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Influence of Hallux Valgus Varus Deformity on First Metatarsal Sagittal Inclination Assessment: A Comparison Between Weightbearing Radiography and Weightbearing Computed Tomography

Title: Influence of Hallux Valgus Varus Deformity on First Metatarsal Sagittal Inclination Assessment: A Comparison Between Weightbearing Radiography and Weightbearing Computed Tomography
Authors: Nishikawa, Danilo Ryuko Candido; Fonseca, Fábio Côrrea Paiva; Lobo, Carlos Felipe Teixeira; Sposeto, Rafael Barban; Macedo, Rodrigo Sousa; Mansur, Nacime Salomao Barbachan; de Cesar Netto, Cesar; Godoy-Santos, Alexandre Leme
Source: Foot & Ankle Orthopaedics ; volume 11, issue 2 ; ISSN 2473-0114 2473-0114
Publisher Information: SAGE Publications
Publication Year: 2026
Description: Background: Radiographic assessment of the sagittal inclination of the first metatarsal (1M) is essential for evaluating foot disorders. However, 1M varus deviation may influence these measurements. This study aimed to determine whether hallux valgus (HV) varus deformity influences the sagittal radiographic inclination of the 1M by comparing weightbearing radiography (WBR) and weightbearing computed tomography (WBCT) images. Methods: Eighty-four feet were analyzed, including HV cases with intermetatarsal angle (IMA) >15° and control feet without HV. The sagittal inclination of the 1M, its base height, and ground lines form a rectangular scalene triangle, in which perspective changes can modify the lengths and angles of its sides. The first metatarsal declination angle (FMDA) and length of the first metatarsal (L1M) were used to assess the influence of 1M varus on sagittal alignment differences between WBR and WBCT. Results: FMDA values showed no significant differences within or between groups, with a mean difference of 0.39° ( P = .98). In contrast, L1M measurements differed significantly between imaging modalities and between HV and control groups, with a mean difference of 2.48 mm ( P < .05). Agreement analysis demonstrated strong concordance between WBR and WBCT measurements, indicating comparable values with minimal systematic bias. Conclusion: In patients with IMA >15°, forefoot geometric changes were reflected with modest L1M differences, although their clinical impact should be interpreted cautiously. Importantly, these changes did not affect FMDA, which remained stable across imaging modalities. The strong agreement between WBR and WBCT supports FMDA as a reliable parameter for assessing 1M sagittal alignment and planning realignment procedures, irrespective of HV severity. Level of Evidence: Level IV, cross-sectional study.
Document Type: article in journal/newspaper
Language: English
DOI: 10.1177/24730114261432620
Availability: https://doi.org/10.1177/24730114261432620; https://journals.sagepub.com/doi/pdf/10.1177/24730114261432620; https://journals.sagepub.com/doi/full-xml/10.1177/24730114261432620
Rights: https://creativecommons.org/licenses/by-nc/4.0/ ; https://journals.sagepub.com/page/policies/text-and-data-mining-license
Accession Number: edsbas.CBB27EE5
Database: BASE