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Updated: Oct 17, 2025

An Anatomical Study of Nerves at Risk During Minimally Invasive Hallux Valgus Surgery
15:04

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Association of First Metatarsal Pronation Correction With Patient-Reported Outcomes and Recurrence Rates in Hallux

Matthew S Conti1, Tamanna J Patel1, Jiaqi Zhu1

  • 1Hospital for Special Surgery, New York, NY, USA.

Foot & Ankle International
|October 6, 2021
PubMed
Summary

A decrease in first metatarsal pronation after modified Lapidus surgery for hallux valgus (HV) is linked to better patient outcomes and lower recurrence rates. This suggests the rotational aspect of HV deformity is crucial for surgical success.

Keywords:
PROMIShallux valguspatient-reported outcomespronationweightbearing CT scans

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Area of Science:

  • Orthopedic Surgery
  • Foot and Ankle Surgery
  • Biomechanical Analysis

Background:

  • Hallux valgus (HV) is a common foot deformity.
  • The modified Lapidus procedure is a surgical option for severe HV.
  • Understanding factors influencing outcomes after this procedure is important.

Purpose of the Study:

  • To investigate the association between postoperative first metatarsal pronation and patient-reported outcomes.
  • To determine if reduced pronation correlates with improved physical function, pain reduction, and lower HV recurrence.
  • To analyze outcomes in patients undergoing a modified Lapidus procedure.

Main Methods:

  • Retrospective cohort study of 39 HV patients.
  • Preoperative and postoperative weightbearing CT scans measured first metatarsal pronation.
  • Patient-Reported Outcomes Measurement Information System (PROMIS) scores assessed physical function, pain interference, and intensity.
  • Multivariable and log-binomial regression analyses were employed.

Main Results:

  • Patients with decreased first metatarsal pronation showed a significant improvement in PROMIS physical function scores (7.2 points, P = .007).
  • Recurrence rates of HV deformity were significantly lower in the decreased pronation group (Risk Ratio 0.25, P = .025).

Conclusions:

  • Postoperative reduction in first metatarsal pronation is associated with improved functional outcomes and reduced recurrence after modified Lapidus.
  • The rotational component of hallux valgus deformity appears critical for successful surgical outcomes.
  • Further investigation into the biomechanics of HV deformity is warranted.