Journal of Korean Foot and Ankle Society (대한족부족관절학회지)

Korean Foot & Ankle Society (대한족부족관절학회)
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Radiographic Characteristics and the Clinical Results of the Operative Treatment of the Tarsometatarsal Osteoarthritis with Hallux Valgus Deformity

무지 외반증에 동반된 중족 설상 관절염의 방사선학적 특징과 수술적 치료 결과

  • Choi, Hong-Joon (Department of Orthopedic Surgery, Haeundae Paik Hospital, Inje University College of Medicine)
  • 최홍준 (인제대학교 해운대 백병원 정형외과학교실)
  • Received : 2013.04.12
  • Accepted : 2013.05.21
  • Published : 2013.06.15
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Abstract

Purpose: To evaluate the radiographic characteristics of the tarsometatarsal osteoarthritis with hallux valgus deformity and report the clinical results of the operative treatment. Materials and Methods: This is a retrospective study of 20 patients, 22 feet who had been operated for non-traumatic tarsometatarsal osteoarthritis with hallux valgus (TMT group) and control group of hallux valgus patients without tarsometatarsal osteoarthritis (26 patients, 28 feet) from April 2004 to July 2011. Radiographic characteristics were compared between the groups, using hallux valgus angle, $1^{st}-2^{nd}$ intermetatarsal angle, metatarsal length ratio, metatarsus adductus angle, talonavicular coverage angle, talus-$1^{st}$ metatarsal angle, calcaneal pitch angle and medial cuneiform height. Pre- and postoperative difference of $1^{st}-2^{nd}$ metatarsal declination angle and distance between the $1^{st}-2^{nd}$ metatarsal head were evaluated. The clinical results were evaluated by American Orthopaedics Foot and Ankle Society (AOFAS) midfoot scale and visual analogue scale (VAS). Results: Metatarsal length ratio was significantly larger in TMT group (p<0.001). Metatarsus adductus angle, talonavicular coverage angle, talus-$1^{st}$ metatarsal angle on lateral radiograph, calcaneal pitch angle and medial cuneiform height were different from control group (p<0.001, p<0.001, p=0.001, p=0.010, p=0.006). Postoperative declination of the $2^{nd}$ metatarsal and distance between the $1^{st}-2^{nd}$ metatarsal head were increased (p=0.009, p=0.001). The AOFAS and VAS score were improved (p<0.001, p<0.001). Conclusion: Non-traumatic osteoarthritis of the tarsometatarsal joints seems to be associated with long 2nd metatarsal length, metatarsus adductus and flatfoot deformity. Spur excision may be successful to relieve symptoms when the arthritis was diagnosed in early stage.

Keywords

References

  1. Horton GW, Olney BW. Deformity correction and arthrodesis of the midfoot with a medial plate. Foot Ankle. 1993;14:493-9. https://doi.org/10.1177/107110079301400902
  2. Mann RA, Preiskorn D, Sobel M. Midtarsal and tarsometatarsal arthrodesis for primary degenerative osteoarthritis or osteoarthritis after trauma. J Bone Joint Surg Am. 1996; 78:1376-85. https://doi.org/10.2106/00004623-199609000-00013
  3. Jung HG, Myerson MS, Schon LC. Spectrum of operative treatment and clinical outcomes for atraumatic osteoarthritis of the tarsometatarsal joint. Foot Ankle Int. 2007;28:482-9. https://doi.org/10.3113/FAI.2007.0482
  4. Ferris LR, Vargo R, Alexander IJ. Late reconstruction of the midfoot and tarsometatarsal joints after trauma. Orthop Clin North Am. 1995;26:393-406.
  5. Komenda GA, Myerson MS, Biddinger KR. Results of arthrodesis of the tarsometatarsal joints after traumatic injury. J Bone Joint Surg Am. 1996;78:1665-76. https://doi.org/10.2106/00004623-199611000-00005
  6. Snijders CJ, Snijders JG, Phillipens MM. Biomechanics of hallux valgus and spread foot. Foot Ankle. 1986;7:26-39. https://doi.org/10.1177/107110078600700106
  7. Wanivenhaus AH, Feldner Busztin H. Basal osteotomy of the first metatarsal for the correction of metatarsus primus varus associated with hallux valgus. Foot Ankle. 1988; 8:337-43. https://doi.org/10.1177/107110078800800610
  8. Wanivenhaus AH, Pretterklieber M. First tarsometatarsal joint: an anatomical and biomechanical study. Foot Ankle. 1989;9:153-4. https://doi.org/10.1177/107110078900900401
  9. Ito K, Tanaka Y, Tanaka Y. Degenerative osteoarthrosis of tarsometatarsal joints in hallux valgus: a radiographic study. J Orthop Sci. 2003;8:629-34. https://doi.org/10.1007/s00776-003-0691-1
  10. Greisberg J, Hansen ST Jr, Sangeorzan B. Deformity and degeneration in the hindfoot and midfoot joints of the adult acquired flatfoot. Foot Ankle Int. 2003; 24(7):530-4. https://doi.org/10.1177/107110070302400704
  11. Davitt JS, Kadel N, Sangeorzan BJ et al. An association between functional second metatarsal length and midfoot arthrosis. J Bone Joint Surg Am. 2005;87:795-800. https://doi.org/10.2106/JBJS.C.01238
  12. Morton DJ. The human foot; its evolution, physiology and functional disorders. New York: Columbia University Press; 1935.153-86.
  13. Kilmartin TE, O'Kane C. Fusion of the second metatarsocuneiform joint for the painful osteoarthritis. Foot Ankle Int. 2008;29(11):1079-87. https://doi.org/10.3113/FAI.2008.1079
  14. Coughlin MJ. Juvenile hallux valgus: etiology and treatment. Foot Ankle Int. 1995;16(11):682-97. https://doi.org/10.1177/107110079501601104
  15. Chi TD, Toolan BC, Sangeorzan BJ, Hansen ST Jr. The lateral column lengthening and medial column stabilization procedures. Clin Orthop Relat Res. 1999; 365:81-90. https://doi.org/10.1097/00003086-199908000-00011
  16. King DM, Toolan BC. Associated deformities and hypermobility in hallux valgus: an investigation with weightbearing radiographs. Foot Ankle Int. 2004; 25(4):251-5. https://doi.org/10.1177/107110070402500410
  17. Younger AS, Sawatzky B, Dryden P. Radiographic assessment of adult flatfoot. Foot Ankle Int. 2005;26(10): 820-5. https://doi.org/10.1177/107110070502601006
  18. Thomas JL, Kunkel MW, Lopez R, Sparks D. Radiographic values of the adult foot in a standardized population. J Foot Ankle Surg. 2006;45:3-12. https://doi.org/10.1053/j.jfas.2005.10.014
  19. Arangio GA, Wasser T, Rogman A. Radiographic comparison of standing medial cuneiform arch height in adult with and without aquired flatfoot deformity. Foot Ankle Int. 2006;27(8):636-8. https://doi.org/10.1177/107110070602700813
  20. Horton GA, Park YW, Myerson MS. Role of metatarsus primus elevatus in the pathogenesis of hallux rigidus. Foot Ankle Int. 1999;20(12):777-80. https://doi.org/10.1177/107110079902001204
  21. Kitaoka HB, Alexander IJ, Adelaar RS. Clinical rating systems for the ankle-hindfoot, midfoot, hallux and lesser toes. Foot Ankle Int. 1994;10:193-200.
  22. Mann RA. Biomechanics of the foot and ankle in Coughlin MJ, Mann RA(Ed): Surgery of the Foot and Ankle, 7th ed. St Louis: Mosby; 1999.29.