Metatarsus adductus setting in adult patients: Results of a treatment algorithm with shortening arthrodesis tarsometatarsal joints two and three.

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. LEVEL OF EVIDENCE: IV prospective cases series.

Fixation of the Proximal Metatarsal Crescentic Osteotomy Using a Head Locking X-Plate.

BACKGROUND: We present a new method to stabilize proximal crescentic osteotomies (PCOs) for the correction of moderate to severe hallux valgus. METHODS: A single-center prospective study with a consecutive series of 72 patients (94 feet) with a PCO was performed using a head locking X-plate. The primary aim was to investigate the stability of the osteotomy, measuring the dorsal elevation of the first metatarsal head, first cuneiform height, talus-first metatarsal angle, and first metatarsal inclination pre- and postoperatively. A secondary outcome assessed weight distribution during gait, quality of life, and radiologically documented bone healing process. RESULTS: Ninety-three percent of the feet were within ±2 mm change for dorsal elevation of the first metatarsal head, and 72% for the medial cuneiform height. Eighty-nine percent were within ±4 degrees change for the first metatarsal inclination, 73% for the talus-first metatarsal angle, and 100% for the calcaneus pitch angle. The mean changes between pre- and 1-year postoperative were not significantly different for any of the stability measurements except for the first metatarsal inclination angle. The SF36 showed a significant improvement of physical function, general health, and decreased bodily pain. Harris mat footprints showed a decrease of 46% underneath the second and a pressure decrease of 40% underneath the third metatarsal head. CONCLUSION: This technique, of using a head locking X-plate to stabilize the PCO, showed satisfactory and reproducible results in terms of stability, clinical outcome, bone healing, and patient satisfaction. The plate provided substantial support for the PCO resulting in adequate and easy fixation. LEVEL OF EVIDENCE: Level IV, retrospective case series.