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A trigonometric analysis was developed in an attempt to predict the postoperative hallux valgus angles and intermetatarsal angles after Chevron bunionectomy. This analysis was used in 20 feet to predict postoperative angles, and these predicted values were compared with actual measured roentgenographic values. The postoperative intermetatarsal angles were evaluated to determine their correction to postoperative hallux valgus angles of 20 degrees or less. Using the trigonometric analysis, the postoperative intermetatarsal angles were highly predictable, but the hallux valgus angle could not be reliably predicted for individual patients. The intermetatarsal angle obtained at surgery, however, was indicative of the final hallux valgus angle: 75% of feet with intermetatarsal angles of more than 11 degrees had postoperative hallux valgus angles of more than 20 degrees. Thus, when an intermetatarsal angle of 11 degrees or less can be obtained surgically, the hallux valgus angle can be corrected to 20 degrees or less in most patients.

In certain clinical settings, standard x-rays may be misleading since they only provide two-dimensional representations of three-dimensional structures. After metatarsal osteotomy, the actual first metatarsal shortening may appear magnified on standard x-rays. We investigated variations in metatarsal and intermetatarsal angle (IMA) in a cadaver model and variations of first metatarsal length following in vivo Chevron osteotomies. For skeletal models, changing the foot arch from pes planus to pes cavus changed the first metatarsal length by as much as 19%, whereas the measured IMA remained relatively unchanged. Pronation of the first metatarsal was found to alter the IMA (decreased for planus, increased for cavus). In vivo studies revealed a 3.2-fold difference when actual metatarsal length change following chevron osteotomy was correlated to corrected x-ray change in length (9.5% versus 2.9% P < or = .005). Previous investigators have evaluated hallux valgus deformities with emphasis on metatarsal lengths and IMAs to determine choices of procedure. Based on the results of this study, treatment plans and further evaluation for forefoot surgery may be inaccurate if based solely on x-ray measurements.

Pes planus of the foot is believed to be an important etiological factor in hallux valgus. This study compares the degree of pes planus in normal and hallux valgus feet. The arch index, or ratio of the area of the middle third of the foot to the total footprint area, was calculated on 128 footprints. An unpaired t-test determined no significant difference between the arch index of 32 11-year-old children with hallux valgus and 11-year-olds with no first metatarsophalangeal joint deformity (P greater than .05). The height of the arch is not relevant to the hallux valgus deformity. Arch supports designed to raise the height of the arch can play only a palliative role in the management of the condition.

This study compares the standardized measurements of the foot in nonweight-bearing and weight-bearing radiographs. Both normal and hallux valgus patients were studied. The results show that some changes thought to occur with weight-bearing cannot be consistently demonstrated. Obtaining both weight-bearing and nonweight-bearing views may not be routinely indicated in all patients.

The pathomechanics for the development of the hallux valgus deformity takes place at the first metatarsophalangeal joint--the sesamoid complex. The sesamoid complex consists of seven muscles, eight ligaments, and two sesamoid bones. When the first metatarsal escapes the complex and drifts medially, the sesamoids remain twisted in situ, several of the ligaments "fail," and others contract. The authors propose reduction of the metatarsus primus varus by first metatarsal osteotomy and appropriate ligament releases and plications to restore alignment. A detailed understanding of the pathomechanics is essential for proper interpretation of the problems and anticipated lasting surgeries.

A clinical survey on foot deformities among 166 geriatric inpatients was carried out. Direct measurements on hallux valgus, great toe movements, great toe deformities, lesser toe deformities, arch of the foot, callosities, ankle movements, inversion, and eversion were done by using the goniometer. A specially designed goniometer was created to measure inversion and eversion. The Harris Mat was used to study foot prints in correlation with the various deformities. About 50% of geriatric patients were found to have foot deformities of various types. This compared well with available data in literature. The target population was also checked for their symptomatology which, amazingly, was found to be really insignificant compared with the deformities present. This finding was found to be very much unlike data for Caucasian individuals with foot deformities, 50% of whom had symptoms related to pain and footwear. This major difference in the clinical presentation encourages the authors to carry on their study and, perhaps, direct cross-cultural studies in the future.