Mustafa BULUT, Muhammed Furkan DARILMAZ, Elşad OSMANLI
Baltalimanı Dergisi - 2026;2(2):44-51
Background: To evaluate whether the presence of metatarsalgia at final postoperative follow -up after hallux valgus surgery is associated with preoperative clinical and radiographic parameters together with postoperative first metatarsal shortening and sesamoid position. Methods: This retrospective cohort study included 144 patients treated with distal chevron osteotomy combined with the McBride procedure between 2018 and 2023. Preoperative clinical and radiographic parameters, postoperati ve first metatarsal shortening, and sesamoid position were analyzed. Univariate and multivariate logistic regression analyses were performed to identify independ ent predictors. Model performance was assessed using calibration and discrimination metrics, an d receiver operating characteristic analysis was used to determine optimal cut -off values. Results: Metatarsalgia was present at the final postoperative follow -up examination in 63 patients (43.8%). In the clinically adjusted multivariable analysis, first metatarsal shortening (odds ratio [OR]=1.92, 95% confidence interval [CI]: 1.21 -3.04, p=0.005), postoperative sesamoid position score (OR=3.00, 95% CI: 1.13 -7.98, p=0.028), diabetes mellitus (OR=11.20, 95% CI: 2.70 -46.46, p<0.001), and smok ing status (OR=9.98, 95% CI: 3.01 -33.09, p<0.001) were independently associated with metatarsalgia at final postoperative follow -up. The final model showed high apparent classification performance (Nagelkerke R²=0.670; accuracy=89.4%; sensitivity=85.0%; specificity=92.6%), although the significant Hosmer -Lemeshow test indicated that model calibration should be interpreted cautiously. A first metatarsal shortening threshold of >=4.2 mm showed high specificity (96.3%) but moderate sensitivity (57.1%) for the p resence of metatarsalgia at final postoperative follow -up, whereas a postoperative sesamoid position threshold of >=1 grade showed high sensitivity (90.5%) but limited specificity (51.9%). Conclusion: First metatarsal shortening a nd postoperative sesamoid position were independently associated with the presence of metatarsalgia at final follow -up after hallux valgus surgery. Because most patients had preoperative metatarsalgia, these findings should not be interprete d as demonstrat ing newly developed transfer metatarsalgia in all symptomatic patients. Preservation of first ray length and adequate sesamoi d reduction may help optimize clinical outcomes. Further prospective studies are needed.
