1 Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Osaka, Japan.
2 Department of Orthopaedic Surgery, Shimizu Hospital, Nishikyo-ku, Kyoto, Japan.
Foot Ankle Int. 2019 Jun;40(6):641-647. doi: 10.1177/1071100719835520. Epub 2019 Mar 7.
Operative treatment is indicated for patients who have symptomatic hallux valgus (HV) with moderate to severe metatarsus adductus (MA). However, there is limited information available on the operative procedures and outcomes for the treatment of HV with MA. We aimed to investigate the average 10-year follow-up clinical and radiologic outcomes.
Seventeen patients (21 feet, average age: 60.1 years) with symptomatic HV with moderate to severe MA were operatively treated. Mean postoperative follow-up duration was 114.4 (24-246) months. All feet had metatarsus adductus angle ≥20 degrees on dorsoplantar weight-bearing radiograph. The procedure included a proximal crescentic osteotomy of the first metatarsal and abduction osteotomy of the proximal third of the second and third metatarsals.
The mean American Orthopaedic Foot & Ankle Society scale score improved significantly postoperatively ( P < .001). The mean postoperative visual analog scale score (17 feet) was 2.0 (0-6). Preoperative metatarsalgia was severe in 2 feet, moderate in 17, and mild in 2. At the most recent follow-up evaluation, 11 feet had no pain, 9 had mild pain, and 1 had moderate pain. The mean hallux valgus angle, intermetatarsal angle, and metatarsus adductus angle significantly decreased postoperatively ( P < .001 for all). Recurrence of HV (HV angle ≥ 20 degrees) was observed in 4 feet.
The clinical and radiologic results indicated that our novel operative treatment for HV with moderate to severe MA can achieve significant correction of HV with MA deformities and significant improvement in pain and function.
Level IV, retrospective case series.
对于有症状的拇外翻（HV）伴中重度跖内收（MA）的患者，需要手术治疗。然而，对于 HV 伴 MA 的手术治疗方法和结果，相关信息有限。我们旨在研究平均 10 年的随访临床和影像学结果。
17 例（21 足，平均年龄：60.1 岁）有症状的 HV 伴中重度 MA 的患者接受了手术治疗。平均术后随访时间为 114.4（24-246）个月。所有足在负重正位 X 线片上均有 MA 角≥20 度。手术包括第一跖骨近端新月形截骨和第二、第三跖骨近端外展截骨。
美国矫形足踝协会（AOFAS）评分平均显著改善（P<0.001）。术后（17 足）视觉模拟评分（VAS）均值为 2.0（0-6）。术前跖痛 2 足为重度，17 足为中度，2 足为轻度。末次随访时，11 足无疼痛，9 足轻度疼痛，1 足中度疼痛。术后拇外翻角、第一二跖骨间角和 MA 角均显著减小（均 P<0.001）。4 足出现 HV 复发（HV 角≥20 度）。
临床和影像学结果表明，我们对 HV 伴中重度 MA 的新型手术治疗可显著矫正 HV 伴 MA 畸形，并显著改善疼痛和功能。
IV 级，回顾性病例系列。
