Surgery for metatarsus adductus

NewsBot · Jun 11, 2015

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Combined Medial Cuneiform Osteotomy and Multiple Metatarsal Osteotomies For Correction of Persistent Metatarsus Adductus in Children.
Feng L, Sussman M.
J Pediatr Orthop. 2015 Jun 5

BACKGROUND:
Metatarsus adductus may occur in children after otherwise successful clubfoot treatment or may be an isolated deformity. There are various bony procedures currently in use for treatment of this problem. The purpose of this study was to review our experience with medial cuneiform opening-wedge osteotomy along with transmetatarsal osteotomy through the base of the second to fifth for treatment of the forefoot adductus in children.
METHODS:
From 1992 to 2008, we found 16 patients, 25 feet who underwent the procedure by a single surgeon (MDS) at the Shriners Hospitals for Children in Portland. All preoperative and postoperative radiographs were measured and analyzed and all clinic notes were reviewed.
RESULTS:
Major improvements were seen in the configuration of the foot. Significant differences were found between preoperative and postoperative anteroposterior standing radiographs by measuring the talo-first metatarsal angle, the talo-calcaneal angle, the calcaneal-second metatarsal angle, and the calcaneal-fifth metatarsal angle (P<0.005). On the lateral view the talo-first metatarsal, the talo-calcaneal, the tibio-talar, the tibio-calcaneal, and the pitch angle did not show any change. An unexpected finding was that after the surgery, the lateral subluxation of talo-navicular joint was partially corrected.
CONCLUSIONS:
This retrospective study suggests that combined medial cuneiform opening-wedge osteotomy with transmetatarsal osteotomy through the base of second to fifth can effectively correct this deformity regardless of the underlying cause. In our cases, we achieved good clinical and radiographic results. We have used this procedure for patients 6 years and older who have moderate to severe forefoot adductus.
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Admin2 · Jun 11, 2015

Related Threads:
Other threads tagged with metatarsus adductus
Metatarsus adductus: Development of a non-surgical treatment pathway.

NewsBot · Dec 29, 2015

Management of Metatarsus Adductus, BeanS haped
Foot, Residual Clubfoot Adduction and Z-shaped Foot
in Children, with Conservative Treatment and Double Column
Osteotomy of the First Cuneiform and the Cuboid.
Najdi H, Jawish R.
International Journal of Orthopaedics 2015; 2(6): 438-444

Metatarsus adductus is a deformity located at Lisfranc’s joint in a
pure transverse plane. It is spontaneously corrected for the majority
of newborns. In rare toddler cases, it demonstrates a clinical
stiffness and results in Z-shaped foot, where valgus of the heel
creates equilibration of resistant metatarsus adductus. Although,
recurrent metatarsus adductus varus is observed in treated idiopathic
clubfeet, usually in children over three years, but presence of heel's
valgus is related to the surgical overcorrection of the heel’s varus.
Conservative treatment is advocated in flexible metatarsus adductus.
Surgery is performed after conservative treatment fail, and in walking
patient. Soft tissue releases, osteotomies of metatarsals and lateral
epiphysiodesis of the metatarsal base gave good results on short term,
but deformity recurrence and foot growth disturbance couldn't be
avoided. Although, osteotomies carried out proximal to the Lisfranc's
joint: opening wedge osteotomy of medial cuneiform, calcaneocuboid
fusion and the anterior resection of calcaneus, gave permanent
correction, but they act only on one of the sides of deformity.
Therfore, the theory of elongated lateral column associated with a
shortened medial column is crucial in dealing with this deformity:
combining opening wedge osteotomy of cuneiform with closing
wedge osteotomy of cuboid described by Jawish et al. in children
after 4 years allows in all causes of metatarsus adductus stiffness a
lateral shifting of forefoot. Concerning the associated heel’s valgus, it
is corrected in Z-shaped foot after the double osteotomy cuneiform/
cuboid. However, in complicated treated clubfoot a particular
treatment for the posterior tarsal is necessary
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NewsBot · Jul 28, 2019

The Modified Lepird Procedure for Correction of Metatarsus Adductus.
Siegel SJ
J Foot Ankle Surg. 2019 Jul 23

Metatarsus adductus is a common transverse plane congenital foot deformity. Achieving anatomic correction can be challenging, as all osteotomy procedures have a steep learning curve. A multitude of complications can occur when using traditional pan-metatarsal osteotomy approaches. The modified Lepird procedure is performed with proximal base osteotomies on all 5 metatarsals oriented dorsal distal to plantar proximal. All screws are inserted parallel to each other, allowing the forefoot to move laterally as a unit. The foot and ankle surgeon is able to dial in with precision the exact amount of forefoot abduction necessary to correct the deformity. The modified Lepird procedure dynamically corrects the metatarsus adductus deformity so it can easily prevent any over- or undercorrection that may occur intraoperatively. The author recommends this procedure when pan-metatarsal base osteotomies are required for correction of metatarsus adductus and associated deformities.
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NewsBot · Jun 27, 2022

Metatarsus adductus setting in adult patients: results of a treatment algorithm with shortening arthrodesis tarsometatarsal joints two and three☆
WernerPauli et al
Foot and Ankle Surgery; 26 June 2022

Background
This study proposes a treatment algorithm based on the correction of symptomatic metatarsus adductus (MA) associated with hallux abducto-valgo (HAV) through tarsometatarsal joint 2-3 (TMTJ) shortening arthrodesis. Our hypothesis is that the proposed algorithm leads to realignment of the forefoot rays from two to five and reduction of the talonavicular coverage angle (TNCA) with good clinical and radiographic results.

Methods
Clinical and radiographic evaluations were performed before and after surgery at 1-year follow-up on forty-six consecutive adult patients with MA, midfoot pain, HAV and osteoarthritis and/or instability of the TMTJ 2-3 in whom shortening of the 2nd and 3rd TMT joints according to MAA and treatment of the HV according to deformity was undertaken.

Results
Talus-first metatarsal angle (TFMA) was the only parameter which did not statistically significantly postoperatively change. All other clinical (AOFAS score) and radiological outcomes significantly improved postoperatively.

Conclusion
Although further studies are needed to confirm the proposed data, it would seems that the shortening arthrodesis of rays two and three has consequences on the forefoot and hindfoot by realigning the longitudinal axis of the foot. The consequent application of the algorithm and adequate correction of the HAV allow good clinical and radiographic results to be obtained.
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