Abstract
Purpose of the study: Hallux valgus is often associated with metatarsalgia due to insufficiency of the first ray. The purpose of this prospective study was to learn whether osteotomy of the first metatarsal can correct both conditions.
Material and methods: This series included 35 women and 2 men, mean age 55 years. Metatarsalgia predominated in M2 in these patients with a round forefoot. Pain was a constant sign. Thirty-six patients wore special shoes for comfort with or without an orthesis. The mean preoperative metatarsal varus, measured radiographically was 16°. Scarf osteotomy used a horizontal cut at of the first metatarsal forming a 45° angle with the plantar aspect. Patients were reviewed at three years with a computed tomography of the forefoot. The Kita-oka score was determined.
Results: Thirty-four feet were pain-free at last follow-up. The frontal scan of the forefoot showed the shaft of the first metatarsal had been lowered 2 mm on average. According to the Kitaoka score, outcome was good or very good for 31 feet, fair for 5 and poor for 5. There was a significant correlation between lowering of the first metatarsal and persistent metatarsalgia.
Discussion: Barouk suggested the Scarf technique does not enable sufficient lowering of the first row to correct for around forefoot. The CT scan however showed the metatarsal was lowered 2 mm, which would appear to be sufficient to correct for the insufficient weight-bearing. The result of this series would appear to show that outcome is better then hallux valgus cure plus Weil oseotomy if there is no hallomegaly.
Conclusion: This series shows the usefulness of lowering the first metatarsal for the treatment of hallux valgus with metatarsalgia without hallomegaly.
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