{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:08:50Z","timestamp":1760144930793,"version":"build-2065373602"},"reference-count":37,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2024,6,1]],"date-time":"2024-06-01T00:00:00Z","timestamp":1717200000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Taichung Veterans General Hospital, Taiwan","award":["TCVGH-1125102B"],"award-info":[{"award-number":["TCVGH-1125102B"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>Objective evaluations of transverse tarsometatarsal (TMT) hypermobility\/instability are lacking. This study aims to radiographically explore the relationship between transverse TMT instability and metatarsus adductus (MA) in hallux valgus (HV). This study retrospectively analyzed 207 feet with varying degrees of HV, employing the distance between the first and second metatarsals (M1-2 distance) to assess transverse TMT instability of the first ray. Participants were categorized into MA and non-MA groups. It was found that the M1-2 distance significantly increased with the hallux valgus angle (HVA) and metatarsus adductus angle (MAA), demonstrating significant differences between the MA and non-MA groups. The measurement of M1-2 distance showed high reliability, and its cutoff value was determined to be 4.05 mm. Additionally, the results suggest that the widening of the M1-2 distance may be a predisposing factor for MA in HV patients, highlighting its role in the pathogenesis of this foot condition. These findings highlight the need for a comprehensive assessment of TMT instability on both the axial and sagittal planes for the surgical planning of HV, particularly when complicated by a large MAA. Based on these insights, reoriented first-TMT arthrodesis might be recommended for HV with significant MA to address potential multiplanar instability.<\/jats:p>","DOI":"10.3390\/life14060718","type":"journal-article","created":{"date-parts":[[2024,6,3]],"date-time":"2024-06-03T10:08:38Z","timestamp":1717409318000},"page":"718","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Radiographic Assessment of Transverse Tarsometatarsal Instability Complicated by Metatarsus Adductus in Hallux Valgus Patients"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7688-1671","authenticated-orcid":false,"given":"Shun-Ping","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, Taichung Veterans General Hospital, Taichung 407219, Taiwan"},{"name":"Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung 402202, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6538-9158","authenticated-orcid":false,"given":"Cheng-Min","family":"Shih","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Taichung Veterans General Hospital, Taichung 407219, Taiwan"},{"name":"Department of Physical Therapy, HungKuang University, Taichung 433304, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yu-Hsien","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Taichung Veterans General Hospital, Taichung 407219, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuan-Shao","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Taichung Veterans General Hospital, Taichung 407219, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,6,1]]},"reference":[{"key":"ref_1","unstructured":"Dietz, F.R. (1994). Intoeing--fact, fiction and opinion. Am. Fam. Physician, 50."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.fas.2011.03.002","article-title":"Radiological assessment of metatarsus adductus","volume":"18","author":"Dawoodi","year":"2012","journal-title":"Foot Ankle Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1292","DOI":"10.1177\/1071100714551022","article-title":"Prevalence of metatarsus adductus in patients undergoing hallux valgus surgery","volume":"35","author":"Aiyer","year":"2014","journal-title":"Foot Ankle Int."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1177\/1071100715608372","article-title":"Radiographic Recurrence of Deformity After Hallux Valgus Surgery in Patients With Metatarsus Adductus","volume":"37","author":"Aiyer","year":"2016","journal-title":"Foot Ankle Int."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1590\/1413-785220202801226897","article-title":"Hallux valgus anatomical alterations and its correlation with the radiographic findings","volume":"28","author":"Cavalheiro","year":"2020","journal-title":"Acta Ortop. Bras."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Talaski, G.M., Baumann, A.N., Sleem, B., Anastasio, A.T., Walley, K.C., O\u2019Neill, C.N., and Adams, S.B. (2024). Weightbearing Imaging Assessment of Midfoot Instability in Patients with Confirmed Hallux Valgus Deformity: A Systematic Review of the Literature. Diagnostics, 14.","DOI":"10.3390\/diagnostics14020193"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"219","DOI":"10.7547\/87507315-84-5-219","article-title":"Juvenile hallux abducto valgus association with metatarsus adductus","volume":"84","author":"Banks","year":"1994","journal-title":"J. Am. Podiatr. Med. Assoc."},{"key":"ref_8","first-page":"304","article-title":"Metatarsus adductus and hallux abducto valgus: Their correlation","volume":"26","author":"Lee","year":"1987","journal-title":"J. Foot Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1053\/jfas.2003.50002","article-title":"A radiographic study of the relationship between metatarsus adductus and hallux valgus","volume":"42","author":"Ferrari","year":"2003","journal-title":"J. Foot Ankle Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1057.e1057","DOI":"10.1016\/j.crad.2018.08.004","article-title":"Hallux valgus and metatarsus adductus measurements: Inter-reader reliability and correlations on radiographs and MRI","volume":"73","author":"Dessouky","year":"2018","journal-title":"Clin. Radiol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"180","DOI":"10.1016\/j.fas.2011.10.001","article-title":"Reliability of metatarsus adductus angle and correlation with hallux valgus","volume":"18","author":"Dawoodi","year":"2012","journal-title":"Foot Ankle Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"682","DOI":"10.1177\/107110079501601104","article-title":"Mann Award. Juvenile hallux valgus: Etiology and treatment","volume":"16","author":"Coughlin","year":"1995","journal-title":"Foot Ankle Int."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1177\/1071100720952079","article-title":"Radiographic and Clinical Outcomes of Hallux Valgus and Metatarsus Adductus Treated With a Modified Lapidus Procedure","volume":"42","author":"Conti","year":"2021","journal-title":"Foot Ankle Int."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1016\/j.fcl.2019.10.003","article-title":"Management of Hallux Valgus in Metatarsus Adductus","volume":"25","author":"Reddy","year":"2020","journal-title":"Foot Ankle Clin."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"97","DOI":"10.5005\/jp-journals-10040-1078","article-title":"The Metatarsal Axis Deviation Angle: A Novel Angular Measurement for Planning Surgery of Severe Hallux Valgus","volume":"4","author":"Kantak","year":"2017","journal-title":"J. Foot Ankle Surg. (Asia-Pac.)"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1177\/1071100720962471","article-title":"Weightbearing Computed Tomography and 3-Dimensional Analysis of Mobility Changes of the First Ray After Proximal Oblique Osteotomy for Hallux Valgus","volume":"42","author":"Kimura","year":"2021","journal-title":"Foot Ankle Int."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1016\/j.fcl.2018.02.001","article-title":"Hallux Valgus Deformity and Treatment: A Three-Dimensional Approach: Modified Technique for Lapidus Procedure","volume":"23","author":"Santrock","year":"2018","journal-title":"Foot Ankle Clin."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1177\/107110079401500103","article-title":"Clinical, quantitative assessment of first tarsometatarsal mobility in the sagittal plane and its relation to hallux valgus deformity","volume":"15","author":"Klaue","year":"1994","journal-title":"Foot Ankle Int."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1177\/1071100712460217","article-title":"First ray instability in hallux valgus deformity: A radiokinematic and pedobarographic analysis","volume":"34","author":"Dietze","year":"2013","journal-title":"Foot Ankle Int."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1007\/s00264-021-05198-9","article-title":"Multiplanar instability of the first tarsometatarsal joint in hallux valgus and hallux rigidus patients: A case-control study","volume":"46","author":"Lee","year":"2022","journal-title":"Int. Orthop."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1040","DOI":"10.1177\/107110070202301113","article-title":"Manual examination technique to assess dorsal instability of the first ray","volume":"23","author":"Voellmicke","year":"2002","journal-title":"Foot Ankle Int."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"504","DOI":"10.1177\/1071100714524556","article-title":"First metatarsocuneiform joint mobility: Radiographic, anatomic, and clinical characteristics of the articular surface","volume":"35","author":"Doty","year":"2014","journal-title":"Foot Ankle Int."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"A133","DOI":"10.1186\/1757-1146-7-S1-A133","article-title":"Sagittal and axial mobility of 1st ray in hallux valgus","volume":"7","author":"Young","year":"2014","journal-title":"J. Foot Ankle Res."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"2318","DOI":"10.1016\/j.injury.2022.02.040","article-title":"Lisfranc injury: Refined diagnostic methodology using weightbearing and non-weightbearing radiographs","volume":"53","author":"Hagemeijer","year":"2022","journal-title":"Injury"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"119","DOI":"10.2214\/ajr.155.1.2112832","article-title":"Hallux valgus deformity: Preoperative radiologic assessment","volume":"155","author":"Karasick","year":"1990","journal-title":"AJR Am. J. Roentgenol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1097\/00003086-198106000-00008","article-title":"Hallux valgus\u2014Etiology, anatomy, treatment and surgical considerations","volume":"157","author":"Mann","year":"1981","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_27","unstructured":"Bland, M. (2015). An Introduction to Medical Statistics, Oxford University Press."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1080\/00031305.1957.10501091","article-title":"Nonparametric Statistics","volume":"11","author":"Siegel","year":"1957","journal-title":"Am. Stat."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Dygut, J., and Piwowar, M. (2022). Muscular Systems and Their Influence on Foot Arches and Toes Alignment-Towards the Proper Diagnosis and Treatment of Hallux Valgus. Diagnostics, 12.","DOI":"10.3390\/diagnostics12122945"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1177\/107110079201300301","article-title":"Metatarsocuneiform arthrodesis for management of hallux valgus and metatarsus primus varus","volume":"13","author":"Myerson","year":"1992","journal-title":"Foot Ankle"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1007\/s00508-020-01705-x","article-title":"A novel method of clinical first tarsometatarsal joint hypermobility testing and radiologic verification","volume":"133","author":"Ornig","year":"2021","journal-title":"Wien. Klin. Wochenschr."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"965","DOI":"10.1177\/107110070102201207","article-title":"Mobility of the first tarsometatarsal joint in hallux valgus patients: A radiographic analysis","volume":"22","author":"Faber","year":"2001","journal-title":"Foot Ankle Int."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"376","DOI":"10.1302\/0301-620X.33B3.376","article-title":"Observations on hallux valgus; based on a controlled series","volume":"33-b","author":"Hardy","year":"1951","journal-title":"J. Bone Joint Surg. Br."},{"key":"ref_34","first-page":"583","article-title":"Current management of tarsometatarsal injuries in the athlete","volume":"58","author":"Myerson","year":"2009","journal-title":"Instr. Course Lect."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1177\/1071100718802264","article-title":"Injury Pattern in Ligamentous Lisfranc Injuries in Competitive Athletes","volume":"40","author":"Porter","year":"2019","journal-title":"Foot Ankle Int."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1519","DOI":"10.2106\/00004623-199072100-00013","article-title":"Subtle injuries of the Lisfranc joint","volume":"72","author":"Faciszewski","year":"1990","journal-title":"J. Bone Joint Surg. Am."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1007\/s00256-019-03282-1","article-title":"Imaging in Lisfranc injury: A systematic literature review","volume":"49","author":"Sripanich","year":"2020","journal-title":"Skeletal Radiol."}],"container-title":["Life"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-1729\/14\/6\/718\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T14:52:14Z","timestamp":1760107934000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-1729\/14\/6\/718"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,6,1]]},"references-count":37,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2024,6]]}},"alternative-id":["life14060718"],"URL":"https:\/\/doi.org\/10.3390\/life14060718","relation":{},"ISSN":["2075-1729"],"issn-type":[{"type":"electronic","value":"2075-1729"}],"subject":[],"published":{"date-parts":[[2024,6,1]]}}}