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Effect of the Modified Lapidus Procedure on Pronation of the First Ray in Hallux Valgus.
Foot Ankle Int 2019; :1071100719883325FA

Abstract

BACKGROUND

Hallux valgus (HV) is a triplanar deformity of the first ray including pronation of the first metatarsal with subluxation of the sesamoids. The purpose of this study was to investigate if a first tarsometatarsal fusion (modified Lapidus technique), without preoperative knowledge of pronation measured on weightbearing computed tomographic (CT) scans, changed pronation of the first metatarsal and determine if reduction of the sesamoids was correlated with changes in first metatarsal pronation.

METHODS

Thirty-one feet in 31 patients with HV who underwent a modified Lapidus procedure had preoperative and at least 5-month postoperative weightbearing CT scans and radiographs. Differences in preoperative and postoperative pronation of the first metatarsal using a 3-dimensional computer-aided design, HV angle, and intermetatarsal angle (IMA) were calculated using Wilcoxon signed-rank tests. After dividing patients into groups based on sesamoid station, Kruskal-Wallis H tests were used to compare first metatarsal pronation between the groups.

RESULTS

The mean preoperative and postoperative pronation of the first metatarsal was 29.0 degrees (range 15.8-51.1, SD 8.7) and 20.2 degrees (range 10.4-32.6, SD 5.4), respectively, which was a mean change in pronation of the first ray of -8.8 degrees (P < .001). There was no difference in pronation of the first ray when stratified by postoperative sesamoid position (P > .250). The average preoperative and postoperative IMA was 16.7 degrees (SD 3.2) and 8.8 degrees (SD 2.8), which demonstrated a significant change (P < .001).

CONCLUSIONS

The modified Lapidus procedure was an effective tool to change pronation of the first ray. Reduction of the sesamoids was not associated with postoperative first metatarsal pronation.

LEVEL OF EVIDENCE

Level IV, case series.

Authors+Show Affiliations

Hospital for Special Surgery, New York, NY, USA.University of Pittsburgh Swanson School of Engineering, Pittsburgh, PA, USA.Hospital for Special Surgery, New York, NY, USA.University of Pittsburgh Swanson School of Engineering, Pittsburgh, PA, USA.Hospital for Special Surgery, New York, NY, USA.Hospital for Special Surgery, New York, NY, USA.Orthopaedic Specialists-UPMC, Pittsburgh, PA, USA.Hospital for Special Surgery, New York, NY, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31617413

Citation

Conti, Matthew S., et al. "Effect of the Modified Lapidus Procedure On Pronation of the First Ray in Hallux Valgus." Foot & Ankle International, 2019, p. 1071100719883325.
Conti MS, Willett JF, Garfinkel JH, et al. Effect of the Modified Lapidus Procedure on Pronation of the First Ray in Hallux Valgus. Foot Ankle Int. 2019.
Conti, M. S., Willett, J. F., Garfinkel, J. H., Miller, M. C., Costigliola, S. V., Elliott, A. J., ... Ellis, S. J. (2019). Effect of the Modified Lapidus Procedure on Pronation of the First Ray in Hallux Valgus. Foot & Ankle International, p. 1071100719883325. doi:10.1177/1071100719883325.
Conti MS, et al. Effect of the Modified Lapidus Procedure On Pronation of the First Ray in Hallux Valgus. Foot Ankle Int. 2019 Oct 16;1071100719883325. PubMed PMID: 31617413.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effect of the Modified Lapidus Procedure on Pronation of the First Ray in Hallux Valgus. AU - Conti,Matthew S, AU - Willett,Joseph F, AU - Garfinkel,Jonathan H, AU - Miller,Mark C, AU - Costigliola,Stephen V, AU - Elliott,Andrew J, AU - Conti,Stephen F, AU - Ellis,Scott J, Y1 - 2019/10/16/ PY - 2019/10/17/entrez KW - first metatarsal pronation KW - first tarsometatarsal fusion KW - hallux valgus KW - weightbearing CT scan SP - 1071100719883325 EP - 1071100719883325 JF - Foot & ankle international JO - Foot Ankle Int N2 - BACKGROUND: Hallux valgus (HV) is a triplanar deformity of the first ray including pronation of the first metatarsal with subluxation of the sesamoids. The purpose of this study was to investigate if a first tarsometatarsal fusion (modified Lapidus technique), without preoperative knowledge of pronation measured on weightbearing computed tomographic (CT) scans, changed pronation of the first metatarsal and determine if reduction of the sesamoids was correlated with changes in first metatarsal pronation. METHODS: Thirty-one feet in 31 patients with HV who underwent a modified Lapidus procedure had preoperative and at least 5-month postoperative weightbearing CT scans and radiographs. Differences in preoperative and postoperative pronation of the first metatarsal using a 3-dimensional computer-aided design, HV angle, and intermetatarsal angle (IMA) were calculated using Wilcoxon signed-rank tests. After dividing patients into groups based on sesamoid station, Kruskal-Wallis H tests were used to compare first metatarsal pronation between the groups. RESULTS: The mean preoperative and postoperative pronation of the first metatarsal was 29.0 degrees (range 15.8-51.1, SD 8.7) and 20.2 degrees (range 10.4-32.6, SD 5.4), respectively, which was a mean change in pronation of the first ray of -8.8 degrees (P < .001). There was no difference in pronation of the first ray when stratified by postoperative sesamoid position (P > .250). The average preoperative and postoperative IMA was 16.7 degrees (SD 3.2) and 8.8 degrees (SD 2.8), which demonstrated a significant change (P < .001). CONCLUSIONS: The modified Lapidus procedure was an effective tool to change pronation of the first ray. Reduction of the sesamoids was not associated with postoperative first metatarsal pronation. LEVEL OF EVIDENCE: Level IV, case series. SN - 1944-7876 UR - https://www.unboundmedicine.com/medline/citation/31617413/Effect_of_the_Modified_Lapidus_Procedure_on_Pronation_of_the_First_Ray_in_Hallux_Valgus L2 - http://journals.sagepub.com/doi/full/10.1177/1071100719883325?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -