NDLI: Impact of first metatarsal shortening on forefoot loading pattern: a finite element model study

Content Provider	Springer Nature : BioMed Central
Author	Geng, Xiang Shi, Jiaqi Chen, Wenming Ma, Xin Wang, Xu Zhang, Chao Chen, Li
Abstract	Backgrounds There has long been a consensus that shortening of the first metatarsal during hallux valgus reconstruction could lead to postoperative transfer metatarsalgia. However, appropriate shortening is sometimes beneficial for correcting severe deformities or relieving stiff joints. This study is to investigate, from the biomechanical perspective, whether and how much shortening of the first metatarsal could be allowed. Methods A finite element model of the human foot simulating the push-off phase of the gait was established. Progressive shortening of the first metatarsal from 2 to 8 mm at an increment of 2 mm were sequentially applied to the model, and the corresponding changes in forefoot loading pattern during push-off phase, especially the loading ratio at the central rays, was calculated. The effect of depressing the first metatarsal head was also investigated. Results With increasing shortening level of the first metatarsal, the plantar pressure of the first ray decreased, while that of the lateral rays continued to rise. When the shortening reaches 6 mm, the load ratio of the central rays exceeds a critical threshold of 55%, which was considered risky; but it could still be manipulated to normal if the distal end of the first metatarsal displaced to the plantar side by 3 mm. Conclusions During the first metatarsal osteotomy, a maximum of 6 mm shortening length is considered to be within the safe range. Whenever a higher level of shortening is necessary, pushing down the distal metatarsal segment could be a compensatory procedure to maintain normal plantar force distributions.
Related Links	https://bmcmusculoskeletdisord.biomedcentral.com/counter/pdf/10.1186/s12891-019-2973-6.pdf
Ending Page	9
Page Count	9
Starting Page	1
File Format	HTM / HTML
ISSN	14712474
DOI	10.1186/s12891-019-2973-6
Journal	BMC Musculoskeletal Disorders
Issue Number	1
Volume Number	20
Language	English
Publisher	BioMed Central
Publisher Date	2019-12-27
Access Restriction	Open
Subject Keyword	Orthopedics Rehabilitation Rheumatology Sports Medicine Internal Medicine Epidemiology First metatarsal shortening Plantar pressure Finite element method Hallux valgus Transfer metatarsalgia
Content Type	Text
Resource Type	Article
Subject	Orthopedics and Sports Medicine Rheumatology
Journal Impact Factor	2.2/2023
5-Year Journal Impact Factor	2.6/2023

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