title: Articular chondral damage of the first metatarsal head and sesamoids: analysis of cadaver hallux valgus.
abstract: BACKGROUND
  Evidence of successful correction on postoperative hallux valgus imaging studies may not always correlate with patient satisfaction. Recent attention to the association of cartilaginous degeneration and hallux valgus may provide new insight into treatment algorithms and patient expectations. The purpose of this cadaveric study was to evaluate the degree of chondral damage as it relates to increasing hallux valgus deformity.
  
  
  METHODS
  A total of 39 cadaver first metatarsophalangeal joints were evaluated by radiography, and then dissected to evaluate for chondral damage. Chondral lesion grade, size, and location were recorded and then analyzed based on patient demographics and hallux valgus angle.
  
  
  RESULTS
  Twenty-nine of 39 specimens were considered to have hallux valgus characterized by a hallux valgus angle of 15 degrees or greater. Four of 39 (10%) specimens revealed absence of chondral lesions, and 3 of those were found in the group with a hallux valgus angle of less than 15 degrees. Chondral lesions of increasing size and grade were seen more commonly with a more severe hallux valgus deformity. Particular locations on the metatarsal head appeared to be more prone to cartilaginous lesions when compared to other locations.
  
  
  CONCLUSIONS
  Assessment of first metatarsophalangeal joint articular damage with regard to hallux valgus may be an important clinical parameter for consideration.
  
  
  CONCLUSIONS
  Operative intervention to realign the first metatarsophalangeal joint may correct malalignment and relieve pressure on the widened forefoot, but residual pain within the joint may emanate from preexisting articular cartilaginous lesions. These findings support the concept that earlier intervention with operative realignment of a hallux valgus deformity and specifically the sesamoid complex may diminish degenerative changes.
authors.affiliation: Saint Alphonsus Coughlin Foot & Ankle Clinic, Boise, ID, USA. jessd90@hotmail.com
authors.forename: Jesse F
authors.initials: JF
authors.lastname: Doty
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Coughlin
authors.forename: Shane
authors.initials: S
authors.lastname: Schutt
authors.forename: Christopher
authors.initials: C
authors.lastname: Hirose
authors.forename: Michael
authors.initials: M
authors.lastname: Kennedy
authors.forename: Brett
authors.initials: B
authors.lastname: Grebing
authors.forename: Bertil
authors.initials: B
authors.lastname: Smith
authors.forename: Truitt
authors.initials: T
authors.lastname: Cooper
authors.forename: Pau
authors.initials: P
authors.lastname: Golano
authors.forename: Ramon
authors.initials: R
authors.lastname: Viladot
authors.forename: Richard
authors.initials: R
authors.lastname: Remington
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002102:Cadaver; D002358:Cartilage, Articular / Q000473:pathology*; D005260:Female; D006215:Hallux Valgus / Q000473:pathology*; D006801:Humans; D008297:Male; D008682:Metatarsal Bones / Q000473:pathology*; D008875:Middle Aged; D012716:Sesamoid Bones / Q000473:pathology*
keywords: bunion; chondral lesion; hallux disorders; hallux valgus; osteochondral lesion