Correlations of Sesamoid Bone Subluxation with the Radiologic Measures of Hallux Valgus and Its Clinical Implications

Background and Objectives: Hallux valgus is one of the most common chronic foot complaints, with prevalences of over 23% in adults and up to 35.7% in older adults. However, the prevalence is only 3.5% in adolescents. The pathological causes and pathophysiology of hallux valgus are well-known in various studies and reports. A change in the position of the sesamoid bone under the metatarsal bone of the first toe is known to be the cause of the initial pathophysiology. Purpose: The relationships between the changes in the location of the sesamoid bone and each radiologically measured angle and joint congruency in the hallux valgus remain as yet unknown. Therefore, this study investigated the relationships of sesamoid bone subluxation with the hallux valgus angle, intermetatarsal angle, and metatarsophalangeal joint congruency in hallux valgus patients. The goal is to know the hallux valgus angle, the intermetatarsal angle, and metatarsophalangeal joint congruency’s correlation with hallux valgus severity and prognosis by revealing the relationship between each measured value and sesamoid bone subluxation. Materials and Methods: We reviewed 205 hallux valgus patients who underwent radiographic evaluation and subsequent hallux valgus correction surgery in our orthopedic clinic between March 2015 and February 2020. Sesamoid subluxation was assessed using a new five-grade scale on foot radiographs, and other radiologic measurements were assessed, such as hallux valgus angle, the intermetatarsal angle, distal metatarsal articular angle, joint congruency, etc. Conclusions: Measurements of the hallux valgus angle, interphalangeal angle, and joint congruency exhibited high interobserver and intraobserver reliabilities in this study. They also showed correlations with sesamoid subluxation grade.