Orthopedic Surgeon, Hong Kong Adventist Hospital, Hong Kong, China.
Associate Professor, Department of Statistics and Actuarial Science, University of Hong Kong, Hong Kong, China.
J Foot Ankle Surg. 2022 Mar-Apr;61(2):339-344. doi: 10.1053/j.jfas.2021.09.006. Epub 2021 Sep 17.
Metatarsus adductus and hallux valgus are common foot deformities. Corrective surgery of hallux valgus feet with metatarsus adductus deformity can be challenging and experience a high deformity recurrence rate. The purpose of this study was to demonstrate if the syndesmosis procedure can correct such feet satisfactorily without osteotomies and arthrodesis. 75 hallux valgus feet in 45 patients with a Sgarlato's metatarsal adductus angle ≥15° were studied after having undergone the syndesmosis procedure for an average of 20.22 months. Their average preoperative intermetatarsal angle of 12.56° was improved to 6.00° (p < .001) and metatarsophalangeal angle from 35.61° to 23.46° (p < .001) significantly. Their average American Orthopedic Foot and Ankle Society's clinical scores improved significantly from 56.41 to 90.53 points (p < .001). Fifty-five feet (73.33%) had preoperative metatarsal calluses, and all but 3 had a noticeable reduction in severity. Forty-one patients (91.11%) were able to return to their desired activities and footwear. All relevant raw data formed this study, including x-ray and photographic images, were submitted as Supplementary Material for online viewing and reference. Despite the possible intrinsic rigidity of metatarsus adductus forefoot, this study demonstrated that hallux valgus feet with metatarsus adductus deformity could be corrected anatomically and functionally with the soft tissue syndesmosis procedure and without correcting the preexisting metatarsus adductus deformity. This study also supports the notion that the MA deformity accentuates hallux valgus alignment preoperatively and postoperatively, and possibly all feet in general.
马蹄内翻和拇外翻是常见的足部畸形。对于合并有马蹄内翻畸形的拇外翻脚，矫正手术具有挑战性，畸形复发率较高。本研究旨在证明是否可以通过跗骨间关节融合术来矫正此类足部畸形，而无需进行截骨和关节融合。本研究共纳入 45 例 75 只患有 Sgarlato 跖骨内收角≥15°的拇外翻足患者，所有患者均接受了跗骨间关节融合术，平均随访 20.22 个月。术前平均第 1-2 跖骨间角从 12.56°改善至 6.00°（p<0.001），第 1 跖楔关节角从 35.61°改善至 23.46°（p<0.001）。美国矫形足踝协会临床评分从 56.41 分显著提高至 90.53 分（p<0.001）。术前 55 只（73.33%）足有跖骨胼胝，除 3 只外均显著减轻。41 例（91.11%）患者能够恢复到他们期望的活动和鞋类。本研究所有相关原始数据，包括 X 线和照片图像，均已作为补充材料在线提交，以供查阅和参考。尽管前足马蹄内翻固有刚性可能存在，但本研究表明，合并有马蹄内翻畸形的拇外翻脚可以通过软组织跗骨间关节融合术进行解剖和功能矫正，而无需矫正现有的马蹄内翻畸形。本研究还支持以下观点，即 MA 畸形在术前和术后都使拇外翻的对线更加突出，并且可能对所有足部都是如此。
