Impact of metatarsus adductus on hallux valgus surgery outcomes

NewsBot · Feb 9, 2017

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Correction of Hallux Valgus Deformity in Association With Underlying Metatarsus Adductus Deformity
Naohiro Shibuya, DPM, MS, Daniel C. Jupiter, PhD, Britton S. Plemmons, DPM, Lanster Martin, DPM, Jakob C. Thorud, DPM, MS
Foot & Ankle Specialist February 7, 2017

Presence of underlying metatarsus deformity is known to negatively affect the outcome of hallux valgus corrective surgery. Yet there are many other factors that also affect final outcomes. In order to address the potential relationships between variables, we attempted to evaluate the association of metatarsus adductus with surgical outcomes, independent of other common factors used in evaluation of hallux valgus deformity. We enrolled 154 patients who had undergone hallux valgus corrective surgery and recorded their pre- and postoperative intermetatarsal (IM12) and hallux valgus (HVA) angles, preoperative Engel’s angle, and type of hallux valgus procedure. Using linear and logistic regression models, we identified variables that were independently (1) associated with the final IM12 and HVA and those (2) independently associated with dichotomized postoperative IM12 and HVA. We found that the only factors that were independently associated were preoperative IM12 with postoperative IM12, and preoperative HVA with postoperative HVA. In the linear model, a discretized Engel’s angle of 21 to 25 was marginally negatively associated with the final IM12. There was no detectable relationship between underlying metatarsus adductus deformity and the final outcome of hallux valgus correction after adjusting for other covariates.
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Admin2 · Feb 9, 2017

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NewsBot · Nov 17, 2019

Preliminary results of the correction of metatarsus adductus associated with severe hallux valgus
Nacime Salomão Barbachan Mansur et al
Vol 13 No Supl 1 (2019): Proceedings of the 19th Brazilian Ankle and Foot Medicine and Surgery Congress

Objective: To evaluate the preliminary results of angular corrections from a series of cases of surgical treatment of severe hallux valgus associated with metatarsal adduction. Methods: Data were retrospectively collected from the medical records and pre- and postoperative radiographs of patients undergoing Lapidus arthrodesis combined with lateral rotation osteotomy at the bases of the second and third metatarsals. The following angle measurements were performed before and after surgery: hallux valgus angle, intermetatarsal angle, and the degree of adduction of metatarsal bones (measured using Sgarlato’s and Engel’s angles). The mean follow-up period was 18 months (16-24 months). Results: The mean hallux valgus correction angle was 31° (19-53°), and the mean intermetatarsal correction angle was 5.771° (2-9°). Regarding forefoot adduction, the mean correction angle measured was 15.57° (12-21°) when the Sgarlato technique was used and 15.71° (10-22°) when the Engel technique was used. All measured angles decreased significantly in the postoperative evaluation. Conclusion: Rotational osteotomy at the bases of the second and third metatarsals was effective for correcting metatarsal adduction, allowing the alignment of the first metatarsal and therefore the correction of the deformity.
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NewsBot · Mar 25, 2021

The metatarsaus adductus effect by
the syndesmosis procedure for hallux
valgus correction
Source

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 sideeffect of the syndesmosis procedure. However, it did not compromise function restoration of
the forefoot by evidence of our patients' plantar callus and pedobarographic findings.
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NewsBot · Feb 5, 2022

Treating hallux valgus associated metatarsus adductus by minimally invasive surgery: A simple solution for a difficult problem
Burg Alon, MD et al
February 01, 2022

This study aims to assess a novel minimally invasive surgical technique that addresses hallux valgus accompanied by metatarsus adductus.
We retrospectively analysed the results of 20 patients (21 feet) that underwent a newly developed percutaneous osteotomy procedure of the lesser metatarsal bones in order to correct hallux valgus deformities accompanied by metatarsus adductus. We used x-ray studies in order to evaluate changes in the hallux valgus angle, the first inter-metatarsal angle, and the metatarsal angle (using the modified Sgarlato method). We also compared the pre- and post-operative AOFAS scores when available. The paired sample t-test was used to compare variables.
At a one-year follow-up the mean hallux valgus angle, inter-metatarsal angle and the metatarsal angle have been reduced by 31.62 (-3 to 9), 3.86 ( 11 to 52) and 14.69 ( 4 to 36) respectively (P<0.001 for all). The mean AOFAS score (n=15 feet available) has been improved by a mean of 44.53 (22 to 72, P<0.001). In addition, the patient satisfaction rates were high. Patients suffered from mild to moderate midfoot pain during the first few weeks following surgery, which resolved when union occurred. No cases of lesser metatarsal nonunion have been documented.
The presented minimally invasive method can be used effectively to correct hallux valgus that is associated with metatarsus adductus. Proximal minimally invasive metatarsal osteotomy can effectively correct hallux valgus accompanied by metatarsus adductus.
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NewsBot · Aug 7, 2023

Radiological characteristics of hallux valgus with metatarsus adductus: A matched case-control study
Ryuzo Okuda et al
Journal of Orthopaedic Science; 28 July 2023

Background
No evidence has been found to support the hypothesis that there is a correlation between hallux valgus (HV) and intermetatarsal (IM) angles in HV with metatarsus adductus (MA) and that IM angle in HV with MA is lower than that in HV without MA. The present study aimed to analyze the radiographic characteristics of HV with MA compared to matched controls and to clarify the differences between HV with MA and without MA.

Methods
Preoperative radiographs of 126 female patients (164 feet) who underwent hallux valgus surgery were reviewed. The HV, IM, and MA angles were measured. The MA was defined as MA angle of 20° or greater. Of all the feet, 37 (22.6%) had HV with MA (MA group). Control A (111 feet) having HV without MA was matched by age, gender, and BMI to MA group; Control B (79 feet) having HV without MA was matched by age, gender, BMI, and HV angle to the sub-MA group (31 feet) having HV with MA.

Results
The correlation coefficient between the HV and IM angles in the MA group was considered negligible (r = 0.08, p = 0.63), whereas the correlation coefficient in Control A was considered moderate (r = 0.57, p < 0.00001). The correlation coefficient in the MA group was significantly smaller than in Control A (p < 0.01). There was no significant difference in the HV angle between the sub-MA group and Control B (p = 0.23), but the IM angle was significantly smaller than in Control B (p = 0.002).

Conclusion
There is no significant correlation between the HV and IM angles in HV with MA, as there is in HV without MA. HV with MA has a significantly smaller IM angle for the HV angle compared to HV without MA.
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