The Effect of First Metatarsal Shortening and Sagittal Displacement on Forefoot Pressure in MIS Hallux Valgus Correction
Introduction/Purpose: Minimally invasive surgical (MIS) treatment of hallux valgus (HV) deformity is increasing in popularity. A 2mm-diameter burr is used to create a distal first metatarsal osteotomy prior to capital fragment translation and fixation. The metatarsal will shorten by the burr’s diame...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
SAGE Publishing
2024-04-01
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| Series: | Foot & Ankle Orthopaedics |
| Online Access: | https://doi.org/10.1177/2473011424S00093 |
| _version_ | 1797208345188237312 |
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| author | Andres Lopez MD Edward T. Haupt MD Giselle M. Porter BSc(Med), BSc Yianni Bakaes BSc(Med) Glenn Shi MD J. Benjamin Jackson MD, MBA Paisley Myers PhD Tyler Gonzalez MD, MBA |
| author_facet | Andres Lopez MD Edward T. Haupt MD Giselle M. Porter BSc(Med), BSc Yianni Bakaes BSc(Med) Glenn Shi MD J. Benjamin Jackson MD, MBA Paisley Myers PhD Tyler Gonzalez MD, MBA |
| author_sort | Andres Lopez MD |
| collection | DOAJ |
| description | Introduction/Purpose: Minimally invasive surgical (MIS) treatment of hallux valgus (HV) deformity is increasing in popularity. A 2mm-diameter burr is used to create a distal first metatarsal osteotomy prior to capital fragment translation and fixation. The metatarsal will shorten by the burr’s diameter (2mm). Plantar or dorsal capital fragment displacement may also cause load transference and possibly transfer metatarsalgia. In this study, we examine the effect of MIS HV on forefoot loading mechanics with respect to metatarsal shortening and sagittal plane displacement. Methods: Four lower-limb cadaveric specimens were studied. A pedobarography pressure-sensing mat was used to record forefoot plantar pressure in a controlled weightbearing stance position.10 Control and post-osteotomy measurements were obtained with the capital fragment fixated in 3 possible positions: 0mm, 5mm dorsal, and 5mm plantar displacement. Pedobarography data yielded pressure data within measurable graphical depictions. Raw mean contact pressure measurements were taken under the first and fifth metatarsal heads to establish medial and lateral forefoot loading pressure ratios. A priori power analysis was performed based on previous peer-reviewed pedobarographic data and our study was adequately powered. Results: 40 measurements were recorded and ratios of medial-to-lateral forefoot loading were constructed. Medial forefoot pressure change control versus 0mm displacement, and control versus dorsal displacement was not found to be statistically significant (p=0.525, p=0.55 respectively). Significant medial pressure increase was identified comparing control versus plantar displacement (p=0.006). Lateral pressure increased significantly with dorsal displacement of the osteotomy (p=0.013). Conclusion: MIS hallux valgus correction does not appear to cause increase in lateral forefoot pressure loading when sagittal plane displacements are controlled. Plantar displacement increases medial loading, and dorsal displacement increases lateral loading. The clinician must consider metatarsal head position post-osteotomy, as decrease in medial loading and subsequent increase in lateral loading may lead to lateral forefoot pain and transfer metatarsalgia. |
| first_indexed | 2024-04-24T09:37:20Z |
| format | Article |
| id | doaj.art-3910d181faf44f43b7ffea9b0bdc220a |
| institution | Directory Open Access Journal |
| issn | 2473-0114 |
| language | English |
| last_indexed | 2024-04-24T09:37:20Z |
| publishDate | 2024-04-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Foot & Ankle Orthopaedics |
| spelling | doaj.art-3910d181faf44f43b7ffea9b0bdc220a2024-04-15T09:04:10ZengSAGE PublishingFoot & Ankle Orthopaedics2473-01142024-04-01910.1177/2473011424S00093The Effect of First Metatarsal Shortening and Sagittal Displacement on Forefoot Pressure in MIS Hallux Valgus CorrectionAndres Lopez MDEdward T. Haupt MDGiselle M. Porter BSc(Med), BScYianni Bakaes BSc(Med)Glenn Shi MDJ. Benjamin Jackson MD, MBAPaisley Myers PhDTyler Gonzalez MD, MBAIntroduction/Purpose: Minimally invasive surgical (MIS) treatment of hallux valgus (HV) deformity is increasing in popularity. A 2mm-diameter burr is used to create a distal first metatarsal osteotomy prior to capital fragment translation and fixation. The metatarsal will shorten by the burr’s diameter (2mm). Plantar or dorsal capital fragment displacement may also cause load transference and possibly transfer metatarsalgia. In this study, we examine the effect of MIS HV on forefoot loading mechanics with respect to metatarsal shortening and sagittal plane displacement. Methods: Four lower-limb cadaveric specimens were studied. A pedobarography pressure-sensing mat was used to record forefoot plantar pressure in a controlled weightbearing stance position.10 Control and post-osteotomy measurements were obtained with the capital fragment fixated in 3 possible positions: 0mm, 5mm dorsal, and 5mm plantar displacement. Pedobarography data yielded pressure data within measurable graphical depictions. Raw mean contact pressure measurements were taken under the first and fifth metatarsal heads to establish medial and lateral forefoot loading pressure ratios. A priori power analysis was performed based on previous peer-reviewed pedobarographic data and our study was adequately powered. Results: 40 measurements were recorded and ratios of medial-to-lateral forefoot loading were constructed. Medial forefoot pressure change control versus 0mm displacement, and control versus dorsal displacement was not found to be statistically significant (p=0.525, p=0.55 respectively). Significant medial pressure increase was identified comparing control versus plantar displacement (p=0.006). Lateral pressure increased significantly with dorsal displacement of the osteotomy (p=0.013). Conclusion: MIS hallux valgus correction does not appear to cause increase in lateral forefoot pressure loading when sagittal plane displacements are controlled. Plantar displacement increases medial loading, and dorsal displacement increases lateral loading. The clinician must consider metatarsal head position post-osteotomy, as decrease in medial loading and subsequent increase in lateral loading may lead to lateral forefoot pain and transfer metatarsalgia.https://doi.org/10.1177/2473011424S00093 |
| spellingShingle | Andres Lopez MD Edward T. Haupt MD Giselle M. Porter BSc(Med), BSc Yianni Bakaes BSc(Med) Glenn Shi MD J. Benjamin Jackson MD, MBA Paisley Myers PhD Tyler Gonzalez MD, MBA The Effect of First Metatarsal Shortening and Sagittal Displacement on Forefoot Pressure in MIS Hallux Valgus Correction Foot & Ankle Orthopaedics |
| title | The Effect of First Metatarsal Shortening and Sagittal Displacement on Forefoot Pressure in MIS Hallux Valgus Correction |
| title_full | The Effect of First Metatarsal Shortening and Sagittal Displacement on Forefoot Pressure in MIS Hallux Valgus Correction |
| title_fullStr | The Effect of First Metatarsal Shortening and Sagittal Displacement on Forefoot Pressure in MIS Hallux Valgus Correction |
| title_full_unstemmed | The Effect of First Metatarsal Shortening and Sagittal Displacement on Forefoot Pressure in MIS Hallux Valgus Correction |
| title_short | The Effect of First Metatarsal Shortening and Sagittal Displacement on Forefoot Pressure in MIS Hallux Valgus Correction |
| title_sort | effect of first metatarsal shortening and sagittal displacement on forefoot pressure in mis hallux valgus correction |
| url | https://doi.org/10.1177/2473011424S00093 |
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