Abstract
Introduction
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.
Materials and 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.
Conclusion
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.
Similar content being viewed by others
References
Bonny G, Macnab I (1952) Hallux valgus and hallux rigidus: a critical survey of operative results. J Bone Joint Surg Br 34:366–385
Hardy RH, Clapham JCR (1951) Observations on hallux valgus: based on a controlled series. J Bone Joint Surg Br 33:376–391
Inmann VT (1974) Hallux valgus: a review of etiologic factors. Orthop Clin North Am 5:59–66
Kalen V, Brecher A (1988) Relationship between adolescent bunions and flatfoot. Foot Ankle 8:331–336
King DM, Toolan BC (2004) Associate deformities and hypermobility in hallux valgus: an investigation with weightbearing radiographs. Foot Ankle Int 25:251–255
Koutsogiannis E (1971) Treatment of mobile flat foot by displacement osteotomy of the calcaneus. J Bone Joint Surg Br 53:96–100
Lapidus P (1960) The author’s bunion operations from 1931–1959. Clin Orthop 12:119–135
Mann RA, Coughlin MJ (1981) Hallux valgus: etiology, anatomy, treatment and surgical considerations. Clin Orthop 157:31–41
Mann RA, Rudicel S, Graves SC (1992) Repair of hallux valgus with a distal soft-tissue procedure and proximal metatarsal osteotomy: a long-term follow-up. J Bone Joint Surg Am 74:124–129
Myerson MS, Badekas A (2000) Hypermobility of the first ray. Foot Ankle Clin 5:469–484
Sammarco GJ, Brainard BJ, Sammarco VJ (1993) Bunion correction using proximal chevron osteotomy. Foot Ankle 14:8–14
Scranton PE, McMermatt JE (1995) Prognostic factors in bunion surgery. Foot Ankle Int 16:698–704
Scranton PE, Zuckerman JD (1984) Bunion surgery in adolescents: Results of surgical treatment. J Pediatr Orthop 4:39–43
Sim Fook L, Hodgson AR (1958) A comparison of foot forms among the non-shoe and shoe-wearing Chinese population. J Bone Joint Surg Am 40:1058–1062
Toolan BC, Sangeorzan BJ, Hansen ST Jr (1999) Complex reconstruction for the treatment of dorsolateral peritalar subluxation of the foot. Early results after distraction arthrodesis of the calcaneocuboid joint in conjunction with stabilization of, and transfer of the flexor digitorum longus tendon to, the midfoot to treat acquired pes planovalgus in adults. J Bone Joint Surg Am 81:1545–1560
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Takao, M., Komatsu, F., Oae, K. et al. 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. Arch Orthop Trauma Surg 127, 685–690 (2007). https://doi.org/10.1007/s00402-007-0362-3
Received:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00402-007-0362-3