First metatarsal-sesamoids system and hallux valgus / 中华骨科杂志

ABSTRACT

Objective To study the role of first metatarsal sesamoids s y stem in the pathogenesis of hallux valgus. Methods The sesamoids absolute and relative position (TSP) were measured in 245 normal feet and 141 hallux valgus ones, and the results were statistically analysed with hallux valgus angle(HVA), intermetatarsal angle(IMA) and metatarsal phalangeal joint subluxation. Results The absolute position of sesamoids had no difference in the normal feet and ha llux valgus ones. TSP was correlated with HVA,IMA. TSP≤3 was considered normal in 245 normal feet. 92 hallux valgus feet were surgically treated. 20 cases unde rgone Keller procedures which didnt correct TSP were excluded from this study. 19 cases treated with modified McBride procedures, 24 cases with metatarsal met aphyseal osteotomy, 29 cases with metatarsal basal osteotomy. All the cases were followed up for an average of 4 years(ranged 1－6 years). The postoperative HV A was 5?－10?(average 7?)，IMA was 5?－9?(average 7?)，TSP were all 3 or 4 . According to the evaluation standard made by SUN Junying et al, 60 cases(83％) were assessed as excellent， 8 cases(11％) as good， and 4 cases(6％) as worse ， giving an overall excellent and good rate of 94％. Conclusion TSP is an impo rtant parameter that should be routinely used for postoperative prognosis evalua tion and surgical procedures determination. Osteotomy is preferred to restore no rmal metatarsal-sesamoids system function when TSP is abnormal.