SLR - July 2015 - Joshua C. Hunt

Combined Medial Cuneiform Osteotomy and Multiple Metatarsal Osteotomies For Correction of Persistent Metatarsus Adductus in Children

Reference:  Feng L, Sussman M. Combined medial cuneiform osteotomy and multiple metatarsal osteotomies for correction of persistent metatarsus adductus in children.  Journal of Pediatric Othopaedics. 2015 June 5.

Scientific Literature Review

Reviewed By: Joshua C. Hunt, DPM
Residency Program: Detroit Medical Center

Podiatric Relevance: Metatarsus adductus is a common foot deformity of infancy and childhood. The incidence of metatarsus adductus is reported to be between 0.1 and 1 percent of lives births. The exact etiology is not known but can been seen in otherwise successful clubfoot corrections or as an isolated deformity.

Methods: This was a retrospective analysis over a period of 16 years, from 1992 to 2008, analyzing treatment outcomes of pediatric patients that underwent medial cuneiform opening-wedge osteotomy with transmetatarsal osteotomy through the bases of the second to fifth metatarsals.  A total 16 patients, 25 feet, all greater than 6 years old, underwent the procedure by a single surgeon at Shriners Hospitals in Portland, OR. Preoperative as well as post operative radiographs were reviewed and all clinical encounters were reviewed for a minimum of 1 year of follow-up.    

Results: 16 patients, 25 feet were reviewed. Average age at surgery was 7.1 years with a range of 6 to 9.4 years old. The mean follow up time was 34.2 months with a range of 2.5 to 128.1 months. Eight of the patients had residual club foot, all of which had posterior medial lateral release as infants. Six patients had isolated metatarsus adductus and two had a diagnosis of skewfoot.  Post operative angles were measured on AP projections. The Talo-first metatarsal angle changed from -12.9±9.2 to +2.7±12.8; the talo-calcaneal angle from 28.5±7.5 to 24.2±7.5; the calcaneus-second metatarsal angle decreased from 35.8±10 to 14.5±9.2; and the calcaneus-fifth metatarsal angle changed from _9.1±11.4 to 3.8±9.0. All post operative features of metatarsus adductus showed significant reduction when compared to preoperative radiographs.
Conclusions: The authors concluded that combined medial cuneiform opening-wedge osteotomy with transmetatarsal osteotomy through the base of second to fifth was beneficial for patients and would recommend this procedure for all patients with significant MA regardless of underlying cause. As the foot continues to grow, and the deformity is left untreated, the MA will become more apparent and make shoes much more difficult to wear.  The author states that complications have been minimal but the dorsal skin of the foot, being thin, must be respected.

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