title: Proximal oblique-domed osteotomy of the first metatarsal for the treatment of hallux valgus associate with flat foot: effect to the correction of the longitudinal arch of the foot.
abstract: BACKGROUND
  Flat foot and/or metatarsal primus varus are the major causes of hallux valgus, and it is important to correct these deformities in order to prevent the recurrence of this condition. We demonstrate the clinical and radiological assessment of the correction of hallux valgus, metatarsal primus varus, and flat foot after proximal oblique-domed osteotomy of the metatarsus with distal soft tissue reconstruction.
  
  
  METHODS
  Twenty-seven feet of 22 patients with moderate or severe hallux valgus who had undergone proximal oblique-domed osteotomy were studied. After the adductor hallucis tendon was cut at the attachment of the proximal phalanx and at the sesamoid bone, the osteotomy was performed 3 cm dorsal-distal to the metatarsocuneiform joint to transfer distal fragment approximately 5 mm in the plantar direction, and rotated laterally decreasing the first-second intermetatarsal angle to 5 degrees.
  
  
  RESULTS
  The mean AOFAS score was 54.1 +/- 2.8 points at pre-operation and 92.8 +/- 4.8 points at the most recent follow-up (P < 0.0001). Significant improvement was seen between the hallux valgus angle (P < 0.0001), first-second intermetatarsal angle (P < 0.0001), first-fifth intermetatarsal angle (P < 0.0001), talar pitch (P = 0.0032), and calcaneal plantar angle (P = 0.0327) before surgery and at one year after surgery. The average improvement of the talar pitch and calcaneal plantar angle was 2.6 +/- 1.4 and 2.4 +/- 1.5 degrees, respectively.
  
  
  CONCLUSIONS
  This study suggest that proximal oblique-domed osteotomy of the metatarsal as a surgical procedure for the treatment of moderate or severe hallux valgus with flat foot can be recommended to correct the longitudinal arch of the foot and the first-second intermetatarsal angle.
authors.affiliation: Department of Orthopaedic Surgery, Teikyo University School of Medicine, 2-11-1, Kaga, Itabashi, Tokyo, 173-8605, Japan. mtakao@med.teikyo-u.ac.jp
authors.forename: Masato
authors.initials: M
authors.lastname: Takao
authors.forename: Fumito
authors.initials: F
authors.lastname: Komatsu
authors.forename: Kazunori
authors.initials: K
authors.lastname: Oae
authors.forename: Wataru
authors.initials: W
authors.lastname: Miyamoto
authors.forename: Yuji
authors.initials: Y
authors.lastname: Uchio
authors.forename: Mitsuo
authors.initials: M
authors.lastname: Ochi
authors.forename: Takashi
authors.initials: T
authors.lastname: Matsushita
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005413:Flatfoot / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D006215:Hallux Valgus / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008682:Metatarsal Bones / Q000000981:diagnostic imaging / Q000601:surgery*; D008875:Middle Aged; D010027:Osteotomy / Q000379:methods*; D011859:Radiography; D012720:Severity of Illness Index; D013710:Tendons / Q000601:surgery; D016896:Treatment Outcome