Measurement of transverse forces between the first and second metatarsals: a cadaveric study
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RESEARCH ARTICLE
Open Access
Measurement of transverse forces between the first and second metatarsals: a cadaveric study Viktor Feldman1,2, Meir Nyska1,2, Niv Marom1,2, Omer Slavin1,2, Yaron S. Brin1,2, Uri Farkash1,2 and Ezequiel Palmanovich1,2*
Abstract Background: This study was designed to measure transverse forces between the 1st and 2nd metatarsals after reducing the intermetatarsal angle (IMA) in normal and hallux valgus (HV) feet, during non weight-bearing and weight-bearing phases of gait. Methods: Four cadaver feet, three normal and one with hallux valgus, were used. A new suture button device (CyclaPlex™) composed of screw-type buttons connected with a wire was implanted at the mid-shaft of the 1st and 2nd metatarsals of all the feet. IMA was reduced using a tensioning device to pull the wire which was secured laterally at the 1st metatarsal. The 1st metatarsal was pulled laterally towards the 2nd metatarsal until an IMA of about 6° was achieved. The amount of force applied at this point was registered on the force indicator. Each foot attached to the tensioning device was placed in a special construct loaded with weights equal to the original body weight of the donor and positioned at 15° tilt (simulating propulsion phase of the gait cycle). The intermetatarsal force under load indicated on the tensioning device was recorded. Results: The average recorded transverse intermetatarsal force was 28.5 N (SD 4.2 N) during non weight-bearing phase; the mean increase in the measured force at weight-bearing and 15° tilt was 6 N (SD 2.6 N). Conclusions: We measured the transverse forces between the 1st and 2nd metatarsals with the use of a suture button device (CyclaPlex™). The data obtained from the measurements will provide a better understanding of foot biomechanics and may therefore also facilitate the development of new devices designed to decrease IMA in HV surgery. Keywords: Hallux valgus, CyclaPlex™, Mini TightRope®, Intermetatarsal forces, Foot osteotomy
Background Hallux valgus (HV), one of the most common disorders of the foot causing pain and disability, is often treated by osteotomies. Osteotomies are invasive procedures used to correct 1st metatarsal deformity; however, osteotomies may lead to numerous complications and patient morbidity. Recently, new suture button devices have been used to avoid bone osteotomy. Direct measurement of the transverse forces between the 1st and 2nd metatarsals can advance the design of such devices. * Correspondence: [email protected] 1 Orthopedic Department, Meir General Hospital, Sapir Medical Center, Kfar Saba, Israel 2 Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
The main deformities in HV are increased valgus of the 1st toe (HVA) and 1st metatarsal primus varus, resulting in an increased angle between the 1st and 2nd metatarsals (IMA). IMA is considered abnormal when values are greater than 9° [1]. Heredity is likely to be a major predisposing factor with up to 68 % of patients showing familial tendency [2, 3]. Footwear may be a contri
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