CLINICAL, QUANTITATIVE ASSESSMENT OF 1ST TARSOMETATARSAL MOBILITY IN THE SAGITTAL PLANE AND ITS RELATION TO HALLUX-VALGUS DEFORMITY

Today, bunion surgery is still controversial. Considering that a bunio n deformity in fact may be a result of multiple causes, the rationale of the currently applied techniques of surgical treatment has not been conclusively demonstrated. In view of the known hypermobility syndrom e of the first ray that results in insufficient weightbearing beneath the first metatarsal head, the relationship between this syndrome and hallux valgus deformity has been investigated. The results suggest a d irect relationship between painful hallux valgus deformity and hypermo bility in extension of the first tarsometatarsal joint. A pathological mechanism of symptomatic hallux valgus is proposed that relates this pathology with primary weightbearing disturbances in the forefoot wher e angulation of the first metatarsophalangeal joint is one of the cons equences. The alignment of the metatarsal heads within the sagittal pl ane seems to be a main concern in many hallux valgus deformities. As a consequence, treatment includes reestablishing stable sagittal alignm ent in addition to the horizontal reposition of the metatarsal over th e sesamoid complex. As an example, first tarsometatarsal reorientation arthrodesis regulates the elasticity of the multiarticular first ray within the sagittal plane and may be the treatment of choice in many h allux valgus deformities.