Wu Daniel Yiang
Department of Orthopaedic Surgery, Hong Kong Adventist Hospital, Hong Kong, SAR, China.
J Orthop Case Rep. 2024 May;14(5):83-87. doi: 10.13107/jocr.2024.v14.i05.4442.
If not corrected, the first metatarsal pronation rotation deformity is deemed responsible for the high hallux valgus (HV) deformity recurrence rate. Its correction method by osteotomy and arthrodesis has been recommended, just like the metatarsus primus varus (MPV) deformity correction. Since the pathogenesis of the first metatarsal pronation is not well understood, there may be other surgical approaches to correct it.
A 53-year-old female's HV feet presented with severe left hallux pronation, and positive radiological round head and inferior tubercle shift signs of the first metatarsal. She underwent a non-osteotomy non-arthrodesis soft-tissue procedure that was expected to correct the MPV deformity but not the pronation deformity. Post-operative hallux pronation was reversed, and round head and inferior tubercle signs were corrected.
The first metatarsal hypermobility and displacement of HV feet are probably in all three planes. Correction of MPV in the first metatarsal entirety in the transverse plane without osteotomy or arthrodesis can also induce a correction effect on its sagittal and frontal planes.
如果不加以纠正,第一跖骨旋前畸形被认为是导致高拇外翻(HV)畸形复发率的原因。与第一跖骨内翻(MPV)畸形矫正一样,已推荐通过截骨术和关节固定术来矫正它。由于第一跖骨旋前的发病机制尚未完全了解,可能存在其他手术方法来矫正它。
一名53岁女性的HV足表现为严重的左拇趾旋前,第一跖骨的影像学圆头和下结节移位征阳性。她接受了一种非截骨非关节固定的软组织手术,该手术预期可矫正MPV畸形,但不能矫正旋前畸形。术后拇趾旋前得到纠正,圆头和下结节征也得到矫正。
HV足的第一跖骨活动过度和移位可能在所有三个平面。在不进行截骨术或关节固定术的情况下,在横平面上对第一跖骨整体的MPV进行矫正,也可对其矢状面和额状面产生矫正效果。