Characteristics of Severe Hallux Valgus Deformity with Moderate Intermetatarsal Angle

Chul Hyun Park; Woo Chun Lee; Jung Rae Kim; Seung Whan Lim

doi:10.14193/jkfas.2014.18.4.173

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Park, Lee, Kim, and Lim: Characteristics of Severe Hallux Valgus Deformity with Moderate Intermetatarsal Angle

Original Article

J Korean Foot Ankle Soc 2014;18(4):173-177.

Published online: 19 January 2014

DOI: https://doi.org/10.14193/jkfas.2014.18.4.173

Characteristics of Severe Hallux Valgus Deformity with Moderate Intermetatarsal Angle

Chul Hyun Park, Woo Chun Lee^*, Jung Rae Kim^†, Seung Whan Lim

Department of Orthopaedic Surgery, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Daegu

^*Department of Orthopaedic Surgery, Yeungnam University College of Medicine, Daegu

^†Department of Orthopaedic Surgery, Yeungnam University College of Medicine, Daegu

Corresponding Author: Chul Hyun Park Department of Orthopaedic Surgery, Yeungnam University Medical Center, 170 Hyeonchung-ro, Nam-gu, Daegu 705-703, Korea Tel: 82-53-620-3640, Fax: 82-53-628-4020, E-mail: chpark77@naver.com

Received 15 July 201420 October 2014 Accepted 21 October 2014

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose:

The purpose of this study is to evaluate the characteristics of hallux valgus with severe hallux valgus angle (HVA) and moderate intermetatarsal angle (IMA) after proximal chevron osteotomy.

Materials and Methods:

Between January 2008 and December 2010, 41 patients (48 feet) were treated with proximal chevron osteotomy and distal soft tissue procedure for symptomatic severe hallux valgus deformity (HVA ≥40°). Patients were divided into two groups, group M (IMA <18°) and group S (IMA ≥18°). Mean age of patients was 55.7 years (34∼70 years) in group M and 60.0 years (44∼78 years) in group S. Mean duration of follow-up was 20.4 months (12∼41 months) in group M and 18.5 months (12∼35 months) in group S. Radiographic parameters, including HVA, IMA, sesamoid position, metatarsus adductus angle (MAA), and distal metatarsal articular angle (DMAA), were compared between groups. Clinical results were assessed using American Orthopaedic Foot and Ankle Society (AOFAS) score and visual analogue scale (VAS). Recurrence rate at the last follow-up was compared between group M and group S.

Results:

Preoperative HVA and grade of sesamoid position did not differ between the groups. However, immediate postoperative HVA and grade of sesamoid position were significantly larger in group M. Preoperative MAA and DMAA were significantly larger in group M. No significant difference in AOFAS score and VAS was observed between the groups at the last follow-up. Ten of the 27 feet (37.0%) in group M and two of the 21 feet (9.5%) in group S showed hallux valgus recurrence at the last follow-up. Group M showed a significantly higher recurrence rate than group S.

Conclusion:

Recurrence rate for severe hallux valgus with moderate IMA is higher than that of severe hallux valgus with severe IMA.

Keywords: Hallux valgus, Intermetatarsal angle, Recurrence

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Figure 1.

Modified Sgarlato’s metatarsus adductus angle was measured using the fifth metatarsocuboid point as a reference. A line (a-b) was drawn connecting the midpoint between the most distal medial point of the first cuneiform and the proximal point of the navicular and the midpoint between the proximal and distal lateral points of the cuboid. Another line (c-d) was drawn perpendicular to this line and an angle between the this line and the longitudinal axis (e-f) of the second metatarsal was defined as metatarsus adductus angle.

Figure 2.

Graph showed changes in the mean hallux valgus angle (HVA) over time in group M and group S (*p<0.05). Group M: intermetatarsal angle <18^o, Group S: intermetatarsal angle ≥18^o.

Figure 3.

Graph showed changes in the mean intermetatarsal angle (IMA) over time in group M and group S (*p<0.05). Group M: IMA <18^o, Group S: IMA ≥18^o.

Figure 4.

Graph showed changes in the mean sesamoid position over time in group M and group S (*p<0.05). Group M: intermetatarsal angle <18^o, Group S: intermetatarsal angle ≥18^o.

Table 1.

Demographic Data of Two Groups

	Group M	Group S	p-value
Number of patients	22 (27 feet)	19 (21 feet)
Gender	All females	All females	1.000
Age (yr)	55.7 (34~70)	60 (44~78)	0.090
Follow-up (mo)	20.4 (12~41)	18.5 (12~35)	0.314

Group M: intermetatarsal angle <18°, Group S: intermetatarsal angle ≥18°.

Values are presented as number (feet’s data) or mean (range).

Table 2.

Radiographic Results between Two Groups

	Preop MAA (^o)	Preop DMAA (^o)
Group M	22.3±6.3	16.2±4.8
Group S	16.6±4.3	12.7±5.3
p-value	0.001	0.020

Group M: intermetatarsal angle <18°, Group S: intermetatarsal angle ≥18°.

Values are presented as mean±standard deviation.

Preop: preoperative, MAA: metatarsus adductus angle, DMAA: distal metatarsal articular angle.

Table 3.

Clinical Results between Two Groups

	AOFAS score			VAS
	Preop	Last follow-up	p-value	Preop	Last follow-up	p-value
Group M	44.7±5.3	86.9±7.1	<0.001	6.7±1.0	1.8±1.4	<0.001
Group S	43.9±6.9	89.9±8.2	<0.001	6.8±1.0	2.1±1.3	<0.001
p-value	0.429	0.324		0.405	0.213

Group M: intermetatarsal angle <18°, Group S: intermetatarsal angle ≥18°.

Values are presented as mean±standard deviation.

Preop: preoperative, AOFAS: American Orthopaedic Foot and Ankle Society, VAS: visual analogue scale.

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