Background: Metatarsus primus varus correction is one of the primary surgical objectives for hallux valgus correction. Some soft tissue procedures have shown that the first metatarsal can be adequately realigned without osteotomy. The hypothesis of this study was that this correctability should also be demonstrable preoperatively. The purpose of this study was to assess whether a simple forefoot taping technique could do so and whether it could also be correlated with operative results after the syndesmosis procedure. Methods: Between May 2014 and December 2015, 147 feet with hallux valgus from 85 patients with an average age of 46.2 years underwent the syndesmosis procedure. All were followed prospectively with standing radiographic assessment of their first intermetatarsal angle, metatarsophalangeal angle, and medial sesamoid position preoperatively without and with a forefoot wrapping technique and postoperatively at 10 days, 6 months, and 1 year. Results: Their average preoperative intermetatarsal angle was reduced from 14.4 to 8.4 degrees by the wrapping technique, and their average metatarsophalangeal angle was spontaneously reduced from 31.8 to 21.8 degrees. After a minimum 1-year follow-up, they stabilized at 7.4 and 18.6 degrees, respectively. There was significant correlation between hallux valgus and metatarsus primus varus corrections by both forefoot wrapping and surgical methods with Spearman’s rank correlation of metatarsophalangeal angle and intermetatarsal angle corrections ( r = 0.6077, P < .0001 due to the wrapping method; r = 0.7157, P < .0001 due to the syndesmosis procedure). All raw working radiographic images for this study can be viewed in the Supplemental Material section. Conclusion: This study found that a simple forefoot tape-wrapping technique could be used preoperatively to verify first metatarsal mobility for metatarsus primus varus correction by the soft tissue syndesmosis procedure without osteotomies. Level of Evidence: Level II, prospective comparative study.
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Aims The purpose of this study is to examine the adductus impact on the second metatarsal by the nonosteotomy nonarthrodesis syndesmosis procedure for the hallux valgus deformity correction, and how it would affect the mechanical function of the forefoot in walking. For correcting the metatarsus primus varus deformity of hallux valgus feet, the syndesmosis procedure binds first metatarsal to the second metatarsal with intermetatarsal cerclage sutures. Methods We reviewed clinical records of a single surgical practice from its entire 2014 calendar year. In total, 71 patients (121 surgical feet) qualified for the study with a mean follow-up of 20.3 months (SD 6.2). We measured their metatarsus adductus angle with the Sgarlato’s method (SMAA), and the intermetatarsal angle (IMA) and metatarsophalangeal angle (MPA) with Hardy’s mid axial method. We also assessed their American Orthopaedic Foot & Ankle Society (AOFAS) clinical scale score, and photographic and pedobarographic images for clinical function results. Results SMAA increased from preoperative 15.9° (SD 4.9°) to 17.2° (5.0°) (p < 0.001). IMA and MPA corrected from 14.6° (SD 3.3°) and 31.9° (SD 8.0°) to 7.2° (SD 2.2°) and 18.8° (SD 6.4°) (p < 0.001), respectively. AOFAS score improved from 66.8 (SD 12.0) to 96.1 (SD 8.0) points (p < 0.001). Overall, 98% (119/121) of feet with preoperative plantar calluses had them disappeared or noticeably subsided, and 93% (113/121) of feet demonstrated pedobarographic medialization of forefoot force in walking. We reported all complications. Conclusion This study, for the first time, reported the previously unknown metatarsus adductus side-effect of the syndesmosis procedure. However, it did not compromise function restoration of the forefoot by evidence of our patients' plantar callus and pedobarographic findings. Level of Clinical Evidence: III Cite this article: Bone Jt Open 2021;2(3):174–180.
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