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Radiographs: Hallux Valgus



- Determine Congruency
- wt bearing AP & lateral radiographs:
- IMA: (nl < 10 deg)
    - note that this angle is highly dependent on the technique of measurement
           - some authors measure from down the metatarsal shaft, where as, other authors measure from the center of the metatarsal base to the center of the metatarsal head;

- distal metatarsal articular angle:
    - normally this is zero deg;
    - lateral deviation more than 10 deg is abnormal;
    - typically a moderately severe hallux valgus w/ a significantly increased DMA will be associated w/ a congruent bunion;

- hallux valgus angle:
    - normal < 15-18 deg;
    - when the valgus angle of the 1st MTP joint > 30-35 deg, pronation of the great toe results and other structures are also affected (plantar shift of abductor hallucis & lateral shift of sesamoid & intrinsics, and often hammering of the second toe);

- first metatarsocuneiform joint angle:
    - high angle of inclination or presence of a lateral facet at the base of the 1st MT shaft;
    - this mechanically blocks the the metatarsal from being brought into satisfactory alignment unless an osteotomy of the first metatarsal is carried out;

- sesamoids:
    - moderate subluxation:
           - lateral sesamoid is uncovered 50 to 75 % within 1st IM space;
           - medial sesamoid is located in a central position plantar to the first metatarsal head;
    - severe subluxation:
           - lateral sesamoid moves to the lateral aspect of the first metatarsal head is dorsal to the medial sesamoid;

- Misc:
    - generalized metatarsus adductus:
    - lengths of the 1st & 2nd metatarsals:
    - 1st talometatarsal angle (lat. x-ray):
    - degree of hallux interphalangeus
    - size of Medial Eminence
    - evidence of arthrosis of the 1st MP joint
    - obliquity of the first MT-cuneiform joint



Radiographic analysis of hallux valgus. A two-dimensional coordinate system.

Roentgenographic assessment in hallux valgus.

Metatarsophalangeal and intermetatarsal angle: different values and interpretation of postoperative results dependent on the technique of measurement.



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