Correction of Brachymetatarsia and Medial Angulation of the Great Toe of Apert Foot By Distraction Osteogenesis: A Review of 7 Years of Experience.
BACKGROUND
Apert foot anomalies may cause severe problems such as pain and development of callus formation related to weight redistribution, problems with footwear, and gait disturbances that may limit their daily activities. The main purpose of this study was to review our experience with distraction osteogenesis for the correction of brachymetatarsia and the great toe angulation of the patients with Apert syndrome.


METHODS
This study retrospectively reviewed 7 patients (14 extremities) followed up for Apert syndrome who underwent distraction for the correction of bilateral congenital brachymetatarsia and angulation of the great toe between 2004 and 2008. Correction of the metatarsal inclination angle, the medial angulation of the great toe, the percentage of lengthening, and lengthening rates of distracted bones were evaluated.


RESULTS
Patients ranged in age from 4 to 8 years at the distraction operation, with a mean age of 5.4±1.3 years, and the average length of follow-up was 86.6±21.0 months. The length of the first metatarsal bone increased significantly from the average length of 32.6±5.7 mm to an average of 46.7±6.5 mm (P<0.001). The mean lengthening rate and lengthening percentages of distracted bones were 0.4%±0.1%/month and 30.2%±6.4%/month, respectively. Preoperative and postoperative metatarsal inclination angles were at a mean of 43.8±5.12 and 32.6±3.8, respectively, and the correction of metatarsal inclination was considered as statistically significant (P<0.001). The mean angulation of the great toe reduced significantly from 49.8±11.76 to 13.2±8.5 degrees after distraction (P<0.001). Minor complications such as pin loosening, pin-tract infection, and early union that required reoperation were observed in 5 extremities (35.7%).


CONCLUSIONS
Anatomic features of Apert foot may lead to complaints that may limit patients' daily activities and require as much attention as associated hand and craniofacial anomalies. Distraction appears to be an effective and safe approach for the simultaneous correction of the shortness of the first ray and medial angulation of the great toe.


METHODS
Level IV.
*Department of Plastic Reconstructive and Aesthetic Surgery, Hacettepe University Faculty of Medicine †Ankara Güven Hospital, Orthopedics and Traumatology Clinic, Ankara, Turkey.
Mert
M
Calis
Ali
A
Oznur
Omer
O
Ekin
Ibrahim
I
Vargel
D000168:Acrocephalosyndactylia / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery; D000203:Activities of Daily Living; D053587:Arthrometry, Articular / Q000379:methods; D002648:Child; D002675:Child, Preschool; D005260:Female; D005684:Gait; D006801:Humans; D007870:Leg Length Inequality / Q000209:etiology / Q000503:physiopathology; D008297:Male; D008682:Metatarsal Bones / Q000000981:diagnostic imaging; D019857:Osteogenesis, Distraction / Q000009:adverse effects / Q000379:methods; D010043:Outcome and Process Assessment, Health Care; D016059:Range of Motion, Articular; D012086:Reoperation / Q000379:methods / Q000706:statistics & numerical data; D012189:Retrospective Studies; D014421:Turkey