ArticleInternational orthopaedics2026
A comprehensive weightbearing computed tomography study: the pathogenesis of first metatarsal pronation in sesamoid bone displacement, due to hallux valgus deformity and progressive collapsing foot deformity (PCFD).
Article in International orthopaedics, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeThis study aimed to explore the biomechanical interrelationships in Progressive Collapsing Foot Deformity (PCFD), also known as flatfoot, with concurrent hallux valgus (HV), first metatarsal pronation and sesamoid bone displacement. The primary purposes were to quantify correlations between arch collapse, first metatarsal rotation, HVA (hallux valgus angle), and sesamoid displacement using weight-bearing computed tomography (WBCT), which provides superior three-dimensional insights compared to traditional radiographs. The central research question was: How is M1 rotation related to alterations in arch angles in PCFD and to sesamoid malposition, and is it independent?
methodsA retrospective analysis was conducted on WBCT scans from 22 patients (aged 18-65) with symptomatic PCFD, collected between 2023 and 2025. Inclusion required arch angle > 131°; exclusions included prior surgery or systemic conditions. Scans used a cone-beam system (96 kV, 7.5 mAs, 0.4 mm slices) in bipedal stance. Two observers measured: forefoot arch angle (FAA) for PCFD severity, alpha angle for metatarsal rotation, HVA via axial axes, and sesamoid displacement graded as 0-3 on axial views. Inter-observer reliability was assessed with intraclass correlation coefficients (ICC > 0.8). Spearman's correlations evaluated relationships, with p < 0.05 significant, using SPSS.
resultsAnalysis revealed a strong positive correlation between increased arch angle and increased first metatarsal rotation (r = 0.72, p < 0.01), strong positive correlation between greater arch angle and HVA (r = 0.67, p < 0.01), and moderate positive correlation between greater M1 rotation and sesamoid bone displacement (r = 0.5, p < 0,01). No correlation was found between HVA and metatarsal rotation (r = 0.1, p > 0,01).
conclusionPCFD is strongly associated with hallux valgus deformity and first metatarsal rotation, which is closely linked to sesamoid displacement. Metatarsal rotation appears to be an independent and likely early component of HV deformity, related to foot pronation and sesamoid malposition, and should be specifically evaluated and addressed in both diagnosis and treatment. No significant association exists between hallux valgus angle and metatarsal rotation. Additionally, hallux valgus deformity is associated with increased arch angle, which should be considered in the management of both conditions.
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