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The effect of hallux valgus on the anatomy of the nerves around the first metatarsal bone

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Abstract

Objective

To identify the variations in the location of the nerves that may be at risk in hallux valgus (HV) surgery, and to reveal whether these nerves are affected by the anatomical changes associated with HV.

Method

In the formalin fixed, 46 lower extremities (19 female, 27 male) (9 normal, 14 mild HV, 21 moderate/severe HV), extensor hallucis longus tendon (EHL), deep plantar artery, medial dorsal cutaneous (MDCN), deep fibular (DFN), common plantar digital (CPDN) and proper plantar digital (PPDN) nerves were examined. The branches of MDCN extending to the medial side of foot were recorded in three segments. The positional topography of nerves according to EHL were analyzed on 360° circle and clock models.

Results

Sex-related differences observed in some parameters in direct measurements were not found in the clock model comparisons. In advanced HV angles (> 20°), DFN was closer to EHL in the distal part of the metatarsal bone, while there was no difference in the proximal. The intersection of the medial branch of the MDCN with the EHL was more proximal in HV cases than in normal feet. The location of the nerves in the clock pattern did not change in HV. Of the nerve branches reaching the medial side of the foot, 65.2% were in Part I, 71.7% in Part II, and 4.3% in Part III.

Conclusion

Sex differences in the distance of the nerves to the EHL disappeared when the size effect of the cross-section of the first metatarsal bone region was eliminated with the clock model. Only in advanced HVA (>20°) (not in mild HV), the DFN being closer to the EHL distally and the intersection of the medial branch of the MDCN with the EHL in HV being more proximal than in normal can be interpreted as specific reflections of HV progress. The variations we revealed in the number of branches reaching the inside of the foot may explain the diversity of neuromas or nerve injuries associated with HV surgery.

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Fig. 2

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Data availability

The material used in the study was obtained from the inventory of Anatomy Department Laboratory of Mersin University.

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Acknowledgements

The authors sincerely thank those who donated their bodies to science so that anatomical research could be performed. The results of such studies can contribute to the improvement of the health service that humanity receives. For this reason, we would like to express our gratitude to these donors and their families on behalf of researchers and humanity. Also, thanks to Mersin University Scientific Research Projects Unit for supporting this study.

Funding

The study is supported by Mersin University Scientific Research Projects Unit (PN:2021–1-TP2-4313).

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Authors and Affiliations

  1. Department of Anatomy, Faculty of Medicine, Niğde Ömer Halisdemir University, Niğde, Turkey

    Fatih Çiçek

  2. Department of Anatomy, Faculty of Medicine, Mersin University, Mersin, Turkey

    Zeliha Kurtoğlu Olgunus

  3. Department of Anatomy, Faculty of Medicine, Kahramanmaraş Sütçü İmam University, Kahramanmaraş, Turkey

    Turan Koç

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  1. Fatih Çiçek
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  3. Turan Koç
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Contributions

FÇ: project development, data collection, data analysis, manuscript writing, ZKO: project development, data analysis, preparing Fig. 1, manuscript writing, manuscript editing, TK: data collection, preparing Fig. 2, manuscript editing. All authors reviewed the manuscript.

Corresponding author

Correspondence to Zeliha Kurtoğlu Olgunus.

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The authors declare no conflict of interest.

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All authors (FÇ, ZKO, TK) read the manuscript and have approved the content of the article and agree to present the article in “Surgical and Radiologic Anatomy” for publication.

Ethics approval

The study has been approved by the Board of Ethics of Mersin University (Approval number: 2021–96).

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Çiçek, F., Kurtoğlu Olgunus, Z. & Koç, T. The effect of hallux valgus on the anatomy of the nerves around the first metatarsal bone. Surg Radiol Anat 46, 433–441 (2024). https://doi.org/10.1007/s00276-024-03318-9

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