Is there a place for dorsal hemiepiphysiodesis of the first metatarsal in the treatment of pes cavovarus?

Abstract

The objective of this study is to describe and evaluate dorsal hemiepiphysodesis of the first metatarsal as an osteotomy replacement technique. Retrospective analysis of patients with pes cavovarus (PCV) treated in our center with dorsal hemiepiphysodesis of the first metatarsal. Meary's angle, calcaneal pitch, and Moreau Costa Bartani were compared pre and post-operatively and the ratio between width and foot length was monitored. Between May 2012 and May 2022, eight patients (14 feet) with PCV underwent dorsal hemiepiphysiodesis of the first metatarsal combined with the Steindler procedure. Four patients (50%) were male. The average age for boys at surgery was 10.75 years (10-11) and for girls was 9.75 years (8-11). Most patients (87.5%) had idiopathic PCV and 12.5% had a neurological PCV. Median follow-up was 4.3 years (1.5-10) and a benefit was seen in all patients in Moreau Costa Bartani angle (112.64° vs. 120.59°; P value = 0.003), calcaneal pitch (26.48° vs. 25.36°; P value = 0.091) and Meary's angle (10.60° vs. 5.36°; P value = 0.008) after surgery. Supination improvement was also shown (0.21 vs. 0.24; P value = 0.039). Despite the limited number of patients, the results demonstrated that dorsal hemiepiphysiodesis of the first metatarsal can be a valid alternative to osteotomy of the base of the first metatarsal, with less morbidity and a gradual and dynamic correction throughout growth.