Arch height and first metatarsal joint axis orientation as related variables in foot structure and function

Background: This study investigated the association of arch height combined with first metatarsal joint axis vertical (V) orientation to the size of the 1-2 intermetatarsal angle (IMA) and first metatarsal adduction/abduction position simulating foot postures during gait, kinematics commonly affected by bunion. Materials and Methods: Nine cadaver specimens were mounted in a loading frame. Measures of arch height ratio and IMA were made. With the foot placed in positions seen during normal gait cycle an electromagnetic device measured displacement of the relative angle of rotations between the first metatarsal and navicular, and helical axis (HA) parameters. Canonical correlation analysis assessed the relationship among the variables. Results: A negative relationship (r = -0.73) was found between arch height and first metatarsal HA V-orientation. When considered as combined variables, arch height and metatarsal HA V-orientation accounted for 69% of the variance of IMA and change in first metatarsal adduction/abduction position. Conclusion: Orientation of the first metatarsal joint axis was highly variable between specimens but correlated with arch height. The conjoined factors of arch height and first metatarsal HA V-orientation accounted for most of the variance of IMA and change in first metatarsal adduction/abduction position during the sequence of foot position during simulated gait. Clinical Relevance: These findings suggest that orthotic arch support could reorient the metatarsal joint axis out-of-vertical and in effect, limit the first metatarsal from displacing into an adducted bunion deformity. These findings could help to explain the pathogenesis of bunions.