Abstract
Purpose: Global metatarsus varus is a deformity of the forefoot characterised by medial deviation of all the metatarsals. The condition is often associated with hallux valgus and pes cavus (metatarsus varus sometimes being considered a clinical form of cavus), as well as metatarsal verticalisation predominating on the first ray.
Material and methods: Among twenty patients with metatasus varus in this study fifteen had undergone surgical correction. There were seven men and eight women, mean age 43 years. The deformity was bilateral in most patients (n=10, operated =9) but predominantly on one side in five of them. Metatarsalgia was the common complaint, considered to be global involving the middle rays (n=12 patients), or localised under the head of the first metatarsal (n=3). The calcanean tendon was short in all cases, aggravating subcapital anterior loading. Likewise, 12 of the 15 patients had hallux valgus; mean 45°. For one patient calcaneal osteotomy for valgisation was also performed.
Hallus valgus was corrected whenever present: in three cases an osteotomy was performed alone to raise the first metatarsal followed by a plantar prosthesis. A basal osteotomy of the three middle metatarsals was performed to achieve elevation, valgisation, and shortening: for three cases a Weil osteotomy was performed.
Results: Hallus valgus recurred in all patients who had had correction surgery, with recurrence of metatarsus varus. Basal metatarsal osteotomies healed but after a long period (about six months. Metatarsalgia was unchanged and was situated under the heads that were not perfectly aligned. The Weil osteotomies did not improve the evolution because, like basal osteotomies, they did not prevent recurrence of global metatarsus varus.
Discussion and conclusion: Metatarsus varus is a challenging deformity which responds very poorly to classical treatments of the forefoot. Osteotomy, irrespective of the type, does not prevent recurrence, both for the lateral rays but also for the hallux. Certain authors suggest that metatarsophalangeal arthrodesis could be useful to stabilise the hallux in the corrected position. We have no experience with this method but in light of our results after conservative treatment for joint motion, this would appear to be an interesting option. We have modified our indications in this direction, using a basi-metatarsal osteotomy instead of a Weil osteotomy for the small toes. Lengthening the extensor tendons may be needed.
The abstracts were prepared by Docteur Jean Barthas. Correspondence should be addressed to him at Secrétariat de la Société S.O.F.C.O.T., 56 rue Boissonade, 75014 Paris.
