Yonsei Med J.  2016 May;57(3):741-747. 10.3349/ymj.2016.57.3.741.

Point-Connecting Measurements of the Hallux Valgus Deformity: A New Measurement and Its Clinical Application

• Seo JH
• Ahn JY
• Boedijono

• KMID: 2374096
• DOI: http://doi.org/10.3349/ymj.2016.57.3.741

Abstract

PURPOSE
The aim of this study was to investigate new point-connecting measurements for the hallux valgus angle (HVA) and the first intermetatarsal angle (IMA), which can reflect the degree of subluxation of the first metatarsophalangeal joint (MTPJ). Also, this study attempted to compare the validity of midline measurements and the new point-connecting measurements for the determination of HVA and IMA values.
MATERIALS AND METHODS
Sixty feet of hallux valgus patients who underwent surgery between 2007 and 2011 were classified in terms of the severity of HVA, congruency of the first MTPJ, and type of chevron metatarsal osteotomy. On weight-bearing dorsal-plantar radiographs, HVA and IMA values were measured and compared preoperatively and postoperatively using both the conventional and new methods.
RESULTS
Compared with midline measurements, point-connecting measurements showed higher inter- and intra-observer reliability for preoperative HVA/IMA and similar or higher inter- and intra-observer reliability for postoperative HVA/IMA. Patients who underwent distal chevron metatarsal osteotomy (DCMO) had higher intraclass correlation coefficient for inter- and intra-observer reliability for pre- and post-operative HVA and IMA measured by the point-connecting method compared with the midline method. All differences in the preoperative HVAs and IMAs determined by both the midline method and point-connecting methods were significant between the deviated group and subluxated groups (p=0.001).
CONCLUSION
The point-connecting method for measuring HVA and IMA in the subluxated first MTPJ may better reflect the severity of a HV deformity with higher reliability than the midline method, and is more useful in patients with DCMO than in patients with proximal chevron metatarsal osteotomy.

Keyword

Hallux valgus; hallux valgus angle; intermetatarsal angle; measurement; reliability

MeSH Terms

Adult
Aged
Female
Foot
Hallux Valgus/*diagnostic imaging/surgery
Humans
Male
Metatarsal Bones/*diagnostic imaging/surgery
Metatarsophalangeal Joint/*diagnostic imaging/surgery
Middle Aged
Osteotomy/*methods
Postoperative Period
Reproducibility of Results
Weight-Bearing

Figure

• 

  Fig. 1 Weight-bearing foot anterior-posterior images illustrating the conventional midline measurement method. (A) Midline method showing a HVA of 21° with a subluxated first MTPJ (arrow). (B) The same HVA of 21° was measured using the midline method without subluxation of the first MTPJ. A is more symptomatic than B although same degrees of HVA. HVA, hallux valgus angle; MTPJ, metatarsophalangeal joint.

• 

  Fig. 2 Measurement of the HVA and IMA using the conventional midline method. (A) Preoperative measurement; Miller method using the longitudinal axis of the first and second metatarsal, determined preoperatively by connecting the centers of the metatarsal head (asterisk) for the HVA and IMA. (B) Postoperative measurement; Shima method using a connecting line between the center of the first metatarsal head and the proximal articular surface as the longitudinal axis of the first metatarsal (asterisk) for postoperative determination of the HVA and IMA. HVA, hallux valgus angle; IMA, intermetatarsal angle.

• 

  Fig. 3 Point-connecting measurement of the HVA and IMA using three connecting lines as the longitudinal axis of the proximal phalanges, first metatarsal, and second metatarsal. (A) Preoperative point-connecting method. Line a was defined as the connecting line between most medial prominent point (solid white arrow) of proximal phalanges in the first interphalangeal joint and most medial prominent point (interrupted white arrow) of the first metatarsal head. Line b was defined as the line connecting the most medial prominent point of first metatarsal head (interrupted white arrow) and most medial prominent and sclerotic point (open white arrow) of the first metatarsal base in the tarsometatarsal (TMT) joint. Line c was defined as the connecting line between the most medial prominent point of second metatarsal head (arrowhead) and most medial prominent and sclerotic point (open black arrow) of second metatarsal base in the TMT joint. (B) Postoperative point-connecting method illustrating the longitudinal axis using the same preoperative point method (d, e, and f). HVA, hallux valgus angle; IMA, intermetatarsal angle.

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