Metatarsal Pronation in Hallux Valgus Deformity: A Review

First Metatarsal Rotation in Hallux Valgus Deformity

“…Axial rotation or pronation 22,23,61 of the first metatarsal (M1) has been implicated to be a clinically relevant part of the deformity and may be present in a substantial number of HV operative cases. 45,89 Thus, some authors have proposed incorporating M1 rotation as part of the HV operative correction and suggested that this may lead to improved outcomes and decreased recurrence rates. 51,89 The aim of the present investigation is to provide an up-to-date review of the role that first metatarsal rotation may play in the nature, etiology, and operative decision making for HV.…”

“…45,89 Thus, some authors have proposed incorporating M1 rotation as part of the HV operative correction and suggested that this may lead to improved outcomes and decreased recurrence rates. 51,89 The aim of the present investigation is to provide an up-to-date review of the role that first metatarsal rotation may play in the nature, etiology, and operative decision making for HV.…”

The interobserver reliability of first metatarsal rotational component of axial sesamoid radiographs in hallux valgus

“…Although the clinical use of non-weight-bearing radiographic projections has been widely questioned in the literature (17,19) , most of these studies assessed RC using different techniques that involve technical differences (9,(12)(13)(14)(15) . Furthermore, there is increased interest in RC assessment using weight-bearing CT (4,7,20) . A practical method for assessing RC in plain radiographs could be clinically relevant, since it would allow it to be performed in a transurgical setting, as well as in centers in which no weight-bearing CT scans are available or where it is difficult to recreate the properties of the axial load (10,11) in the operating room.…”

“…Regarding pathophysiology, interest has been expressed in the literature about the role of RC in first metatarsal hallux valgus deformity (7,16) , as well as dynamic factors (18) , such as muscle strength or ligament resistance, that could have a biomechanical effect on the global architecture of a weight-bearing foot (17) in addition to an isolated bone structure. Our results are relevant in morphological terms because they describe the rotation by trying to isolate the first metatarsal deformity.…”

“…This high number can be interpreted to reflect an incomplete understanding of the pathophysiology (4) . Historically, and especially recently, there has been an interest in RC, which can lead to better understanding and resolution in an effort to improve functionality and decrease recurrences (6,7) . Currently, there is controversy about RC assessment due to the technical heterogeneity and load quantity variance involved in both weight-bearing (3,8) and partial weight-bearing radiographic projections (9) .…”