[Lapidus arthrodesis combined with middle metatarsal base rotation osteotomy in treatment of hallux valgus with metatarsus adductus].

Abstract

Objective: To explore effectiveness of the Lapidus arthrodesis combined with the middle metatarsal base rotation osteotomy in the treatment of hallux valgus (HV) with metatarsus adductus (MA).

Methods: Between February 2023 and September 2024, 18 patients (18 feet) of HV with MA were underwent Lapidus arthrodesis combined with the middle metatarsal base rotation osteotomy. There were 5 males and 13 females with an age of 50-68 years (mean, 55.3 years). The foot deformity was characterized by severe HV, redness and swelling at the utricle, and the corpus callosum on the plantar side of the forefoot. The preoperative American Orthopaedic Foot and Ankle Society (AOFAS) score was 44.2±3.8 and visual analogue scale (VAS) score was 7.1±0.9 after walking 1 km. The AOFAS score and VAS score were adopted to evaluate the postoperative function of the foot. The hallux valgus angle (HVA), metatarsus adductus angle (MAA), intermetatarsal angle (IMA), and distal metatarsal articular angle (DMAA) were measured after operation.

Results: All incisions healed by first intention. All patients were followed up 12-26 months (mean, 18 months). At last follow-up, the AOFAS score and VAS score after walking 1 km were 84.2±3.9 and 2.0±0.8, respectively, showing significant differences when compared with preoperative scores ( P<0.05). Imaging review showed that the osteotomy sites all healed, with a healing time of (10.25±2.15) weeks. At last follow-up, the HVA, MAA, IMA, and DMAA were significantly lower than preoperative ones ( P<0.05). During follow-up, all patients exhibited diffuse swelling of the feet, 10 patients experienced stiffness in the great toe, 1 foot showed numbness caused by medial plantar cutaneous nerve injury, and 1 foot of skin irritation caused by internal fixation.

Conclusion: For HV with MA, the Lapidus arthrodesis combined with middle metatarsal base rotation osteotomy can effectively correct deformity and relieve pain.