Abstract
OBJECTIVE: This study aimed to investigate the potential association between transfer metatarsalgia, a complication that may arise post operatively following hallux valgus surgery, and the preoperative relative second metatarsal length measured on weight-bearing radio graphs. Additionally, it was sought to evaluate the predictive value of this radiographic parameter. METHODS: A total of 126 patients who underwent primary hallux valgus surgery between January 2022 and December 2023 and had a minimum follow-up of 12 months were retrospectively reviewed. Patients were categorized into 2 groups based on the presence or absence of transfer metatarsalgia during the postoperative follow-up. Relative second metatarsal length was measured as the primary radiographic variable using preoperative weight-bearing anteroposterior foot radiographs. In addition, the hallux valgus angle (HVA) and the intermetatarsal angle (IMA) were evaluated preoperatively. Clinical outcomes were assessed using the American Orthopaedic Foot and Ankle Society Hallux Metatarsophalangeal-Interphalangeal (AOFAS Hallux MTP-IP) score at the 12-month follow-up. Demographic and surgical variables, such as age, sex, surgical technique, and implant type, were also recorded. Group comparisons were performed, and multivariate logistic regression and receiver operating characteristic (ROC) curve analyses were conducted to identify variables predictive of transfer metatarsalgia. RESULTS: Patients who developed transfer metatarsalgia had significantly higher preoperative relative second metatarsal length values (P < .001). Among the variables included in the multivariate logistic regression model, only relative second metatarsal length was found to be a statistically significant predictor of transfer metatarsalgia (odds ratio: 5.176; 95% CI: 2.813-9.493). Receiver operating characteristic curve analysis identified a threshold value of 2.15 mm, which was adopted as 2 mm for clinical applicability, with an area under the curve of 0.832, sensitivity of 79.4%, and specificity of 78.2%. In contrast, other parameters such as age, sex, surgical technique, implant type, preoperative HVA, IMA, and postoperative AOFAS Hallux MTP-IP scores were not significantly associated with the development of transfer metatarsalgia. CONCLUSION: Relative second metatarsal length was found to be significantly associated with the development of postoperative transfer metatarsalgia, and ROC analysis identified 2 mm as a clinically applicable cutoff value. Preoperative measurement of relative second metatarsal length can help identify patients at higher risk of this complication, allowing for improved patient counseling and more informed surgical planning. Cite this article as: Karagoz B, Bayrak HC, Dincer DE. The relationship between preoperative relative second metatarsal length and postoperative transfer metatarsalgia following hallux valgus surgery. Acta Orthop Traumatol Turc., 2025;59(6):387-393.