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Bones of the Lower Limb: Tibia and Fibula01:10

Bones of the Lower Limb: Tibia and Fibula

The tibia is the main weight-bearing bone of the lower leg. It is larger than the fibula with which it is paired. The tibia is also the second longest bone in the body and is located right below the skin. The proximal end of the tibia forms the medial and the lateral condyle, which articulates with the condyles of the femur to form the knee joint. Between the articulating surfaces is the irregular elevated area known as the intercondylar eminence that serves as the inferior attachment point for...

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Updated: Jun 19, 2026

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Lesser Metatarsals Load after Minimally-Invasive Surgery for Hallux Valgus Correction: A Finite Element Model.

Henrique Mansur1, Bruno Abdo2, Gabriel Ferraz Ferreira3

  • 1Department of Foot and Ankle Surgery, Instituto Return to Play and Instituto D'Or de Pesquisa e Ensino (IDOR), Brasília, DF, Brazil.

Revista Brasileira De Ortopedia
|December 12, 2025
PubMed
Summary
This summary is machine-generated.

Minimally-invasive Chevron-Akin (MICA) osteotomy for hallux valgus increases tension on lesser metatarsals. Fixing the first metatarsal with one bicortical and one intramedullary screw minimizes this load, concentrating forces on the metatarsal shaft.

Keywords:
finite element analysisfoot deformities, congenitalhallux valgusminimally invasive surgical procedures

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Area of Science:

  • Orthopedic surgery
  • Biomechanics
  • Foot and ankle surgery

Background:

  • Hallux valgus (HV) is a common foot deformity.
  • Minimally-invasive Chevron-Akin (MICA) osteotomy is a surgical technique used to correct HV.
  • Understanding the biomechanical impact of MICA on adjacent structures is crucial for optimizing surgical outcomes.

Purpose of the Study:

  • To analyze the biomechanical consequences on the lesser metatarsals following MICA osteotomy.
  • To compare the effects of different screw configurations for first metatarsal fixation.
  • To evaluate load distribution under physiological and supraphysiological conditions using finite element analysis.

Main Methods:

  • A finite element method (FEM) model was created from CT scans of a hallux valgus foot.
  • Five distinct screw configurations for MICA fixation were simulated.
  • Maximal tension in the lesser metatarsals was measured for each configuration under varying load conditions.

Main Results:

  • The configuration using one intramedullary and one bicortical screw for the first metatarsal osteotomy resulted in the lowest tension on the lesser metatarsals.
  • The second and fourth metatarsals consistently experienced the highest loads across all tested configurations.
  • Tensile load values ranged from 30-70 MPa (physiological) and 50-350 MPa (supraphysiological) for the optimal configuration, reaching up to 230 MPa and 600 MPa for less optimal configurations.

Conclusions:

  • MICA surgery for hallux valgus can increase tension forces on the lesser metatarsals, particularly the second and fourth.
  • Fixation of the first metatarsal with a combination of one bicortical and one intramedullary screw appears to be the biomechanically favorable configuration.
  • Load concentration on the metatarsal shaft (diaphysis) was observed regardless of the fixation technique used.