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Category: Midfoot/Forefoot Introduction/Purpose: An association between hallux rigidus and metatarsus elevates has been reported in the literature. These findings were based on standard weightbearing radiographs, but have not found general consensus among foot and ankle surgeons. The aims of this study were to 1) assess foot alignment in patients affected by hallux rigidus using 3D reconstructions from a weighbearing CT scan and 2) assess intra and interobserver reliability of weightbearing CT scan imaging (pedCAT, Curvebeam, Warrington, USA). Methods: In this prospective consecutive study, 50 patients with hallux rigidus underwent a weightbearing CT scan. The control group consisted of 50 consecutive patients that underwent a weightbearing CT scan for other reasons (i.e. assessing ankle fusion union, subtalar fusion union, etc). The following angles were measured by 2 investigators: 1st metatarsal length, 2nd metatarsal length, declination of the 1st and 2nd metatarsal, 1st-2nd intermetatarsal angle, hallux valgus angle, and foot width. Each investigator measured each foot twice, 1 month apart. The mean of the values was used for statistical analysis. Results: Intra and interobserver reliability was excellent. There was a statistically significant difference between the declination ratio (1st to 2nd metatarsal) in the hallux rigidus group (0.81) compared to the control group (0.92). Hallux valgus angle was also significantly lower in the hallux rigidus group (12 degrees) compared to the control group (15 degrees). Finally, patients with stages 1 and 2 according to Coughlin & Shurnas classification has significantly higher declination ratios compared to stages 3 and 4. Conclusion: Patients with hallux rigidus demonstrated a lower declination of the first-to-second metatarsal, indicating metatarsus elevatus. While it was not possible to determine whether the elevatus caused or was a result of hallux rigidus, it appears that metatarsus elevatus correlates with the severity of the arthritis. The smaller hallux valgus angle in the hallux rigidus population indicates that true hallux rigidus in association with a true bunion is unlikely. Finally, weightbearing CT imaging proved to be a reliable method of assessing foot alignment.

Category: Midfoot/Forefoot Introduction/Purpose: Midfoot arthrodesis requires a structural graft where bone loss from AVN, osteomyelitis and erosive arthritis is present in the navicular, cuneiform or 1st metatarsal. The goal of this study was to evaluate radiographic outcomes of midfoot bone block arthrodesis. Methods: A retrospective, IRB approved study was completed evaluating midfoot arthrodesis between 2002 and 2014. where structural bone graft was used as part of an arthrodesis of the tarsometatarsal (TMT) joints or the naviculocuneiform (NC) joints or both. Demographic characteristics were obtained including age, body mass index (BMI), diagnosis, diabetes or tobacco use, indication for use of bone block, location of the bone block, and type of graft used. Radiographic data collected included time to union, the number of patients in which union was obtained, and graft length Results: Over a 12-year period, there were a total of 33 with an average age of 57.9 years, and included 20 females and 13 males with an average BMI of 29. The average length of follow up was 24 months. The most common diagnoses was erosive midfoot arthritis (11) and prior navicular fracture associated with AVN (9). Structural allograft was used in all patients. (first TMT (10), talocuneiform (9), other combinations (14)). Various types of biologic agents were used in 20 of 33 arthrodeses. Radiographic evidence of union was found in 21/33 patients (63.6%) at an average of 4.7 months after surgery. Twelve patients developed a nonunion. The risk factors for nonunion include age > 50, the presence of erosive osteoarthritis, AVN of the navicular and lack of use of biologic stimulation. There was no correlation between the presence of diabetes, a prior history of infection or prior history of trauma and development of nonunion. Conclusion: The radiographic fusion rate of patients undergoing large structural midfoot bone graft arthrodesis was 63.6% with radiographic evidence of healing present in this group at 4.77 months after surgery. This is the first known study reporting on radiographic outcomes of structural bone graft arthrodesis of the midfoot. The rate of fusion seen here is slightly better compared with recent studies evaluating healing of large defects using femoral head structural allografts. Nonetheless, the risk of non-union remains far greater than when an in situ arthrodesis of these same joints are performed.

Category: Midfoot/Forefoot Introduction/Purpose: The reliability of range of motion (ROM) measurements has not been established for the hallux metatarsophalangeal (MTP) joint in patients with hallux rigidus. The aim of the present study was to prospectively assess the clinical versus radiographic difference in ROM of the arthritic hallux MTP joint. Methods: One-hundred consecutive patients who presented with any grade of hallux rigidus were included in this prospective study to determine the hallux MTP dorsiflexion. Clinical range of motion using a goniometer and radiographic range of motion on dynamic xrays was recorded. Inter and intra-rater reliability were calculated. Results: The mean difference between clinical and radiographic dorsiflexion was 13°. This difference was statistically significant. For all measurements clinical dorsiflexion was equal or less than radiographically-measured dorsiflexion. The difference was significantly greater in patients with a clinical dorsiflexion of less than 30° than in patients with 30° or more. Radiographic measurement of hallux dorsiflexion had an excellent intra- and inter-observer reliability. Conclusion: This study describes a reliable, reproducible, and straightforward method of measuring hallux MTP ROM that eliminates the “human” component of measuring clinical ROM and all the variables that are encountered when making said measurement.