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Background:This study aimed to compare clinical and radiographic outcomes and recurrence rates after reverse proximal chevron metatarsal osteotomy (PCMO) for patients with hallux valgus (HV) with or without metatarsus adductus (MA). We hypothesized that patients with MA would have poorer outcomes and a higher radiographic recurrence rate than those without MA.Methods:This retrospective single-surgeon series comprised 144 patients (173 feet) with moderate to severe HV, treated with PCMO and Akin osteotomy without lesser metatarsal procedures, who were grouped according to the presence (MA group) or absence of MA (non-MA group). Clinical assessment included the American Orthopaedic Foot & Ankle Society (AOFAS) score, pain visual analog scale (VAS), and patient satisfaction rating. Radiographic assessments included metatarsus adductus angle (MAA), HV angle (HVA), and intermetatarsal angle (IMA).Results:The prevalence of the MA was 24.2%. The mean MAA was 23.1 ± 3.3 degrees in the MA group. There were no differences in the mean AOFAS score and pain VAS score at the final follow-up between the 2 groups (all P > .05). The patient satisfaction rate was 73.8% in the MA group vs 90.1% in the non-MA group ( P = .017). The mean postoperative HVA and IMA significantly improved at the final follow-up in both groups, respectively (all P < .001). Preoperative and postoperative HVA were larger in the MA group vs non-MA group. However, no significant difference was found in the improvement of HVA and IMA after surgery between the 2 groups (all P > .05). The recurrence rate was 28.6% in the MA group and 6.1% in the non-MA group ( P < .001).Conclusion:HV patients associated with the MA had a higher degree of preoperative HV, lower correction of the HVA, higher radiographic recurrence rate, and poorer patient satisfaction than those without MA post-PCMO without lesser metatarsal procedures. Therefore, a more extensive HV correction procedure or the addition of a lesser metatarsal realignment procedure may need to be considered.Level of Evidence:Level III, retrospective comparative series.

Category: Bunion Introduction/Purpose: Studies have demonstrated that patients with hallux valgus (HV) deformities have increased mobility in the first tarsometatarsal (TMT) joint. Anatomical factors widely considered to play a role in the instability are shape and frontal plane orientation of the joint. An oblique rather than horizontal orientation of the articular surfaces and a round shape, rather than a flat shape, are believed to predispose to the deformity. The purpose of this study was to assess whether the shape and angulation of the first TMT joint are affected by the positioning of the foot and orientation of the x-ray beam. Methods: Ten adult above knee fresh frozen cadaveric specimens were used, with a mean age of 79.9 (range, 54-88) years. There were no clinical forefoot deformities noted in any of the feet. One of the specimens had moderate ankle arthritis and one had a mild cavus-varus. A radiolucent loading apparatus was built that, allowing neutral positioning of a plantigrade foot and controlled angulation of 5o, 10 o, 15o and 20o in dorsiflexion, plantarflexion, inversion and eversion. Fluoroscopic images were obtained of each cadaveric specimen in all seventeen different positions, with the x-ray beam perpendicular to the floor and aiming to the base of the 1st metatarsal. Two blinded orthopaedic surgeons independently measured the 1st tarsometatarsal (TMT) joint angle and graded the distal articular cartilage of the medial cuneiform as flat or curved. Readers also graded the image quality into assessing the joint into “Low”, “Intermediate” and “Good”. Results: 1st TMT joint angle was 112.92o ± 6.89o. Values were significantly different between cadaveric specimens (pConclusion: Our cadaveric study found that the shape and angulation of the first TMT joint is affected by the positioning of the foot and orientation of the x-ray beam. Clinical usefulness of the 1st TMT radiographic anatomical characteristics is limited and should not influence in the treatment of patients with possible instability the first tarsometatarsal (TMT) joint.

Background: Hallux valgus deformity consists of a lateral deviation of the great toe, metatarsus varus, and pronation of the first metatarsal. Most osteotomies only correct varus, but not the pronation of the metatarsal. Persistent postoperative pronation has been shown to increase deformity recurrence and have worse functional outcomes. The proximal rotational metatarsal osteotomy (PROMO) technique reliably corrects pronation and varus through a stable osteotomy, avoiding fusing any healthy joints. The objective of this research is to show a prospective series of the PROMO technique. Methods: Twenty-five patients (30 feet) were operated with the PROMO technique. The sample included 22 women and 3 men, average age 46 years (range 22-59), for a mean prospective follow-up of 1 year (range 9-14 months). Inclusion criteria included symptomatic hallux valgus deformities, absence of severe joint arthritis, or inflammatory arthropathies, with a metatarsal malrotation of 10 degrees or more, with no tarsometatarsal subluxation or arthritis on the anteroposterior or lateral foot radiograph views. The mean preoperative and postoperative Lower Extremity Functional Scale (LEFS) score, metatarsophalangeal angle, intermetatarsal angle, metatarsal malrotation, complications, satisfaction, and recurrence were recorded. Results: The mean preoperative and postoperative LEFS scores were 56 and 73. The median pre-/postoperative metatarsophalangeal angle was 32.5/4 degrees and the intermetatarsal angle 15.5/5 degrees. The metatarsal rotation was satisfactorily corrected in 24 of 25 patients. An Akin osteotomy was needed in 27 of 30 feet. All patients were satisfied with the surgery, and no recurrence or complications were found. Conclusions: PROMO is a reliable technique, with good short-term results in terms of angular correction, satisfaction, and recurrence. Long-term studies are needed to determine if a lower hallux recurrence rate occurs with the correction of metatarsal rotation in comparison with conventional osteotomies. Level of evidence: IV, prospective case series.

Background: Metatarsus adductus (MA) is a common pediatric foot deformity. Current recommendations suggest observation until 4–6 months, then casting if the deformity persists. Based on our review of the literatures, no randomized controlled trial has been conducted to study the effectiveness of parental stretching in the correction of MA in newborn. Material and methods: Ninety-four newborn feet that were diagnosed as MA by clinical examination were enrolled. Feet were randomized into two groups: observation group and stretching group. Outcome measurements were performed to compare success rate between groups. Results: According to Pearson’s χ2 test, there were no statistically significant differences between groups with regard to the overall success of the parental stretching program ( p = 0.191). There was also no significant difference between groups for mild degree or moderate-to-severe degree ( p = 0.134, p = 0.274, respectively). A more rapid success rate was observed in the stretching group at the first month follow-up, but rate of improvement then decreased. The stretching group tended to have a lower success rate compared to the observation group in moderate-to-severe feet, but the difference was not statistically significant. Conclusions: Parental stretching program found no benefit over observation group in this study. Parental stretching program should not be applied for newborn babies with moderate-to-severe MA as the result from the study appeared to have lower success rate compared to observation group. Observe until 4–6 months, then corrective casting for the persisting deformity is recommended.