Outcomes of surgical management of hallux abductovalgus with concomitant metatarsus adductus deformity: A systematic review

Abstract

Metatarsus adductus (MA) deformity adds to the complexity of hallux abductovalgus (HAV) correction. Scant literature exists on the outcomes of HAV correction with concomitant MA. The purpose of this study was to evaluate the literature on the outcomes, complications, and treatment strategies of HAV with concomitant MA deformity. A comprehensive systematic review was performed. Mean radiographic outcomes, patient reported outcome measure scores, and complication rates were calculated. A total of 279 articles were initially identified. 8 articles met the inclusion criteria, for a total of 237 feet. Procedures undertaken exhibited substantial heterogeneity across studies, revealing the lack of a standardized surgical approach. Studies were divided into two separate groups based on procedural selection: A) Isolated 1st ray procedures; B) Combined 1st and lesser ray procedures. The intermetatarsal, hallux valgus, and metatarsus adductus angles were all significantly improved. There was no significant difference in final radiographic angles between the two groups. Recurrence occurred in 12.2 % of patients, necessitating revision in 1.7 %. The total complication rate was 7.2 %, with nonunion as the primary complication at 1.7 %. The overall mean AOFAS score improved from 53.4 preoperatively to 88.8 postoperatively (p < 0.00001). The overall mean postoperative VAS score was 1.4. There was no significant difference in complication rates or AOFAS scores between the groups. No “gold standard” treatment exists for surgical management of HAV with MA. However, favorable functional outcomes with a low reoperation rate can be expected with a combination of arthrodesis and osteotomy procedures.