[Comparison of effectiveness of multiple metatarsal osteotomy and first metatarsophalangeal arthrodesis for severe metatarsal adductus hallux valgus deformity].

OBJECTIVE

To compare effectiveness of multiple metatarsal osteotomy versus first metatarsophalangeal arthrodesis in treating severe metatarsal adductus hallux valgus deformity.

METHODS

A retrospective analysis was conducted on the clinical data of 25 patients with severe metatarsal adductus hallux valgus deformity admitted between June 2010 and May 2014 who met the selective criteria. Among them, 15 patients underwent multiple metatarsal osteotomy (osteotomy group), while 10 patients underwent first metatarsophalangeal arthrodesis (fusion group). There was no significant difference between groups ( >0.05) in gender, age, disease duration, affected side, preoperative American Orthopaedic Foot and Ankle Society (AOFAS) score, visual analogue scale (VAS) score for pain, intermetatarsal angle (IMA), hallux valgus angle (HVA), or metatarsal adduction angle (MAA). The osteotomy group underwent fixation with screws and/or staples fixation, while the fusion group utilized anatomic fusion plates and trans-articular compression screws. The study compared the following outcome indicators between groups: operation time, pre- and post-operative differences (change values) in AOFAS scores, VAS scores, and radiographic parameters (HVA, MAA), osteotomy healing outcomes, and recurrence of hallux valgus deformity.

RESULTS

Both surgical procedures were completed successfully. The operation time was significantly shorter in the fusion group than in the osteotomy group ( <0.05). All patients were followed up 96-144 months (mean, 116 months). The follow-up time was (129.1±7.2) months in the osteotomy group and (104.4±8.0) months in the fusion group, with no significant difference between groups ( >0.05). X-ray films revealed the radiographic union in two groups, and the fusion time was significantly shorter in the fusion group than in the osteotomy group ( <0.05). At last follow-up, both groups demonstrated significant improvements in AOFAS and VAS scores compared to preoperative levels ( <0.05). However, the differences in the change values of AOFAS and VAS scores between groups were not significant ( >0.05). During follow-up, 3 cases (20%) of deformity recurrence occurred in the osteotomy group, while no recurrence was observed in the fusion group. There was no significant difference in the incidences of deformity recurrence between groups ( >0.05).

CONCLUSION

For severe metatarsus adductus hallux valgus deformities, both multiple metatarsal osteotomy and first metatarsophalangeal arthrodesis can correct the deformity. The former preserves metatarsophalangeal joint mobility but demands high technical proficiency from the surgeon, involves relatively longer operation times, extended bone healing periods, and higher complication incidences. The latter procedure is relatively simpler, facilitates faster postoperative recovery, allows early weight-bearing, and yields more reliable outcomes, though it sacrifices first metatarsophalangeal joint mobility.