Spring ligament insufficiency and hallux valgus as an independent risk factors for first ray instability |
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| Institution: | 1. The Queen Elizabeth Hospital, Gayton Road, Kings Lynn, Norfolk, England PE30 4ET, United Kingdom;2. James Paget Hospital, Lowestoft Road Gorleston-on-Sea, Great Yarmouth NR31 6LA, United Kingdom;1. Orthopedic Surgeons, Inc, 2790 Clay Edwards Drive, Suite 650, Kansas City, MO 64116, USA;2. Congress Orthopedic Associates, 800 South Raymond, 2nd Floor, Pasadena, CA 91105, USA;3. Foot and Ankle Surgery, UCLA Harbor Medical Center, 1000 W Carson Street, Torrance, CA 90502, USA;1. Orthopedic & Traumatology Department, Federal University of São Paulo, Av. Albert Einstein, 627 – Morumbi, São Paulo, SP CEP 05652.000, Brazil;2. Foot and Ankle Clinic;3. Department of Locomotor Apparatus, Federal University of Minas Gerais, Av. Prof. Alfredo Balena, 190 - Belo Horizonte, MG CEP 30130-100, Brazil;1. Faculty of Health Sciences, Western University, Elborn College, Room 1588, London, ON, N6G 1H1, Canada;2. Department of Physical Therapy, MClSc Program in Wound Healing, Western University, Elborn College, Room 1588, London, ON, N6G 1H1, Canada;3. Department of Physical Therapy, University of Toronto, 500 University Ave, Toronto, ON, M5G 1V7, Canada;4. KITE, Toronto Rehab Institute, University Health Network, 550 University Ave, Toronto, ON, M5G 2A2, Canada;1. School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria 3086, Australia;2. School of Health Sciences, Faculty of Medicine and Health, University of Newcastle, Ourimbah, New South Wales 2258, Australia |
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| Abstract: | IntroductionFirst ray instability (FRI) arising from failed plantar/interosseous ligaments is strongly associated with planovalgus, leading to synovitis and deformity. Our hypothesis is that proximal spring ligament insufficiency (SLI) drives secondary FRI in the absence of hallux valgus (HV) and may be an independent risk factor.MethodsPatients with FRI, screened by Klaue’s test, were recruited. Patients’ normal contralateral feet with previous radiographs were included as controls. First ray dorsal translation was measured with a digital Klauemeter. Spring ligament integrity was assessed using lateral translation distance as an indirect measure of spring ligament strain. Intermetatarsal angle and hallux valgus angle were recorded to classify the severity of HV.ResultsSeventy feet included, 54 had symptomatic FRI and 16 were asymptomatic contralateral feet included as control. Twenty-three feet had moderate/severe HV and 47 had mild/normal HV. Moderate/severe HV was associated with FRI (OR, 10.31; p = 0.029). Forty-five feet with SLI had a strong association with FRI (OR, 100.7; p < 0.0001). SLI without moderate/severe HV was the most prevalent group (31/54), followed by SLI with moderate/severe HV, 29.63% (16/54). Moderate/severe HV without SLI was prevalent in 11.1% (6/54) and 1.85% (1/54) had no SLI or moderate/severe HV. In a multivariate logistic regression analysis model, both SLI and severe/moderate HV were independent predictors of FRI.ConclusionThis is the first study that links SLI and HV as independent risk factors to FRI. 98.15% of FRI can be attributed to SLI, HV or both. First ray instability may allude to the strong presence of spring ligament insufficiency in the absence of hallux valgus.Level of evidenceLevel III, retrospective cohort study. |
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| Keywords: | Spring ligament failure Tarsometatarsal instability Hallux valgus First ray instability Medial column instability |
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