Technique Tip: A Simple Method to Treat Hallux Valgus with Severe Metatarsus Adductus

Abstract

highlighted in hallux valgus surgery, few studies have discussed management of hallux valgus with metatarsus adductus. Some methods were already introduced to correct metatarsus adductus using distal oblique osteotomy or lateral closing base wedge osteotomy of the lesser metatarsals. However, these are extensive procedures with a risk of complications associated with the shortening and malposition of the lesser metatarsals. Although some authors proposed another method to correct hallux valgus using a stable osteotomy such as a scarf osteotomy, or a stable fixation device such as a locking plate for prevention of recurrence, these methods cannot obtain sufficient space for translation of the first metatarsal because of the lack of correction of metatarsus adductus. The technique described here is believed to be easier to perform and has several advantages over the above techniques. The aim of this study was to introduce this simple and effective method for modified proximal chevron osteotomy for hallux valgus with metatarsus adductus. The present case was approved by our Institutional Review Board and informed consent was obtained from the patient. Metatarsus adductus is a deformity characterized by adduction of the lesser metatarsals. Concomitant metatarsus adductus is prevalent in about 30% of patients undergoing hallux valgus surgery. Metatarsus adductus is a risk factor for postoperative recurrence as well as a cause of hallux valgus. Moreover, it is difficult to correct hallux valgus in the presence of metatarsus adductus because there is insufficient space between the first and second metatarsals for lateral translation of the first metatarsal, due to varus position of the second metatarsal. In addition, there is an increased risk of recurrence after surgery for hallux valgus without correction of metatarsus adductus, because medial translation force by the second metatarsal is constantly applied at the first metatarsal head. Although the importance of metatarsus adductus has been Technical Report