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A Hallux Valgus Surgical Planning Survey Using WBCT-based 3D Printing
François Lintz1,2, Enrico Pozzessere2, Wolfram Grün2,3,4
1Clinique de l'Union, Department of Foot and Ankle Surgery, Ramsay Healthcare, Saint Jean, France.
Foot & Ankle Orthopaedics
|March 19, 2025
Summary
Three-dimensional (3D) printing and weightbearing computed tomography (WBCT) significantly impact hallux valgus (HV) surgical planning, particularly for rotational corrections. These advanced imaging techniques offer greater insight than traditional 2D radiographs.
Area of Science:
- Orthopedics
- Surgical Planning
- Medical Imaging
Background:
- Hallux valgus (HV) is increasingly recognized as a complex 3-dimensional (3D) deformity.
- While 3D printing may improve visualization of multiplanar HV aspects, its effect on surgical planning requires investigation.
- This study evaluates how surgical plans for hallux valgus change with sequential review of 2D radiographs, 3D weightbearing computed tomography (WBCT), and 3D-printed models.
Purpose of the Study:
- To assess the impact of 3D-printed models and WBCT on surgical planning for hallux valgus (HV).
- To compare the influence of 2D radiographs, WBCT, and 3D-printed models on surgical decision-making in HV cases.
- To hypothesize that 3D printing will have the greatest impact on surgical planning for HV.
Main Methods:
- A single hallux valgus case was presented to 30 surgeons in a masked, stepwise manner.
- Surgeons recorded surgical plans after reviewing 2D radiographs, 3D WBCT, and 3D-printed models.
- Surgeons rated the influence of WBCT and 3D printing on a Likert scale, with follow-up surveys assessing effects on correction amplitudes.
Main Results:
- Surgical plans changed in 30% of cases after WBCT and 43.3% after 3D printing.
- Significant differences in surgical procedures were noted between radiography, WBCT, and 3D printing.
- WBCT and 3D printing notably influenced correction amplitudes for pronation and distal metatarsal articular angle (DMAA), more so than the intermetatarsal angle (IMA).
Conclusions:
- Both WBCT and 3D printing significantly influence hallux valgus surgical planning, primarily affecting first ray tarsometatarsal procedures.
- Rotational components, including pronation and DMAA, are perceived as the most impacted aspects by these advanced imaging modalities.
- Future research should investigate the cost-effectiveness, patient outcomes, and broader applicability of combining WBCT and 3D printing for multiplanar deformities.
