KT Lee’s Orthopedic Foot & Ankle Clinic, Seoul, Korea Department of Orthopedic Surgery, Ajou University Hospital, Suwon, Korea*

Kyung Tai Lee, M.D., Young Uk Park, M.D.*, Hyuk Jegal, M.D

IP joint Skin Crease Angle of Big toe As a Predicting Tool for DMAA

In Hallux Valgus Surgery

# 396

IP joint Skin Crease Angle of Big toe As a Predicting Tool for DMAA

In Hallux Valgus Surgery

My disclosure is in the Final AOFAS Mobile App.

I have no potential conflicts with this presentation.

Hyuk Jegal, M.D.

Introduction • Difficult Factors for Bunion Surgery Hypermobility, M. adductus, Flatfoot etc

• DMAA ; one of difficult factors affect the surgical results

• Severe Hallux valgus with highly increased DMAA Complication such as arthritic change, iatrogenic Hallux varus

• Little known about DMAA except Excellent intra-observer reliability

Rotation affects DMAA the more severe, the larger DMAA in HV deformity

Measurement of DMAA

• Intraoperatively compared between anatomic and radiologic DMAA intraoperatively ; anatomic DMAA is larger than radiological value

Anatomic DMAA

KT Lee et al et al at AOFAS annual meeting 1999 Armaneck et al J Foot Surg. 1986

Bigtoe IP joint skin crease meaning?

Purpose of this study

To investigate 1) Statistical relationship between IP joint Skin Crease Angle of Big toe and DMAA 2) Possibility of using IP joint Skin Crease Angle as predicting reference of DMAA in Hallux Valgus Surgery in operation

Material & Methods

Result

moderately positive correlation

Anatomical factors Inclination : cavus to flatfoot Rotation Varus deviation Aging

Discussion

Ahmed G Elsaid et al Foot Ankle Int 2006 Vittetoe et al . Foot Ankle Int 1994

Robinson et al. Foot Ankle Int 2006 Gokhan CAKMAK et al . AOTT 2013

Vittetoe et al. Foot Ankle Int 1994

Eustace S et al. Skeletal Radiol 1993

DMAA measurement : difficult

Clinical factors : Observers, Radiological factors Difficult to measure DMAA exactly reference points may vary physician dependent

Radiologic Quality some radiographs : more difficult to assess than others manual vs computer-assisted

DMAA does has effect on postop. Results? not always but, it is important in severe Hallux valgus case

“DMAA was not significant for prediction of the postoperative hallux valgus angle in logistic regression, but was significantly increased in patients with severe hallux valgus.”

Deenik AR et al. BMC Musculoskeltal Disord 2008

“rotational proximal crescentic osteotomy performed metatarsals had a lower postoperative DMAA, rather than the expected higher measurements”

Brodsky JW et al. CORR 2006

Discussion

The results of the present study shows moderate positive correlation : ; IP joint skin crease angle and DMAA

Could check easily

Little affected by Anatomic, Radiologic factors and observer Reference of DMAA in Hallux valgus surgery intraoperatively

Conclusion

References 1. Ahmed G.Elsaid et al. First Metatarsal Bone : An Anatomic Study. Foot Ankle Int 2006;27(12):1041-1048.

2. Andrew H.N. Robinson et al. Variation of the Distal Metatarsal Articular Angle with Axial Rotation and Inclination of the First Metatarsal . Foot Ankle Int 2006;27(12):1036-1040.

3. Charles L Salzman et al . Coronal Plane Rotation of the First Metatarsal . Foot Ankle Int. 1996;17(3):157-161.

4. David A. Vittetoe et al. Validity and Reliability of the First Distal Metatarsal Articular Angle. Foot Ankle Int. 1994;15(10):541-547.

5. Eustace S et al. Radiographic features that enable assessment of first metatarsal rotation : the role of pronation in hallux valgus. Skeletal Radiology 1993;22 :153-156.

6. Gokhan CAKMAK et al. The effect of pronation and inclination on the measurement of the hallucal distal metatarsal articular set angle. Acta Orthop Traumatol Turc 2013;47(5):354-358.

7. James R Jastifer et al. Comparison of Radiographic and Anatomic Distal Metatarsal Articular Angle in Cadaver Feet. Foot Ankle Int 2014; 35(4):389-393.

8. James W. Brosdsky et al. Surgery for Hallux Valgus with Proximal Crescentic Ostetomy Causes Variable Postoperative Pressure Patterns. CORR 2006 ;443(2):280-286.

9. Michael J Coughlin et al. Hallux Valgus in Men : Effect of the Distal Metatarsal Articular Angle on Hallux Valgus Correction . J Foot Ankle Int 1997;18(8):463-470.

10. Michael J Coughlin et al. Angular Measurements in the Evaluation of Hallux Valgus Deformities. Foot Ankle Int 2002;23(1) : 68-74.

11. Paul Dayton et al. Clarification of the Anatomic Definition of the Bunion Deformity. J Foot Ankle Surgery 2014;53:160-163.

12. Richardson E.G. et al. First Metatarsal Head-Shaft Angle : A Method of Determination. Foot Ankle Int. 1993;14(4) : 181-185.

13. Thomas D. Chi et al. Intra- and Inter-observer Reliability of the Distal Metatarsal Articular Angle in Adult Hallux Valgus. Foot Ankle Int. 2002;23(8):722-726.

14. Umberger B.R. et al. Reliability and Validity of first Metatarsophalangeal joint orientation measured with an electomagnetic tracking device. Clinical Biomechanics 1999;14:74-76.