Correct arch with HAV surgery?

NewsBot · Jun 2, 2007

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Proximal oblique-domed osteotomy of the first metatarsal for the treatment of hallux valgus associate with flat foot: effect to the correction of the longitudinal arch of the foot.
Takao M, Komatsu F, Oae K, Miyamoto W, Uchio Y, Ochi M,
Arch Orthop Trauma Surg. 2007 May 31; [Epub ahead of print]

INTRODUCTION: Flat foot and/or metatarsal primus varus are the major causes of hallux valgus, and it is important to correct these deformities in order to prevent the recurrence of this condition. We demonstrate the clinical and radiological assessment of the correction of hallux valgus, metatarsal primus varus, and flat foot after proximal oblique-domed osteotomy of the metatarsus with distal soft tissue reconstruction.

MATERIALS AND METHODS: Twenty-seven feet of 22 patients with moderate or severe hallux valgus who had undergone proximal oblique-domed osteotomy were studied. After the adductor hallucis tendon was cut at the attachment of the proximal phalanx and at the sesamoid bone, the osteotomy was performed 3 cm dorsal-distal to the metatarsocuneiform joint to transfer distal fragment approximately 5 mm in the plantar direction, and rotated laterally decreasing the first-second intermetatarsal angle to 5 degrees.

RESULTS: The mean AOFAS score was 54.1 +/- 2.8 points at pre-operation and 92.8 +/- 4.8 points at the most recent follow-up (P < 0.0001). Significant improvement was seen between the hallux valgus angle (P < 0.0001), first-second intermetatarsal angle (P < 0.0001), first-fifth intermetatarsal angle (P < 0.0001), talar pitch (P = 0.0032), and calcaneal plantar angle (P = 0.0327) before surgery and at one year after surgery. The average improvement of the talar pitch and calcaneal plantar angle was 2.6 +/- 1.4 and 2.4 +/- 1.5 degrees, respectively.

CONCLUSION: This study suggest that proximal oblique-domed osteotomy of the metatarsal as a surgical procedure for the treatment of moderate or severe hallux valgus with flat foot can be recommended to correct the longitudinal arch of the foot and the first-second intermetatarsal angle
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Bruce Williams · Jun 3, 2007

NewsBot said:

Proximal oblique-domed osteotomy of the first metatarsal for the treatment of hallux valgus associate with flat foot: effect to the correction of the longitudinal arch of the foot.
Takao M, Komatsu F, Oae K, Miyamoto W, Uchio Y, Ochi M,
Arch Orthop Trauma Surg. 2007 May 31; [Epub ahead of print]
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The problem w/ this is that there is no real long-term informaion on follow up are apparently arch height.

In my opinion you would need to fuse the 1st met-cuneiform joint and possible the 1st met-cun-navicular joint in a plantarflexed posion to really raise the medial arch.

If you don't address the dorsiflexion stiffness component you will rarely if ever get a true change in arch height. Just plantarflexing the 1st ray in my experience, distal or proximal is not enough.

IMHO
Bruce Williams

drsarbes · Jun 5, 2007

I think the entire premise is incorrect, i.e., that you can "correct" a pes planus by plantarflexing the first metatarsal.
There is obviously more to a pes planus deformity than a first ray that is dorsiflexed. If, in those rare instances where a simple forefoot varus caused by a dorsally mobile first ray in an otherwise normal foot is causing pronation, than perhaps plantarflexing the first metatarsal will make a difference.
Dr. Steve

NewsBot · Jul 25, 2014

The Radiographic Effects of the Scarf Bunionectomy on Rearfoot Alignment
Nicholas G. Argerakis, DPM; Lowell Weil Jr, DPM, MBA; Lowell Scott Weil Sr, DPM; Dimitrios Anagnostopoulos, MD; Catherine A. Feuerstein, DPM; Erin E. Klein, DPM, MS; Ashley K. Boccio, BS
Foot Ankle Spec July 24, 2014

Statement of Purpose. Excessive pronation of the rearfoot has been implicated as a destabilizing force in the progression of hallux abducto valgus. Although the scarf bunionectomy has been shown to effectively correct the intermetatarsal angle associated with hallux valgus deformity, its effect on the rearfoot has yet to be established. The purpose of this case series is to demonstrate the effect of the scarf bunionectomy on rearfoot alignment.

Methodology. Medical records were reviewed to isolate patients who underwent unilateral or bilateral scarf bunionectomies (with or without akin osteotomy) who had complete medical records, follow-up of at least 12 months, and met the inclusion/exclusion criteria. Preoperative and postoperative radiographic measurements were analyzed at various postoperative time intervals. Standard deviations and statistical significance was obtained.

Results. One hundred feet (71 patients) were included in this analysis. The long-term results of this study highlighted the scarf osteotomy’s ability to affect the medial longitudinal arch by decreasing the intermetatarsal angle and lateral talar-first metatarsal angle. The talar declination and calcaneal inclination angle were not significantly altered with the scarf bunionectomy.

Conclusion. This case series demonstrates that the scarf bunionectomy had significant effect on radiographic alignment of the bunion deformity and medial longitudinal arch over time. However, its effect on the rearfoot position was not statistically significant.
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