The Role of Weightbearing Computed Tomography in Assessing First Metatarsal Pronation in Hallux Valgus: A Systematic Review.

Abstract

Hallux valgus is a multiplanar deformity often involving first metatarsal pronation. Weightbearing computed tomography may improve assessment compared to standard radiographs, which are limited to two-dimensional views. A systematic review was conducted according to PRISMA guidelines. PubMed and Cochrane databases were searched for studies evaluating weightbearing computed tomography in assessing HV components, including metatarsal pronation and sesamoid position. Study quality was assessed using the Newcastle-Ottawa Scale. Fourteen studies (706 feet) were included. Weightbearing computed tomography consistently outperformed Weightbearing radiographs in detecting first metatarsal pronation and allowed more accurate differentiation between intrinsic torsion and joint malalignment. Pronation and sesamoid displacement were correlated, though thresholds and clinical significance varied. Nine studies were low risk of bias. Weightbearing computed tomography provides a more accurate and reproducible assessment of metatarsal pronation and sesamoid alignment than weightbearing radiographs. However, its clinical impact remains uncertain. Future studies should standardize measurements and assess whether pronation correction improves surgical outcomes.