Evaluation of the longitudinal arch of the foot with hallux valgus using a newly developed two-dimensional coordinate system

doi:10.1007/s007760100056

Journal of Orthopaedic Science

Volume 6, Issue 2, April 2001, Pages 110-118

https://doi.org/10.1007/s007760100056 Get rights and content

Abstract

The purposes of the present study were to establish a method for the evaluation of the longitudinal arch, using a two-dimensional coordinate system, and to clarify the main point of flattening of the foot in patients with hallux valgus. Measurements on a weight-bearing lateral radiograph of the foot were performed in 186 feet of 110 women with symptomatic hallux valgus and in 93 normal feet of 72 women. A two-dimensional coordinate system was used to perform the measurements. In this coordinate system, the line connecting the lowest point of the first metatarsal head and the lowest point (O) of the calcaneus is fixed as the x-axis, and the line that is perpendicular to the x-axis and intersects the x-axis at point O is fixed as the y-axis. The mean values of the y- coordinates at the points of the medial longitudinal arch of the foot in the patients with hallux valgus were significantly lower than those in the normal subjects (P < 0.001). The values were noticeably lower at points on the navicular. However, no change was observed in the posterior talus body. The new coordinate system indicated that the main points of flattening of the foot in patients with hallux valgus were the plantar flexion of the talus and the sinking of the navicular.

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Hindfoot fusion for AAFD could improve preoperative HV deformity to some degree. HV correction was associated with proper realignment of the midfoot and hindfoot.
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The present study aimed to clarify the morphological patterns of the calcaneus and talus that are associated with hallux valgus angle (HVA) by quantifying the differences in the hindfoot bone morphology between left and right sides in HV patients with clear bilateral difference of HVA.
Three-dimensional (3D) computed tomography scans of 32 feet of 16 patients with HV who had right-to-left HVA differences of more than 5 degrees (68.8 ± 8.6 years) were enrolled, and 3D surface models of the calcaneus and talus were generated. A total of 556 and 430 landmarks were placed on the calcaneal and talar surfaces, respectively, to calculate the principal components (PCs) of shape variations. The PC scores were compared between the small and large HVA sides within an individual.
The calcaneus in patients with a larger HVA (mean, 43.2 degrees) possessed slender calcaneal tuberosity, more medially oriented posterior articular surface in the coronal plane, and narrower and more concave anterior-middle articular surfaces compared to those with a small HVA (mean, 33.7 degrees). The talus with a larger HVA exhibited more medially oriented talar head in the transverse plane and more anteriorly protruded lateral region of the talar head compared to the small HVA.
The morphological patterns of the calcaneus in patients with a larger HVA allows the hindfoot bones to easily rotate in the everting direction, while those of the talus could induce a larger internal rotation of the first metatarsal. These morphological patterns of the calcaneus and talus could be structural factors affecting the HV.
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The findings of this study reveal that the GFH angle (as an HV index) is influenced by forefoot flatness and misalignment of the midfoot skeleton. Komeda et al. considered the NH to be an index of flat feet, which influences HV [30]. However, in this study, the SHN angle was identified as an independent variable via multiple regression analysis.
A thorough understanding of the influence of the foot skeletal structure on hallux valgus (HV) is required for HV prevention. We developed a system using a 3D foot scanner on a smartphone to clarify the relationships between foot features and HV risk.
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Age-dependent foot-feature variations were observed slightly for males and distinctively for females. For females, the great toe–first metatarsal head–heel (GFH) angle associated with HV increased with age, i.e., the GFH angle increased with age, suggesting that HV increased with age. Multiple regression analysis revealed that the features determining the GFH angle are the second toe–heel–navicular angle, bone distance axis, and transverse arch length and height. The adjusted coefficients of determination were 0.54 and 0.52 for males and females, respectively.
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Importantly, the association between FHB thickness and navicular height and drop was significant even after adjusting for the hallux valgus angle. Previous studies demonstrated that individuals with hallux valgus show lower MLA [11], higher prevalence of flatfoot [12], and smaller foot intrinsic muscles [13,14] than those without. Similar to these results, the hallux valgus angle was negatively correlated with navicular height in this study.
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We studied 88 community-dwelling older adults (mean age 74.2 ± 6.2 years). We measured the navicular height, the calcaneus inclination, and hallux valgus angle on the right foot in the sitting and standing positions using a 3D foot scanner. Then, we calculated the navicular drop and changes in the calcaneus inclination from the sitting to the standing position. The muscle thickness of the flexor hallucis brevis (FHB), flexor digitorum brevis (FDB), and abductor hallucis (AbH) was measured on the right foot using Bmode ultrasonography.
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Our data suggest that FHB plays an important role in preventing navicular drop and that intrinsic muscles likely do not contribute to the rearfoot angle in older adults.
Biomechanical behavior of valgus foot in children with cerebral palsy: A comparative study
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The FE prediction also revealed that the deformation region in the VF mainly concentrated on the MLA and forefoot. For the VF, the MLA collapse was the main pathological characteristic (Komeda et al., 2001). This result may play a guiding role to investigate the MLA collapse in VF of CP children.
Valgus foot (VF) is the most common foot deformity in children with cerebral palsy (CP), which seriously affects the foot balance in standing and posture control in walking. Little information about the locus and stress of internal bones was available. To accurately describe the biomechanical behavior of the internal bones of VF in CP, we compared the locus and stress of internal bones between the normal foot (NF) and VF by finite element models. Compared with the NF, displacement of the talus and navicular drop in VF increased by 109% and 171% in vertical direction respectively, and the locus of talus had a tendency to clockwise rotation and downward movement in coronal plane. In addition, the abduction angle of forefoot in VF increased up to 10.3°, which was twice more than that in the NF. Moreover, the lateral metatarsophalangeal joints were upward tilted 6.3° comparing with touchdown posture of NF, and peak von Mises stress of the internal bones in VF model concentrated on the fourth metatarsal. The simulation showed that locus of the forefoot, downward rotation of talus head and navicular drop were meaningful to quantify the collapse of medial longitudinal arch. It would provide some suggestions to the rehabilitation treatments of the CP children's VF.
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Evaluation of the longitudinal arch of the foot with hallux valgus using a newly developed two-dimensional coordinate system

Abstract

Orthop Clin North Am

Arch Phys Med Rehabil

Complications of plantar fascia rupture associated with corticosteroid injection

Foot Ankle

Hypermobile flatfoot in childern

Clin Orthop

Hindfoot arthrodesis in adults utilizing a dowel graft technique

Clin Orthop

Incidence, origin, and prevention of certain foot defects

BMJ

Observations on hallux valgus

J Bone Joint Surg Br

The mechanics of the hind foot in club foot as demonstrated radiographically

J Bone Joint Surg Br

Der Hallux valgus und die übrigen Zehenverkrümmungen

Ergeb Chir Orthop

Disorders of the hallus and the first ray

Relationship between adolescent bunions and flatfeet

Foot Ankle

Subtalar arthrodesis for posterior tibiar tendon dysfunction and pes planus

Clin Orthop

Treatment of clubfoot by posterior capsulectomy

Clin Orthop