Metatarsocuneiform arthrodesis for management of hallux valgus and metatarsus primus varus.

Sixty-seven closing wedge arthrodesis procedures of the first metatarsocuneiform joint were performed in 41 females and 12 males. Follow-up averaged 28 months (range 16-49 months) and was performed in 51 of 53 patients with a questionnaire, clinical examination, and comparison of pre- and postoperative weightbearing radiographs. The average hallux valgus angle was 34.5 degrees (range 20 degrees-75 degrees) and was corrected to 13.0 degrees (range-10 degrees-22 degrees) postoperatively. The average intermetatarsal angle was 14.3 degrees (range 9.5 degrees-34 degrees) and was corrected to an average of 5.8 degrees (range 0 degrees-12 degrees) postoperatively. Complications included seven superficial pin tract infections, three symptomatic dorsal bunions, one of which required repeat surgery, seven nonunions, one of which was symptomatic, one hallux varus, and three neuromas of the deep peroneal nerve. The range of motion of the hallux metatarsophalangeal joint was 85% of normal postoperatively. A total of 77% of the patients were totally relieved, 15% partially relieved, and 8% not relieved with respect to pain, comfort, appearance of the foot, and shoewear following surgery. The specific indications for performing this operation are discussed.