SLR - March 2022 - Ashley V. Mosseri
Reference: Lee, J., Lee, H.S., Jeong, JJ., Seo D.K., Kee T., So S., Rak Choi Y. Distal Chevron Metatarsal Osteotomy is a Viable Treatment Option for Hallux Valgus with Metatarsus Adductus- Multicentre Retrospective Study. Int Orthop. 2021 Sept;45(9):2261–2270.Level of Evidence: Level III, Multicenter Retrospective Study
Scientific Literature Review
Reviewed By: Ashley V. Mosseri, DPM, MSc
Residency Program: Westside Regional Medical Center – Plantation, FL
Podiatric Relevance: Metatarsus Adductus (MA) is a forefoot deformity where the lesser metatarsals sit in an adducted position. Typically, MA is associated with hallux valgus (HV) deformity and can contribute to risk of recurrence following HV correction. There is limited literature demonstrating guidelines on the surgical treatment of HV depending on the severity of MA. A distal chevron metatarsal osteotomy (DCMO) is typically indicated for mild to moderate HV deformity. In this study, authors assessed the clinical and radiographic outcomes of patients with HV in conjunction with MA that were treated with a DCMO, without correction of the lesser metatarsals.
Methods: This was a multicenter retrospective study of 35 patients (45 feet) at four hospitals, who had undergone a DCMO from 2010-2018. Enrolled patients had at least one year of follow-up postoperatively. The patients were divided into groups based upon grade of deformity using the metatarsus adductus angle (MAA) with concomitant HV deformity. Patients enrolled were categorized as either mild (18o<MAA<20o) or moderate (20o<MAA).. Patients who underwent a concurrent Akin with the DCMO were included. Surgical technique was a standard protocol and described in detail in the manuscript. Radiographic outcomes measured included: the hallux valgus angle (HVA), the intermetatarsal angle (IMA), the MAA and lateral sesamoid grade. These were measured preoperatively and at three months and one year postoperatively on a weight bearing anteroposterior foot radiograph. Clinical outcomes were assessed using the foot function index (FFI) and visual analogue scale (VAS). For all statistical analysis, p-value <0.05 was considered statistically significant.
Results: The mean follow up period was 20.5 months. Clinical outcomes for both groups as assessed by the FFI and VAS improved significantly (p<0.001). When comparing the clinical improvements between the mild and moderate groups, no significant statistical difference was observed (p>0.05). There was a statistically significant improvement (p < 0.001) of the HVA and IMA in both the mild and the moderate deformity groups when comparing preoperative values to one year postoperative values. MAA had no significant statistical difference (p=0.361) as this was not addressed surgically. There was not a statistically significant difference in HVA, IMA and sesamoid position when comparing the mild deformity group to the moderate deformity group. Recurrence in 5 cases at the one year postoperatively was reported. None of those five patients expressed a need for revision surgery.
Conclusions: This study focused on the radiographic and clinical outcomes of patients with HV and MA who underwent a DCMO surgical correction. Patients with HV with concomitant MA have a history of poor results postoperatively with high recurrence rates. The authors concluded that the DCMO had satisfactory outcomes for patients with HV and MA with minimal recurrence at one year. It should be emphasized that patient selection should be taken into consideration when addressing surgical correction for HV with MA. That being said, the DCMO is supported to be a viable surgical modality for reduction of HV deformity in patients with mild or moderate MA without the need to address the MA deformity.