Instrumented Correction of Metatarsus Adductus with Hallux Valgus - A Multicenter Radiographic Assessment.

Abstract

Failure to address metatarsus adductus (MTA) with coexisting hallux valgus (HV) has resulted in mixed outcomes and increased deformity recurrence. The purpose of this study was to investigate early radiographic and clinical outcomes of a novel instrumented 2^nd and 3^rd TMT corrective arthrodesis combined with instrumented triplanar 1^st TMT arthrodesis with early weightbearing. Radiographs and medical records from subjects undergoing this surgical approach were retrospectively reviewed. Forty-three subjects (N=43 feet) with a mean ± SD age of 41.6±14.2 (range 15 to 62) years were treated at four institutions with a mean ± SD follow-up time of 17.7 ± 10.6 (range 11.5 to 51.0) months. Radiographic parameters demonstrated improvements in the mean ± SD Sgarlato's angle (26.3 ± 5.7 to 10.2 ± 3.8 degrees), baseline 'True Intermetatarsal Angle' (23.2 ± 6.6 degrees) to measured Intermetatarsal Angle at final follow-up (3.7 ± 2.4 degrees), Hallux Valgus Angle (32.3 ± 8.4 to 7.2 ± 6.6 degrees), Tibial Sesamoid Position (5.0 ± 1.5 to 1.3 ± 1.1) and Osseous Foot Width (97.8 ± 7.0 to 86.8 ± 7.5 mm). The novel baseline Plumbline measurement was 93.0% positive in the study cohort and converted to a negative reading following MTA correction in 90.7% of subjects. All (N=43) feet studied achieved stable arthrodesis at the time of final clinical and radiographic assessment. One patient required hardware removal. Radiographic outcomes of an instrumented triplanar correction and multi-planar locking plate fixation were promising with correction of the MTA and HV deformities and favorable healing noted. Level of evidence: Level 4, case series.