedic Surgery, Rouen University Hospital, Rouen, France

    Matthieu Lalevee

  4. Foot and Ankle Unit, Orthopedic and Traumatology Department, Clinica Alemana, Vitacura, Chile

    Pablo Wagner & Emilio Wagner

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  1. Nacime Salomão Barbachan Mansur
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Contributions

Nacime Salomão Barbachan Mansur: had full access to all the data in the study and takes responsibility for the integrity and accuracy of the data analysis, literature revision, study design, writing, paper submissions, and data collecting.

Matthieu Lalevee: co-supervisor, writing, data collecting, and paper submission.

Eli Schmidt: literature revision, writing.

Kevin Dibbern: literature revision, writing.

Pablo Wagner: literature revision, writing.

Emilio Wagner: literature revision, writing.

Caio Nery: literature revision, writing.

Cesar de Cesar Netto: supervisor, literature revision, writing, study design, and paper submissions.

Each author contributed to the refinement of the study protocol and approved the final manuscript.

Corresponding author

Correspondence to Cesar de Cesar Netto.

Ethics declarations

Ethics and means of dissemination

University Ethics Committee approved this research under the number 202012422 in accordance with the Declaration of Helsinki.

Competing interests

Nacime Salomao Barbachan Mansur, MD, PhD (Brazil): Brazilian Foot and Ankle Society: Board or committee member. Pablo Wagner, MD (Chile); DePuy, A Johnson & Johnson Company: other financial or material support Elsevier: Editorial or governing board paragon28: IP royalties. Emilio Wagner, MD: Arthrex, Inc: Paid consultant DePuy, A Johnson & Johnson Company: Other financial or material support; Research support Paragon28: IP royalties Promedon Chile: Other financial or material support. Caio Augusto de Souza Nery, MD, PhD (Brazil): Arthrex: Paid presenter or speaker. Cesar De Cesar Netto, MD, PhD (Iowa City, IA): American Orthopaedic Foot and Ankle Society: Board or committee member CurveBeam: Paid consultant; Stock or stock Options Foot and Ankle International: Editorial or governing board Nextremity: Paid consultant Ossio: Paid consultant Paragon 28: IP royalties; Paid consultant Weightbearing CT International Study Group: Board or committee member Zimmer: Paid consultant. The other authors have nothing to disclose.

Disclaimer

The cited companies did not finance the study or participate in any phase of its conduction. The implants used in this study were from several companies as the surgeries were performed at a public hospital.

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According to the ICMJE data sharing police, core records will be shared through Mendeley Data and available upon request.

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Level of Evidence: Level III, Retrospective Diagnostic Study

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Mansur, N.S.B., Lalevee, M., Schmidt, E. et al. Correlation between indirect radiographic parameters of first metatarsal rotation in hallux valgus and values on weight-bearing computed tomography. International Orthopaedics (SICOT) 45, 3111–3118 (2021). https://doi.org/10.1007/s00264-021-05136-9

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