Effect of Metatarsus Adductus on Hallux Valgus Treated With Proximal Reverse Chevron Metatarsal Osteotomy

Abstract

Background: This study aimed to compare clinical and radiographic outcomes and recurrence rates after reverse proximal chevron metatarsal osteotomy (PCMO) for patients with hallux valgus (HV) with or without metatarsus adductus (MA). We hypothesized that patients with MA would have poorer outcomes and a higher radiographic recurrence rate than those without MA. Methods: This retrospective single-surgeon series comprised 144 patients (173 feet) with moderate to severe HV, treated with PCMO and Akin osteotomy without lesser metatarsal procedures, who were grouped according to the presence (MA group) or absence of MA (non-MA group). Clinical assessment included the American Orthopaedic Foot & Ankle Society (AOFAS) score, pain visual analog scale (VAS), and patient satisfaction rating. Radiographic assessments included metatarsus adductus angle (MAA), HV angle (HVA), and intermetatarsal angle (IMA). Results: The prevalence of the MA was 24.2%. The mean MAA was 23.1 ± 3.3 degrees in the MA group. There were no differences in the mean AOFAS score and pain VAS score at the final follow-up between the 2 groups (all P > .05). The patient satisfaction rate was 73.8% in the MA group vs 90.1% in the non-MA group ( P = .017). The mean postoperative HVA and IMA significantly improved at the final follow-up in both groups, respectively (all P < .001). Preoperative and postoperative HVA were larger in the MA group vs non-MA group. However, no significant difference was found in the improvement of HVA and IMA after surgery between the 2 groups (all P > .05). The recurrence rate was 28.6% in the MA group and 6.1% in the non-MA group ( P < .001). Conclusion: HV patients associated with the MA had a higher degree of preoperative HV, lower correction of the HVA, higher radiographic recurrence rate, and poorer patient satisfaction than those without MA post-PCMO without lesser metatarsal procedures. Therefore, a more extensive HV correction procedure or the addition of a lesser metatarsal realignment procedure may need to be considered. Level of Evidence: Level III, retrospective comparative series.

Pain Management of Hallux Valgus Surgery Is Achieved by Cocktail Therapy

“…e osteotomy vertex was established at 0.8-1 cm and 1/3 above the articular surface of the head, and the direction of the fourth metatarsal bone was used as the osteotomy direction. Mini-swing saw "V" shaped 70 °∼80 °angle osteotomy, forming a short upper arm, long lower arm improved osteotomy [14]. We clamp the diaphysis of the first metatarsal bone with a tissue forceps, traction the thumb, and push the distal bone 5-8 mm laterally to the proper position of orthosis, and clamp the distal part of the lower arm with vascular forceps to prevent the elevation of the metatarsal bone.…”

What’s New in Foot and Ankle Surgery

“…Hallux valgus surgery in individuals with metatarsus adductus is a challenging problem. Choi et al 9 reviewed 173 feet with hallux valgus and compared those with metatarsus adductus (42 feet) and those without metatarsus adductus (131 feet) after proximal chevron and Akin osteotomies. At a median follow-up of 32 months, the authors found no difference in the improvement of the hallux valgus angle and the intermetatarsal angle between groups.…”

Recent Advances in Foot and Ankle Surgery

“…Hallux valgus surgery in patients already having metatarsus adductus is a challenging problem in foot. In a study by Choi et al [2] they took 173 feet sample with hallux valgus and compared those with metatarsus adductus (42 feet) and those without metatarsus adductus (131 feet) after proximal chevron and Akin osteotomies. At a median follow-up of 32 months, no difference in the improvement of the hallux valgus angle and the intermetatarsal angle between groups.…”