First Metatarsal Rotation and Hindfoot Alignment in Patients with Hallus Valgus

Description

In this presentation, Ali Najefi discusses first metatarsal rotation in relation to hallux valgus, a common foot deformity. He explains how hallux valgus is a multiplanar deformity typically treated through scarf and chevron osteotomies, which effectively correct the anteroposterior (AP) plane deformity but may fail to address coronal plane rotation, leading to high recurrence rates of up to 70% over time.



Najefi outlines the concept of metatarsal rotation, particularly external rotation, and differentiates it from axial plane rotation, emphasizing its significance in treatment outcomes. He introduces methods for assessing rotation via plain X-rays and coronal plane CT scans, explaining how angles like the alpha angle and the metatarsal pronation angle are determined. Najefi's study analyses data from 102 patients, revealing that about 31% of those with hallux valgus exhibit abnormal metatarsal rotation, yet this rotation does not correlate with the severity of hallux valgus as measured by conventional radiographic angles.



He argues for the importance of assessing hindfoot alignment and the intermetatarsal angle (IMA) as predictors of metatarsal rotation, alongside outlining the need for individualized assessments in pre-operative planning. The discussion leads to inquiries about the implications of metatarsal rotation on surgical outcomes, highlighting ongoing efforts in current research to improve surgical techniques and patient satisfaction regarding hallux valgus corrections.



The session concludes with a collaborative discussion addressing questions from the audience about the findings and their potential impact on future surgical practices, as well as the relationship between metatarsal rotation and overall foot function.

DOI: 10.1302/3114-221390

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