Combination of first metatarsophalangeal joint arthrodesis and proximal correction for severe hallux valgus deformity.
BACKGROUND
Arthrodesis of the first metatarso-phalangeal (MTP-1) joint is a widely accepted procedure for the treatment of hallux valgus in patients with MTP-1 degeneration, severe or recurrent deformity, or inflammatory arthritis. This study aimed to evaluate if an additional more proximal correction was beneficial in cases with a severely increased intermetatarsal 1-2 angle (IMA 1-2).


METHODS
A consecutive series of 18 feet (4 bilateral, all females; mean age, 61 years) with severe hallux valgus and an increased IMA 1-2 treated by MTP-1 fusion and an additional more proximal correction (Mau osteotomy or modified Lapidus procedure) was evaluated. Radiographs were analyzed for IMA 1-2 and hallux valgus angles (HVA), and for the position of the tibial sesamoid according to the AOFAS guidelines.


RESULTS
At a mean followup of 14 months, all patients were satisfied or very satisfied with the results of surgery. There were no intraoperative complications. The IMA 1-2 significantly improved from a mean of 18.8 degrees before surgery to 4.6 degrees at followup (p < 0.001) and the HVA from a mean of 49.9 degrees to 9.7 degrees (p < 0.001), respectively. Sesamoid position improved two grades on average. We found no difference between the Mau osteotomy and the modified Lapidus procedure.


CONCLUSIONS
The present results indicate that the combination of a more proximal procedure with a MTP-1 arthrodesis in cases of hallux valgus with severely increased IMA 1-2 has a high correction capability and achieved normal HVAs as well as normal IMAs 1-2. This technique appeared to be safe and clinically successful.
Department of Orthopaedic Surgery, Foot and Ankle Center, Schulthess Clinic, Zurich, Switzerland. pascal.rippstein@kws.ch
Pascal F
PF
Rippstein
Young-Uk
YU
Park
Florian D
FD
Naal
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001174:Arthrodesis / Q000379:methods*; D001178:Arthroplasty; D005260:Female; D005500:Follow-Up Studies; D006215:Hallux Valgus / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008682:Metatarsal Bones / Q000601:surgery; D008683:Metatarsophalangeal Joint / Q000601:surgery*; D008875:Middle Aged; D010027:Osteotomy; D017060:Patient Satisfaction; D011859:Radiography; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013639:Tarsal Bones / Q000601:surgery; D013710:Tendons / Q000601:surgery; D014033:Toe Joint / Q000601:surgery