Radiographic Assessment of Foot Alignment in Juvenile Hallux Valgus and Its Relationship to Flatfoot

Abstract

BACKGROUND: The relationship between juvenile hallux valgus (JHV) and flatfoot has not been clearly established. The aim of this study was to assess radiographic measurements in feet with JHV compared with matched controls and to investigate whether the foot alignment of JHV is related to flatfoot.

METHODS: We retrospectively reviewed 163 patients with JHV as defined as hallux valgus angle greater than 20 degrees and intermetatarsal greater than angle than 10 degrees. Patients with open physes of the feet and who had weight-bearing radiographs of the feet were included. Another 55 normal participants served as controls. Patients with JHV were divided into 2 subgroups: Group 1 included patients with asymptomatic JHV and group 2 consisted of those treated with correctional surgery for painful JHV. Twelve radiographic indices were analyzed, including calcaneal pitch angle, tibiocalcaneal angle, talocalcaneal angle, naviculocuboid overlap, talonavicular coverage angle, lateral talo-first metatarsal angle, anteroposterior talo-first metatarsal angle, metatarsus adductus angle, hallux valgus angle, intermetatarsal angle, distal metatarsal articular angle, and first metatarsal cuneiform angle. The groups were compared by age, gender, and the above radiographic parameters.

RESULTS: There was no significant difference in hindfoot alignment of patients with JHV and controls. Naviculocuboid overlap (P <.001), lateral talo-first metatarsal angle (P = .002), and metatarsus adductus angle (P = .004) were significantly greater in patients with JHV than in controls, whereas the anteroposterior talo-first metatarsal angle (P = .026) was significantly less. Symptomatic and asymptomatic JHV patient subsets showed no significant radiologic differences.

CONCLUSION: Radiographic profiles in patients with JHV were inconsistent with regard to features of flatfoot, and foot alignment was unrelated to the presence of symptoms or degree of deformity in JHV.

LEVEL OF EVIDENCE: Level III, retrospective comparative series.