Aims

The purpose of this study is to examine the adductus impact on the second metatarsal by the nonosteotomy nonarthrodesis syndesmosis procedure for the hallux valgus deformity correction, and how it would affect the mechanical function of the forefoot in walking. For correcting the metatarsus primus varus deformity of hallux valgus feet, the syndesmosis procedure binds first metatarsal to the second metatarsal with intermetatarsal cerclage sutures.

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 hallux valgus angle is sensitive to the assessment method

An 11 year prospective longitudinal study assessed the relationship between major neonatal foot deformities and developmental dysplasia of the hip (DDH). From 41,474 infants born between 01/01/1996 and 31/12/2006 with 614 foot deformities were referred as ‘risk factors’ in a screening/surveillance programme for DDH. All hips were clinically examined and sonographically imaged in a specialist Paediatric Orthopaedic clinic. The 614 cases were subdivided into: 436 postural equinovarus deformities (TEV), 60 fixed congenital talipes equinovarus (CTEV), 93 congenital talipes calcaneovalgus (CTCV) & 25 metatarsus adductus. The overall risk of sonographic dysplasia/instability was as follows: TEV 1:27, CTEV 1:8.6, CTCV 1:5.2, Metatarsus adductus 1:25. The Relative Risk (RR) of sonographic dysplasia/instability in TEV vs CTEV was 0.31 (95% CI 0.12–0.80; p=0.0057; OR=0.29). The Relative Risk of dysplasia/instability in CTCV vs. Postural TEV is 5.27 (95% CI 2.57–10.8; p< 0.0001; OR=6.30). The risk of Type IV hip instability or irreducible dislocation in CTCV was 1:15.4 (6.5%), 1:25 (4%) in metatarsus adductus and 1:436 (0.2%) in TEV. There were no cases of hip instability (Type IV) or irreducible dislocation in the CTEV cases. The routine screening for DDH in cases of postural TEV and fixed CTEV is no longer advocated. Postural TEV is poorly defined as a deformity in the literature leading to the over diagnosis of a possibly spurious condition. Sonographic imaging and surveillance of the hips in cases of CTCV and metatarsus adductus should continue

In a prospective study over 11 years we assessed the relationship between neonatal deformities of the foot and the presence of ultrasonographic developmental dysplasia of the hip (DDH). Between 1 January 1996 and 31 December 2006, 614 infants with deformities of the foot were referred for clinical and ultrasonographic evaluation. There were 436 cases of postural talipes equinovarus deformity (TEV), 60 of fixed congenital talipes equinovarus (CTEV), 93 of congenital talipes calcaneovalgus (CTCV) and 25 of metatarsus adductus.

The overall risk of ultrasonographic dysplasia or instability was 1:27 in postural TEV, 1:8.6 in CTEV, 1:5.2 in CTCV and 1:25 in metatarsus adductus.

The risk of type-IV instability of the hip or irreducible dislocation was 1:436 (0.2%) in postural TEV, 1:15.4 (6.5%) in CTCV and 1:25 (4%) in metatarsus adductus. There were no cases of hip instability (type IV) or of irreducible dislocation in the CTEV group.

Routine screening for DDH in cases of postural TEV and CTEV is no longer advocated. The former is poorly defined, leading to the over-diagnosis of a possibly spurious condition. Ultrasonographic imaging and surveillance of hips in infants with CTCV and possibly those with metatarsus adductus should continue.

The purpose of this study was to compare the results of proximal and distal chevron osteotomy in patients with moderate hallux valgus.

We retrospectively reviewed 34 proximal chevron osteotomies without lateral release (PCO group) and 33 distal chevron osteotomies (DCO group) performed sequentially by a single surgeon. There were no differences between the groups with regard to age, length of follow-up, demographic or radiological parameters. The clinical results were assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) scoring system and the radiological results were compared between the groups.

At a mean follow-up of 14.6 months (14 to 32) there were no significant differences in the mean AOFAS scores between the DCO and PCO groups (93.9 (82 to 100) and 91.8 (77 to 100), respectively; p = 0.176). The mean hallux valgus angle, intermetatarsal angle and sesamoid position were the same in both groups. The metatarsal declination angle decreased significantly in the PCO group (p = 0.005) and the mean shortening of the first metatarsal was significantly greater in the DCO group (p < 0.001).

We conclude that the clinical and radiological outcome after a DCO is comparable with that after a PCO; longer follow-up would be needed to assess the risk of avascular necrosis.

Cite this article: Bone Joint J 2013;95-B:649–56.