Plantar Pressure Distribution Before and After Surgery for Lesser Metatarsophalangeal Joint Dislocation With Hallux Valgus.

Hallux valgus surgery and open reduction of the lesser metatarsophalangeal joints with metatarsal shortening osteotomy help treat severe hallux valgus concomitant with the lesser metatarsophalangeal joint dislocation; however, pre- and postoperative plantar pressure distribution and its effect on the foot remain unclear. The pre- and postoperative groups comprised 16 patients with moderate-to-severe symptomatic hallux valgus with lesser metatarsophalangeal joint dislocation. All feet underwent open reduction and collateral ligament reconstruction of the second metatarsophalangeal joint and proximal metatarsal shortening osteotomy under the second metatarsal with proximal osteotomy of the first metatarsal. Twenty healthy participants (20 feet) were included in the control group. The plantar pressure distribution was determined by measuring the peak pressure, maximum force, contact area, and force-time integral for 12 regions. Under the second toe, all measurements in the preoperative group were significantly lower than those of the control group. The peak pressure, maximum force, and contact area of the postoperative group were significantly greater than those of the preoperative group. However, no differences were observed between the postoperative and control groups. Under the second metatarsal head, the peak pressure of the preoperative group was significantly higher than that of the control group. The peak pressure of the postoperative group was significantly lower than that of the preoperative group and showed no differences from the control group. Open reduction and collateral ligament reconstruction of the lesser metatarsophalangeal joints and proximal metatarsal shortening osteotomy with proximal osteotomy of the first metatarsal in hallux valgus with lesser metatarsophalangeal joints dislocation cases may improve operative outcomes, including favorable foot function.

[Treatment of Hallux valgus]. / Behandlung des Hallux valgus.

Treatment of Hallux valgus Abstract. Hallux valgus deformity is a common foot deformity and includes a valgus deviation and pronation of the big toe with a prominent metatarsophalangeal (MTP) I joint (pseudoexostosis). If a hallux valgus deformity is clinically evident, standardized X-rays of the foot should be obtained for further assessment. A few radiological parameters are sufficient to adequately assess conventional X-rays in general practice. After the diagnosis has been made, the general practitioner can establish a conservative therapy (e.g., shoe inserts) in most cases. If surgical therapy is necessary, a large number of different techniques are described in the literature. In general, the clinical results after surgical reconstruction are satisfactory with a rather low complication rate.

Outcome of proximal triple derotational metatarsal osteotomy for three-dimensional correction of hallux valgus deformity.

PURPOSE: To correct hallux valgus deformities in patients with a greater pronation of the first metatarsal, we designed a novel proximal triple derotational metatarsal osteotomy (PTDMO), which could be used to achieve three-dimensional correction of hallux valgus deformities at the proximal metatarsal level. METHODS: We prospectively evaluated the radiographic and clinical outcomes of 13 consecutive cases underwent PTDMO between November 2018 and May 2020. The minimum follow-up for inclusion was 12 months. The hallux valgus angle (HVA), first-to-second intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA), relative length of the second metatarsal, and medial sesamoid position on the weight bearing foot anteroposterior radiographs, and the degree of the first metatarsal pronation on forefoot axial radiographs were measured pre-operatively, at six weeks post-operatively, and at the final follow-up. The American Orthopaedic Foot and Ankle Society (AOFAS) score and Foot Ankle Outcome Scores (FAOS) were measured. RESULTS: In the comparison of pre-operative and final follow-up parameters, HVA, IMA, and DMAA were significantly improved post-operatively (all, P < 0.001). The relative length of the second metatarsal did not differ significantly post-operatively (P = 0.724). The medial sesamoid was significantly reduced (P = 0.01), and the first metatarsal pronation decreased by 10.16° (P = 0.034). Regarding clinical parameters, the AOFAS score and FAOS in all categories significantly improved post-operatively (all, P < 0.001). CONCLUSION: PTDMO resulted in satisfactory radiographic and clinical outcomes with respect to deformity correction and pain relief, with significant post-operative reduced pronation of the first metatarsal.

Post-operative hallux varus: a review of treatment methods.

PURPOSE: Hallux varus is a classical complication of hallux valgus surgery with a medium rate of 6%. MATERIAL AND METHODS: Methods of treatment are MTP1 fusion or conservative joint operations. Hallux varus results from imbalance between excessive medial capsule retraction or tensioning and excessive lateral laxity or soft-tissue release but also and mainly from an over displacement of the first metatarsal which reduces the intermetatarsal angle and thus leads to medial displacement of the great toe. A majority are well tolerated, but few need to be re-operated upon. RESULTS: Factors guiding choice are mainly range of motion and reducibility of the first metatarsophalangeal joint and tendon balance. Joint sparing could be decided for a mobile and well balancesd MTP1 with two options, soft-tissue repairing such as tendon and ligament transfer and reverse osteotomies. The choice depends mainly on the radiological features as an unduly closed intermetarsal angle which leads to a reverse scarf or chevron osteotomy whatever previous surgery was or was not with an osteotomy. CONCLUSION: Conservative treatment is tricky, and MTP1 fusion is still a reliable procedure which can be used widely.

Triplanar Correction for First Metatarsophalangeal Fusion.

Successful deformity correction utilizing first metatarsophalangeal (MTP) fusion for hallux valgus with concomitant degenerative changes of the first MTP joint is well documented. Currently, there is limited discussion in the literature focusing on triplanar correction of the first MTP arthrodesis. Presented is a novel approach for triplane correction and fusion of the first MTP joint utilizing a biplanar locked plating system.

Distal chevron osteotomy with lateral release for moderate to severe hallux valgus patients aged sixty years and over.

PURPOSE: To analyze the outcome of distal chevron metatarsal osteotomy (DCMO) with lateral release for moderate to severe hallux valgus patients aged 60 years or more. METHODS: Consecutive 77 DCMOs in 54 patients were evaluated. Average age at operation was 65.1 ± 4.3 (range 60~79) years; the mean follow-up period was 20.5 ± 14.2 (range 12~93) months. Hallux valgus angle (HVA), first to second inter-metatarsal angle (IMA), and lateral sesamoid grades were measured. Considering the weak bone quality of the patients, fixation failures such as pin migration, callus formation, delayed union, and first metatarsal bone shortening were reviewed. Osteoarthritis (OA) of the first metatarsophalangeal joint (MTPJ), limitation of 1st MTPJ motion (LOM), and transfer metatarsalgia were also reviewed. RESULTS: HVA, IMA, and sesamoid grades were improved at three months and final follow-up. The mean HVA was 36.9° ± 7.0° preoperatively and 6.8° ± 7.1° at final follow-up. The mean correction angle of HVA was 31.3° ± 8.5° at three months and 30.1° ± 8.9° at final follow-up. The mean IMA was 16.3° ± 3.0° pre-operatively and 7.7° ± 2.7° at final follow-up. Hallux varus deformity was observed in three feet. Instability of osteotomy site was observed in one foot. Mean metatarsal shortening length was 1.26 ± 2.1 mm at three month follow-up. There were no cases of transfer metatarsalgia after operation. OA was observed in four feet post-operatively. LOM was observed in ten feet (13.0%). There were no instances of re-fracture or avascular necrosis (AVN). CONCLUSION: Despite concerns about aggravation of OA and fixation failure, distal chevron osteotomy with lateral release was safe on patients aged 60 years and over.

Conversion of First Metatarsophalangeal Joint Arthrodesis to Interpositional Arthroplasty With Acellular Dermal Matrix for First Ray Ulceration: A Case Report.

The purpose of this study is to report the outcome of the conversion of a first metatarsophalangeal (MTP) joint arthrodesis to an interpositional arthroplasty with an acellular dermal matrix for a chronic nonhealing first ray wound. To our knowledge, this is the first case report converting a first ray arthrodesis to an interpositional arthroplasty to heal a chronic ulceration. A 78-year-old female developed a chronic neuropathic ulceration under the first metatarsal head and hallux after a first MTP joint arthrodesis. The patient failed local wound care and underwent gastrocnemius recession, hallux interphalangeal joint fusion, and an interpositional arthroplasty with the use of an acellular dermal matrix. Bone tunnels were placed proximal to the metatarsal neck, where absorbable sutures affixed to the dermal matrix were passed from plantar to dorsal, and the graft was secured to the reamed metatarsal head and associated capsule. Postoperative radiographs revealed improved alignment of the first MTP joint. Complete reepithelialization of the plantar ulceration occurred within 2 weeks postoperatively. At the 16-month follow-up, the patient was ambulating without restriction and continued to be free of first ray ulceration and infection. This case study details the use of an acellular dermal matrix in an interpositional arthroplasty to offload a chronic nonhealing ulceration secondary to elevated first ray pressure associated with first MTP joint arthrodesis. The goal of this treatment is to reduce pain, heal the ulceration, and prevent its recurrence.

Synthetic Cartilage Implant Hemiarthroplasty for Second MTP Joint Osteoarthrosis.

Synthetic cartilage hemiarthroplasty has been used successfully in the first metatarsophalangeal (MTP) joint and might also provide an alternative surgical intervention for second MTP joint osteoarthritis and Freiberg disease. Synthetic cartilage implant hemiarthroplasty was performed on 23 consecutive patients for the treatment of painful second MTP joint disease. Joint damage ranged from mild to severe. Mean follow-up period was 43 months ± 17.6 (range, 28-79 months). Mean age at the time of surgery was 55 years ± 16 (range, 20-73 years). Each participant attended for clinical assessment and an interview which included completion of 2 patient-reported outcome measures: the Manchester-Oxford Foot Questionnaire (MOXFQ) and the Foot and Ankle Ability Measure (FAAM). The implant failed in 2 participants (9%) and required removal and revision. Four participants (17%) reported dissatisfaction with the surgery because of continued pain. Nine participants (43%) reported second MTP joint stiffness; however, this was symptomatic in just 5 cases. Sixteen participants (70%) were pain free and totally satisfied with their outcome. Eleven of 21 participants (52%) reported an improvement in all 3 categories of the MOXFQ. FAAM scores demonstrated good overall function and activity, with a mean score of 91 ± 16 (range, 44-100). There were no postoperative infections, transfer metatarsalgia, or floating toe deformity. In preserving metatarsal and phalanx length as well as the collateral ligaments of the joint, synthetic cartilage implant hemiarthroplasty avoids some of the important risks of metatarsal osteotomy and basal phalangectomy. A range of alternative surgical options are still available if the synthetic cartilage implant fails to resolve symptoms.

Clinical effectiveness and safety of Weil's osteotomy and distal metatarsal mini-invasive osteotomy (DMMO) in the treatment of metatarsalgia: A systematic review.

BACKGROUND: Weil's osteotomy (WO) is the most applied surgical treatment for metatarsalgia, a persistent pain in the lesser metatarsals' heads. We aim to review its effectiveness and safety compared to the percutaneous technique known as distal metatarsal mini-invasive osteotomy (DMMO). METHODS: Systematic review in Medline, Pubmed, Embase, Cinahl and Cochrane Library. We included studies that directly compared WO and DMMO for the treatment of primary metatarsalgia. Data on pain, function, complications and patients' satisfaction were extracted and narratively synthesized. RESULTS: Four retrospective studies were identified. There were no significant differences in clinical effectiveness or patients' satisfaction. Time to bone healing was significantly longer for DMMO, whereas WO showed more wound problems and metatarsophalangeal stiffness. Other complications were infrequent in the two procedures. CONCLUSION: Evidence on the direct comparison of WO and DMMO is scarce and of low quality. Randomized studies are needed in order to control for potential confounders.

Modified Lindgren-Turan Osteotomy for Hallux Valgus Deformity - a Review of 60 Cases.

PURPOSE OF THE STUDY To evaluate the clinical and radiological results of a new modification of relatively less-known Lindgren-Turan osteotomy technique in HV deformity that is performed by combining bunionectomy and capsuloplasty. MATERIAL AND METHODS 60 feet of 52 patients with moderate and heavy deformity who were operated between 2009 and 2014 were included in the study. The patients had clinically severe pain, did not respond to at least 6-month conservative treatment and had moderate and severe deformity before Hallux valgus angle (HVA), intermetatarsal angle (IMA), distal metatarsal joint angle (DMAA), proximal phalangeal joint angles (PPAA) and shortening amount in the first metatarsus were measured through preoperative and follow-up radiography. Clinical evaluations were conducted on all patients using American Orthopedic Foot and Ankle Society's (AOFAS) and visual analog scale (VAS). Data of the radiological and clinical evaluations in preoperative and follow-up periods were compared statistically. Statistical significance was accepted at p < 0.05. RESULTS 42 (76.1%) and 10 (23.9%) of 52 patients were female and male, respectively. Mean age of the patients was 50.9±15.52 years. Mean follow-up period of the patients was 43.3±2.1. Preoperative and last measurements: HVA: 36.34°±6.36° - 15.6°±2.83°, IMA: 12.62°±2.24° - 5.83°±1.32°, DMAA: 16.3°±3.45° - 10.3°±2.24°, PFAA: 7.24°±1.32° - 6.12°±0.84° (p < 0.001). Shortness of first metatarsus was measured to be 5.94±1.84 mm. Mean VAS values of the patients which was 8.6±0.4 before the operation was detected as 0.8±0.04 after follow-up (p < 0.001). AOFAS score of the patients which was 42.4±5.3 before the operation was found to be 88.9±7.6 (p < 0.001). All patients started to work again within 5.22±1.7 weeks. Union was completely seen along osteotomy line in all cases. Three patients had screw extraction. Two patients had superficial wound infection. DISCUSSION Capsule plication which we apply with osteotomy as part of our surgical procedure is a significant point in correcting deformity and raising stability. First metatarsophalangeal rigidity risk can be avoided with a controlled plication in operation and by giving the final decision after testing. Such flexibility shows that soft tissue contracture is not the main factor of deformity, so lateral release is not indicated. Thus, our opinion is that digital nerve damage and extra scar are avoided during lateral release. The osteotomy we applied which is extraarticular and subcapital, and protection of racket-shaped capsule cannot be attributed to finding no AVN case. CONCLUSIONS Modified Lindgren-Turan surgical procedure which is applied with capsuloplasty and bunionectomy is an effective and reliable method in treatment of moderate and severe HV deformities. It is recommended as a satisfactory option in HV treatment due to its ease in surgery, use of single incision and perfect clinical and radiological long-term results. Key words:hallux valgus, osteotomy, Lindgren-Turan, capsuloplasty, capsulorrhaphy, bunionectomy, plication.

[Lapidus arthrodesis]. / Lapidus-Arthrodese.

The tarso-metatarsal 1 joint (TMT-I) arthrodesis is a treatment option or moderate to severe hallux valgus (HV) deformities. Instability of the TMT1 joint is still a debatable indication. Using stable osteosynthesis techniques allows early postoperative weight bearing. Plantar plating combined with a lag screw is the biomechanical most stable construct. An additional intermetatarsal screw can improve the horizontal stability. Clinical results are good and radiological parameters stay constant, even in the long term.

[Soft tissue techniques in hallux valgus surgery]. / Weichteiltechniken in der Hallux-valgus-Chirurgie.

The hallux valgus represents combined bony and soft tissue pathology. In addition to known bony surgical procedures, addressing the soft tissue with regard to the anatomical structures, the surgical technique and the extent of correction are discussed.The goal of the operation is the restoration of the physiological balance between the active and passive stabilizing factors of the MTP-I-joint. The joint capsule, the ligaments and the tendons of the first ray act directly as stabilizing structures, whereas the hind foot and the position of the upper ankle have an indirect influence on the MTP-I-joint.The present work gives an overview of the pathoanatomy of the MTP-I-joint in the hallux valgus pathology. The individual anatomical structures are presented with regard to their physiological and pathological influence and the possible therapeutic options.

Plantar pressure and surgical indication of toe arthroplasty for rheumatoid forefoot deformity.

OBJECTIVES: The objective of this study is to clarify the surgical indication for rheumatoid forefoot deformity according to background characteristics and plantar pressure. METHODS: Patients with rheumatoid arthritis were divided into a non-surgical group (group N) and a surgical group (group S). The former consisted of 225 ft, and the latter consisted of 88 ft. DAS28, Japanese Society for Surgery of the Foot rheumatoid arthritis foot and ankle scale (JSSF scale) and hallux valgus angle (HVA) were evaluated as background characteristics. Distribution of peak pressure as plantar pressure was measured in nine sections. RESULTS: In groups N and S, the mean DAS28 was 3.6 and 3.0, the mean JSSF scale was 81.1 and 63.0, and the mean HVA was 19.9° and 35.3°, respectively. The mean peak pressure of group S at the first and third metatarsophalangeal joints was significantly higher compared with group N. Significant differences between the two groups were also seen in Δ pressure (the difference between the maximum and minimum peak pressure values). The cut-off values were 75.0 for JSSF scale, 24.9° for HVA and 3.94 kg/cm2 for Δ pressure. CONCLUSIONS: The combined assessment of HVA and Δ pressure was found to be useful as an indication for surgical treatment of the forefoot.

[The Primary Metatarsalgia: Pathogenesis, Biomechanics and Surgical Treatment].

This paper presents a comprehensive review on the current concept of the diagnosis and treatment of central metatarsalgia on the basis of medical literature analyses. Metatarsalgia is the term for pain in the forefoot. This is a set of symptoms corresponding to a wide range of diseases. Central metatarsalgia is a kind of metatarsalgia which arises from structural-functional changes that lead to excessive pressure in the area of metatarsal heads. The data analysis demonstrated that presently various types of osteotomies of metatarsal bones are the main surgical treatment options with the chance of complication ranging from 6 to 50%. Weil-osteotomy is known to be the most popular type of osteotomy for treatment of central metatarsalgia. The most common complication of Weil-osteotomy is floating toe, the one that doesn't contact with the supporting surface. In case Weil-osteotomy and intraphalangeal arthrodesis with trans acticular fixation are both performed, the complication of floating toe increases up to 50%. When Weil osteotomy, plantar plate repair, extensor digitorum longum tendon lengthening and triple Weil-osteotomy are performed simultaneously, the complication rate is 15% approximately which is much lower. Using combined osteotomy techniques as well as taking into account structural-functional pathologic changes of the forefoot and ligaments repair of metatarsalphalangeal joint will ensure the most successful development of surgical treatment techniques for central metatarsalgia.

Long-term outcome of joint-preserving surgery by combination metatarsal osteotomies for shortening for forefoot deformity in patients with rheumatoid arthritis.

OBJECTIVES: We report the long-term outcome of joint-preserving surgery by combining metatarsal osteotomies for shortening for forefoot deformity in patients with rheumatoid arthritis (RA). METHODS: Forty-three patients (57 feet) aged 41.7-70.8 years (mean, 57.7 years) underwent a combination of first tarsometatarsal fusion and distal realignment (modified Lapidus procedure), shortening oblique osteotomies of the bases of metatarsals 2-4, and fifth ray osteotomy (modified Coughlin procedure). Patients were followed up for 64-108 months (mean, 76.6 months). RESULTS: Average postoperative Foot Function Index scores for pain, disability, and activity were 10.3, 19.9, and 16.2, respectively. Average Japanese Society for Surgery of the Foot RA foot and ankle score improved significantly from 52.1 points preoperatively to 90.3 points postoperatively. Postoperatively, 41% of patients reported some forefoot stiffness, but showed no disability. Residual deformity and callosity were absent in all patients. Average hallux valgus and intermetatarsal angles decreased postoperatively from 48.5° to 8.6° and from 15.2° to 4.6°, respectively. Nonunion in two metatarsals, hardware breakage in three, and mild infection in one were identified during follow-up. CONCLUSIONS: With good perioperative medical management of RA, surgical repositioning of the metatarsophalangeal joints by proximal metatarsal shortening and consequent relaxing of the surrounding soft tissue shows successful long-term results.

A comparative study on the results of the modified Ludloff osteotomy for hallux valgus deformities with minimal erosion of the metatarsophalangeal joints in rheumatoid patients versus non-rheumatoid patients.

OBJECTIVES: We aimed to compare the outcomes of joint-preserving surgery for hallux valgus deformities with minimal erosion of the metatarsophalangeal joint in rheumatoid patients with non-rheumatoid controls, and to determine the prognostic factors of recurrence in rheumatoid patients. METHODS: A total of 18 rheumatoid patients (20 feet, Group I) and 35 non-rheumatoid patients (39 feet, Group II) were included. The mean follow-up was 29.6 months. Radiographic and clinical outcomes were compared. To identify the prognostic factors for recurrences in rheumatoid patients, subgroup analyses were done in Group I. RESULTS: Most of the outcomes showed favorable results in both groups. However, Group II had better results in hallux valgus angle (HVA) (15.9° vs. 7.9°, p < 0.001), and in sesamoid position (p = 0.040) at final follow-up. Group I showed higher recurrence rate (50% vs. 0%). The final American Orthopaedic Foot and Ankle Society score was better in Group II (82.1 vs. 90.7, p = 0.014). The large preoperative HVA, non-performance of Akin osteotomy, and insufficient reduction of sesamoid position were related to recurrence in rheumatoid patients. CONCLUSIONS: Joint-preserving surgery for hallux valgus deformities in rheumatoid forefoot deformity showed favorable results in mid-term follow-up; however, it should be warned of possible recurrent deformities.

Extended indications for foot and ankle arthroscopy.

Advances in foot and ankle arthroscopy have allowed surgeons to diagnose and treat a broadening array of disorders that were previously limited to open procedures. Arthroscopy of the posterior ankle, subtalar joint, and first metatarsophalangeal joint and tendoscopy can be used to address common foot and ankle ailments, with the potential benefits of decreased pain, fast recovery, and low complication rates. Posterior ankle and subtalar arthroscopy can be used to manage impingement, arthrofibrosis, synovitis, arthritis, fractures, and osteochondral defects. First metatarsophalangeal joint arthroscopy can address osteophytes, chronic synovitis, osteochondral defects, and degenerative joint disease. Tendoscopy is a minimally invasive alternative for evaluation and débridement of the Achilles, posterior tibial, flexor hallucis longus, and peroneal tendons.

Hallux Valgus Bunion Splint: Surgical Dressing Technique.

BACKGROUND: Hallux valgus is a common condition with a complex etiology resulting in numerous treatment options. Recurrence of the deformity can occur following correction. Surgical technique and possibly also postoperative care play a role in reducing recurrence rates. This article highlights a postoperative surgical dressing technique which allows for semirigid support during the immediate postoperative period. METHODS: A wooden tongue depressor placed along the medial border of the hallux comprises the primary support for the dressing. The rigidity of the tongue depressor allows for the hallux to be drawn toward the depressor, encouraging neutral alignment of the hallux. Dressings are removed 2 weeks postoperatively, with new dressings applied in similar fashion and maintained in place until 6 weeks postoperatively. RESULTS: Based upon our observations, our surgical dressing technique provides sufficient support following hallux valgus correction surgery while being straightforward to replicate without the need for frequent dressing changes. The dressing materials are of negligible cost and are typically readily available. No associated wound complications have been observed. CONCLUSIONS: We present an easily replicable and affordable option for postoperative hallux valgus correction surgical dressings. LEVELS OF EVIDENCE: Level V: Expert Opinion.

Midfoot width changes after first metatarsal osteotomy in hallux valgus surgery: A biomechanical effect?

Hallux valgus is a challenging pathology characterized by a valgus deformity in the metatarsophalangeal area of the first ray. The aim of this study was to analyze the influence of first metatarsal osteotomy on the relationship between midfoot bones in patients with hallux valgus. The sample consisted of patients from the orthopedics and traumatology outpatient clinic who underwent surgical treatment for hallux valgus. Preoperative and postoperative X-rays were compared regarding the width of the midfoot and the tarsometatarsal joint. The sample consisted of 17 women, with 22 feet assessed in each group. The distance from the medial cuneiform to the cuboid, the distance from the intermediate cuneiform to the cuboid, the distance between the first and fifth metatarsals, and the distance between the second and fifth metatarsals reduced significantly between pre- and postoperative assessments. Hallux valgus correction through osteotomy of the first metatarsal leads to a structural change in the midfoot. Further studies should determine whether these changes persist over time.

Proximal rotational closing-wedge osteotomy of the first metatarsal in rheumatoid arthritis: clinical and radiographic evaluation of a continuous series of 35 cases.

OBJECTIVES: The introduction of powerful antirheumatic drugs has dramatically improved the treatment of rheumatoid arthritis (RA), leading clinicians to reconsider the benefits of joint preservation for rheumatoid forefoot deformities. We have employed joint-preserving forefoot surgeries, including rotational closing-wedge osteotomy of the first metatarsal. The aim of our study is to assess the short-term results of this procedure. METHODS: From January 2011 through December 2011, 35 feet were treated with this procedure. Subjective, functional, and radiographic outcomes were surveyed. RESULTS: The mean Japanese Society for Surgery of the Foot improved from a preoperative level of 52.6 to 68.7 postoperatively. The average hallux valgus and intermetatarsal angles improved from 47.3° preoperatively to 17.5° postoperatively, and from 16.7° preoperatively to 9.0° postoperatively, respectively. To assess the repositioning of pronation deformities of the first metatarsal, the position of the medial sesamoid was also surveyed according to the measurement system proposed by Hardy and Clapham. All feet except two were classified as grade V or higher preoperatively; 25 of these were grade IV or lower at the latest follow-up. CONCLUSIONS: Rotational closing-wedge osteotomy of the first metatarsal was beneficial for correcting forefoot deformities in RA over the short term.