title: The influence of the length of the first metatarsal on transfer metatarsalgia after Wu's osteotomy.
abstract: BACKGROUND
  The aim of this study was to evaluate how changes in the length of the first metatarsal, hallux valgus angle (HVA), intermetatarsal 1-2 angle (IMA), plantar angulation and sesamoid position influence the severity of the postoperative 2-5 metatarsalgia and to determine patient satisfaction with the cosmetic outcome after Wu's osteotomy.
  
  
  METHODS
  A retrospective analysis of the clinical data and radiographs of 87 cases was performed at a mean followup time of 4.2 years after Wu's subcapital cross osteotomies.
  
  
  RESULTS
  The mean HVA decreased from 42 to 13 degrees, the mean IMA 1-2 from 22 to 10 degrees. The mean first metatarsal lengthening was 0.3 mm. A negative correlation was found between lengthening of the first metatarsal and metatarsalgia at rays 2 and 3. No such pattern was found between the fourth and fifth metatarsal. No correlation was found between the 2-5 metatarsalgia and the decrease in either the HVA or the IMA 1-2. A positive correlation was detected between the HVA decrease and the patients' satisfaction with their postoperative foot alignment; there was no correlation between the perceived postoperative foot alignment and either the first metatarsal lengthening or the IMA 1-2 decrease.
  
  
  CONCLUSIONS
  Preservation of the length of the first metatarsal during osteotomy seems to prevent the postoperative transfer metatarsalgia on the second and third rays; however, it has no major influence on the satisfaction of the patients with their foot alignment. A greater correction of the HVA angle resulted in a higher level of satisfaction with the foot cosmesis.
authors.affiliation: University of Szeged, Department of Orthopaedics, 6 Semmelweis Street, Szeged, 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: Krisztina
authors.initials: K
authors.lastname: Boda
authors.forename: László
authors.initials: L
authors.lastname: Róde
authors.forename: Péter
authors.initials: P
authors.lastname: Kellermann
mesh_terms: D005260:Female; D006215:Hallux Valgus / Q000601:surgery*; D006801:Humans; D008297:Male; D037061:Metatarsalgia / Q000209:etiology* / Q000517:prevention & control*; D008875:Middle Aged; D010027:Osteotomy / Q000009:adverse effects* / Q000379:methods* / Q000592:standards; D017060:Patient Satisfaction; D012189:Retrospective Studies; D016896:Treatment Outcome