Impact of first metatarsal shortening on forefoot loading pattern: a finite element model study
Abstract Backgrounds There has long been a consensus that shortening of the first metatarsal during hallux valgus reconstruction could lead to postoperative transfer metatarsalgia. However, appropriate shortening is sometimes beneficial for correcting severe deformities or relieving stiff joints. Th...
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2019-12-01
|
| Series: | BMC Musculoskeletal Disorders |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12891-019-2973-6 |
| _version_ | 1818920421319245824 |
|---|---|
| author | Xiang Geng Jiaqi Shi Wenming Chen Xin Ma Xu Wang Chao Zhang Li Chen |
| author_facet | Xiang Geng Jiaqi Shi Wenming Chen Xin Ma Xu Wang Chao Zhang Li Chen |
| author_sort | Xiang Geng |
| collection | DOAJ |
| description | Abstract Backgrounds There has long been a consensus that shortening of the first metatarsal during hallux valgus reconstruction could lead to postoperative transfer metatarsalgia. However, appropriate shortening is sometimes beneficial for correcting severe deformities or relieving stiff joints. This study is to investigate, from the biomechanical perspective, whether and how much shortening of the first metatarsal could be allowed. Methods A finite element model of the human foot simulating the push-off phase of the gait was established. Progressive shortening of the first metatarsal from 2 to 8 mm at an increment of 2 mm were sequentially applied to the model, and the corresponding changes in forefoot loading pattern during push-off phase, especially the loading ratio at the central rays, was calculated. The effect of depressing the first metatarsal head was also investigated. Results With increasing shortening level of the first metatarsal, the plantar pressure of the first ray decreased, while that of the lateral rays continued to rise. When the shortening reaches 6 mm, the load ratio of the central rays exceeds a critical threshold of 55%, which was considered risky; but it could still be manipulated to normal if the distal end of the first metatarsal displaced to the plantar side by 3 mm. Conclusions During the first metatarsal osteotomy, a maximum of 6 mm shortening length is considered to be within the safe range. Whenever a higher level of shortening is necessary, pushing down the distal metatarsal segment could be a compensatory procedure to maintain normal plantar force distributions. |
| first_indexed | 2024-12-20T01:21:29Z |
| format | Article |
| id | doaj.art-3b81d5a34afb4001926f51c40ca8660a |
| institution | Directory Open Access Journal |
| issn | 1471-2474 |
| language | English |
| last_indexed | 2024-12-20T01:21:29Z |
| publishDate | 2019-12-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Musculoskeletal Disorders |
| spelling | doaj.art-3b81d5a34afb4001926f51c40ca8660a2022-12-21T19:58:25ZengBMCBMC Musculoskeletal Disorders1471-24742019-12-012011910.1186/s12891-019-2973-6Impact of first metatarsal shortening on forefoot loading pattern: a finite element model studyXiang Geng0Jiaqi Shi1Wenming Chen2Xin Ma3Xu Wang4Chao Zhang5Li Chen6Department of Orthopedics, Huashan Hospital, Fudan UniversityDepartment of Orthopedics, Huashan Hospital, Fudan UniversityAcademy for Engineering & Technology, Fudan UniversityDepartment of Orthopedics, Huashan Hospital, Fudan UniversityDepartment of Orthopedics, Huashan Hospital, Fudan UniversityDepartment of Orthopedics, Huashan Hospital, Fudan UniversityDepartment of Orthopedics, Huashan Hospital, Fudan UniversityAbstract Backgrounds There has long been a consensus that shortening of the first metatarsal during hallux valgus reconstruction could lead to postoperative transfer metatarsalgia. However, appropriate shortening is sometimes beneficial for correcting severe deformities or relieving stiff joints. This study is to investigate, from the biomechanical perspective, whether and how much shortening of the first metatarsal could be allowed. Methods A finite element model of the human foot simulating the push-off phase of the gait was established. Progressive shortening of the first metatarsal from 2 to 8 mm at an increment of 2 mm were sequentially applied to the model, and the corresponding changes in forefoot loading pattern during push-off phase, especially the loading ratio at the central rays, was calculated. The effect of depressing the first metatarsal head was also investigated. Results With increasing shortening level of the first metatarsal, the plantar pressure of the first ray decreased, while that of the lateral rays continued to rise. When the shortening reaches 6 mm, the load ratio of the central rays exceeds a critical threshold of 55%, which was considered risky; but it could still be manipulated to normal if the distal end of the first metatarsal displaced to the plantar side by 3 mm. Conclusions During the first metatarsal osteotomy, a maximum of 6 mm shortening length is considered to be within the safe range. Whenever a higher level of shortening is necessary, pushing down the distal metatarsal segment could be a compensatory procedure to maintain normal plantar force distributions.https://doi.org/10.1186/s12891-019-2973-6First metatarsal shorteningPlantar pressureFinite element methodHallux valgusTransfer metatarsalgia |
| spellingShingle | Xiang Geng Jiaqi Shi Wenming Chen Xin Ma Xu Wang Chao Zhang Li Chen Impact of first metatarsal shortening on forefoot loading pattern: a finite element model study BMC Musculoskeletal Disorders First metatarsal shortening Plantar pressure Finite element method Hallux valgus Transfer metatarsalgia |
| title | Impact of first metatarsal shortening on forefoot loading pattern: a finite element model study |
| title_full | Impact of first metatarsal shortening on forefoot loading pattern: a finite element model study |
| title_fullStr | Impact of first metatarsal shortening on forefoot loading pattern: a finite element model study |
| title_full_unstemmed | Impact of first metatarsal shortening on forefoot loading pattern: a finite element model study |
| title_short | Impact of first metatarsal shortening on forefoot loading pattern: a finite element model study |
| title_sort | impact of first metatarsal shortening on forefoot loading pattern a finite element model study |
| topic | First metatarsal shortening Plantar pressure Finite element method Hallux valgus Transfer metatarsalgia |
| url | https://doi.org/10.1186/s12891-019-2973-6 |
| work_keys_str_mv | AT xianggeng impactoffirstmetatarsalshorteningonforefootloadingpatternafiniteelementmodelstudy AT jiaqishi impactoffirstmetatarsalshorteningonforefootloadingpatternafiniteelementmodelstudy AT wenmingchen impactoffirstmetatarsalshorteningonforefootloadingpatternafiniteelementmodelstudy AT xinma impactoffirstmetatarsalshorteningonforefootloadingpatternafiniteelementmodelstudy AT xuwang impactoffirstmetatarsalshorteningonforefootloadingpatternafiniteelementmodelstudy AT chaozhang impactoffirstmetatarsalshorteningonforefootloadingpatternafiniteelementmodelstudy AT lichen impactoffirstmetatarsalshorteningonforefootloadingpatternafiniteelementmodelstudy |