Background. Metatarsus adductus is the most common forefoot deformity. Variable prevalence values were reported in literature using different techniques in different populations. Numerous radiological measurements have been proposed to assess this deformity with a paucity of studies reporting the reliability of these methods. The metatarsus adductus angle was shown to correlate with the severity of hallux abductovalgus in normal feet and preselected populations of juvenile hallux valgus. Materials & Methods. Weight bearing dorsoplantar radiographs of 150 feet were examined for 5 angles commonly used in assessing metatarsus adductus: angle between the second metatarsus and the longitudinal axis of the lesser tarsus (using the 4th or 5th metatarso-cuboid joint as a reference), Engel's angle and modified angle's angle. The prevalence of metatarsus adductus was assessed according to published criteria for different techniques. Inter and intra-observer reliabilities of these angles were evaluated on 50 X-rays. Linear regression tests were used to assess the correlation between hallux valgus and different angles used in assessing metatarsus adductus. Results. Intraclass correlation coefficients were high for intra- as well as inter-observer reliability for the 5 angles tested. Prevalence of metatarsus adductus ranged (45–70%) depending on the angle used in the same population. Only the metatarsus adductus angle using the 4th metatasro-cuboid joint as a reference demonstrated significant correlation between metatarsus adductus and hallux abductovalgus angles. Conclusions. Five techniques commonly used in assessing metatarsus adductus demonstrated high inter and intra-observer reliability values. Prevalence of metatarsus adductus and the correlation between the severity of this deformity and
Introduction. Trends in hallux valgus surgery continue to evolve. Basal metatarsal osteotomy theoretically provides the greatest correction, but is under-represented in the literature. This paper reports our early experience with a plate-fixed, opening- wedge basal osteotomy, combined with a new form of distal soft tissue correction (in preference to Akin phalangeal osteotomy). Materials and Methods. Thirty-three patients are reported here. The basal metatarsal osteotomy is fixed with the ‘Low Profile’ Arthrex titanium plate. No bone graft or filler is required, providing the osteotomy is within about 12mm of the base. Distal soft tissue correction comprised a full lateral release, and then proximal advancement of a complete capsular ‘sleeve’ on the medial side. The plate serves as a rigid anchoring point for the tensioning stitches. Using this technique, almost any degree of hallux valgus can be corrected, and there is even potential for over-correction. Functional outcome was assessed using the Manchester-Oxford foot and ankle score (MOXF). Radiographically the intermetatarsal angle was evaluated pre-operatively and at least 6 months postoperatively. Patients’ satisfaction and complication rates were recorded. Results. Clinical 87% (29 of 33) reported high satisfaction with the functional and cosmetic outcome. The opening basal wedge osteotomy slightly lengthens the first ray and as result none of our patients developed transfer metatarsalgia. Results. Radiology
