ABSTRACT
Underlying metatarsus adductus (MA) is commonly seen in patients with hallux valgus
(HV) deformity, with implications regarding procedure selection and hallux valgus
recurrence. Lapidus, or first tarsometatarsal fusion, is commonly performed allowing
reduction in intermetatarsal angle (IMA) but this procedure has not been established
as an approach to provide partial correction of MA deformity. Retrospective assessment
of preoperative and postoperative metatarsus adductus angle (MAA), IMA and hallux
abductus angle (HAA) in patients treated with Lapidus fusion for HV. Significance
was determined via paired t test with a p value of <.05. All cases involved manual transverse plane manipulation to reduce
both IMA and MAA during screw insertion. Intermetatarsal angle and Engel's angle were
measured on preoperative AP radiographs to determine the presence of underlying MA
in patients undergoing Lapidus fusion for HV. Ten weeks and 1 year postoperative radiographs
were measured to determine degree of correction of IMA, HAA, and MAA. Thirty-four
patients met inclusion criteria, which is approximately 46% of our sample population.
The average preoperative IMA was 19.4˚ (range 12-32) and the average postoperative
IMA was 9.7˚ (range 6-14). The average preoperative Engel's angle was 27.4˚ (range
24-34) and the average postoperative Engel's angle was 22.6˚ (range 15-28) with mean
improvement in MA of 6.6˚. Of the 34, 27 (79.4%) patients had a normal Engel's angle
at 10 weeks postoperatively. All measures of change met level of significance (p < .05). Of the 34 patients, 21 had radiographs taken beyond the 1 year mark (average
53 weeks). These patients were found to have an average Engel's angle of 23.0˚, which
is not statistically significantly different from their 10 week measurements. Of the
21 patients, 17 (81%) maintained normal Engel's angle past 1 year. Metatarsus adductus
varies regarding degree of reducibility and complicates preoperative angular measurement
and correction of HV. Based on these findings, we recommend Lapidus fusion using this
specified manipulation technique to obtain comprehensive transverse plane correction.
Level of Clinical Evidence
Keywords
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References
- Abductory midfoot osteotomy procedure for metatarsus adductus.J Foot Ankle Surg. 1995; 34 (153-16)
- Metatarsus adductus and hallux abducto valgus: their correlation.J Foot Surg. 1987; 26: 304-308
- Prevalence of metatarsus adductus in symptomatic hallux valgus and its influence on functional outcome.Foot Ankle Int. 2015; 36: 1316-1321
- Defining the incidence of metatarsus adductus in patients undergoing hallux valgus surgery.Foot Ankle Int. 2014; 35: 1292-1297
- Radiographic recurrence of deformity after hallux valgus surgery in patients with metatarsus adductus.Foot Ankle Int. 2016; 37: 165-171
- Late results of modified Mitchell procedure for the treatment of hallux valgus.Foot Ankle Int. 1999; 20: 296-300
- Correction of hallux valgus deformity in association with underlying metatarsus adductus deformity.Foot Ankle Spec. 2017; 10: 538-542
- A simplified metatarsus adductus angle.J Am Podiatry Assoc. 1983; 73: 620-662
- The reliability of angular measurements in hallux valgus deformities.Foot Ankle Int. 2001; 22: 369-379
- Diagnosis and treatment of first metatarsophalangeal joint disorders. Section 3: hallux varus.J Foot Ankle Surg. 2003; 42: 137-142
- Operative treatment for hallux valgus with moderate to severe metatarsus adductus.Foot Ankle Int. 2019; 40: 641-647
- Rotational scarf and akin osteotomy for correction of hallux valgus associated with metatarsus adductus.Foot Ankle Int. 2010; 31: 220-228
- Algorithm for severe hallux valgus associated with metatarsus adductus.Foot Ankle Int. 2015; 36: 499-503
- Introduction and evaluation of hallux abductovalgus.in: banks AS Downey MS Martin DE Miller SJ McGlamry's Comprehensive Textbook of Foot and Ankle Surgery. Lippincott, Williams and Wilkins, Philadelphia2000: 485-491
- Metatarsus adductus: radiographic and pathomechanical analysis.Podiatry Inst. 2014; : 25-30
- Reliability of metatarsus adductus angle and correlation with hallux valgus.Foot Ankle Surg. 2012; 18: 180-186
Article info
Publication history
Published online: June 21, 2021
Footnotes
Financial Disclosure: T.J. Boffeli has ownership in Surgical Design Innovations, Park Ridge, IL.
Conflict of Interest: T.J. Boffeli is on the editorial board of Podiatry Today.
Identification
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© 2021 by the American College of Foot and Ankle Surgeons. All rights reserved.
