title: The effect of first ray shortening in the development of metatarsalgia in the second through fourth rays after metatarsal osteotomy.
abstract: BACKGROUND
  The aims of this study were to determine the severity of metatarsalgia of the second through fifth rays after shortening of the first ray for correction of hallux valgus deformity and patient satisfaction of the cosmetic results.
  
  
  METHODS
  Two hundred and forty metatarsal osteotomies (Wilson osteotomy as modified by Lindgren and Turan) were evaluated 4.19+/-1.29 years postoperatively. The procedure involved a slightly oblique subcapital osteotomy of the first metatarsal and fixation with one screw.
  
  
  RESULTS
  The average decrease in the hallux valgus angle was 26+/-5 degrees, the 1-2 intermetatarsal angle was 8.4+/-4 degrees, and the average shortening of the first metatarsal was 3.8+/-1.8 mm. Positive correlations were found between metatarsalgia of the second through fourth rays and first ray shortening (p<0.001 second ray, p<0.001 third ray, and p<0.001 fourth ray); there was no correlation between the fifth ray and first ray shortening. No correlation was found between a decrease in the hallux valgus angle or 1-2 intermetatarsal angle and metatarsalgia in the second through fifth rays. A positive correlation was detected between postoperative foot alignment and decrease in the hallux valgus (p<0.001) and a negative correlation between postoperative foot alignment and first ray shortening (p<0.01). No correlation was noted between postoperative foot alignment and the 1-2 intermetatarsal angle.
  
  
  CONCLUSIONS
  Excessive shortening of the first metatarsal should be avoided to decrease the occurrence of postoperative transfer metatarsalgia. We found a greater patient satisfaction with foot alignment in patients who had a greater decrease in the hallux valgus angle and less shortening of the first ray.
authors.affiliation: Department of Orthopaedics, University of Szeged, 6. Semmelweis Street, Szeged 6723, Hungary. tothk@orto.szote.u-szeged.hu
authors.forename: Kálmán
authors.initials: K
authors.lastname: Tóth
authors.forename: István
authors.initials: I
authors.lastname: Huszanyik
authors.forename: Péter
authors.initials: P
authors.lastname: Kellermann
authors.forename: Krisztina
authors.initials: K
authors.lastname: Boda
authors.forename: László
authors.initials: L
authors.lastname: Róde
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D006215:Hallux Valgus / Q000601:surgery*; D006801:Humans; D008297:Male; D008682:Metatarsal Bones / Q000601:surgery*; D037061:Metatarsalgia / Q000209:etiology*; D010027:Osteotomy / Q000009:adverse effects / Q000379:methods*; D017060:Patient Satisfaction; D013997:Time Factors