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PubMed1996

Congenital metatarsus adductus in early human fetal development: a histologic study.

Two feet with congenital metatarsus adductus from fetuses at early development (16 and 19 weeks of gestation) were studied by making serial histologic sections in the horizontal plane of the foot. It was observed that the shape of the medial cuneiform was altered and the first cuneometatarsal joint tilted toward the medial and dorsal directions. The first metatarsal appeared normal, whereas the other metatarsals were deformed in slight adduction at the metaphyseal level. Subluxation at the other cuneometatarsal joints and naviculocuneiform joint was not observed, and the navicular showed no signs of medial or lateral displacement in relation to the head of the talus. No histologic abnormalities of the joint capsules, ligaments, or tendons were observed. On the basis of these pathologic findings, the possibility of a developmental abnormality of the medial cuneiform as a pathogenic factor for the congenital metatarsus adductus deformity should be considered.

Embryonic and Fetal Development↗
PubMedDate not supplied

Cuneiform and cuboid wedge osteotomies for correction of residual metatarsus adductus: a surgical review.

Metatarsus adductus is a deformity in which the metatarsals are deviated in the transverse plane when compared with the longitudinal axis of the lesser tarsus. A brief review of the deformity is presented including the causes, radiographic analysis, conservative treatment, and a surgical approach. A series of cases of metatarsus adductus is presented in which a proximal surgical approach consisted of cuneiform and cuboid wedge osteotomies with staple fixation. The described procedure has advantages over the traditional metatarsal wedge osteotomies by providing large cancellous bone-to-bone interfaces for excellent healing potential, easier fixation, sagittal plane stability, and avoidance of the physis at the base of the first metatarsal.

Adolescent↗
PubMedDate not supplied

[The modified Ludloff osteotomy for correction of severe metatarsus primus varus with hallux valgus deformity].

AIM: The present study investigates the clinical and radiological mid-term results of the modified Ludloff osteotomy, a proximal metatarsal osteotomy for surgical correction of severe metatarsus primus varus with hallux valgus deformity. METHOD: 70 feet in 67 patients from 25 to 78 years (average age 56 years) were included in this prospective study. The patients were evaluated with the American Orthopaedic Foot and Ankle Society (AOFAS) forefoot metatarsophalangeal interphalangeal score, which was used preoperatively and at an average follow-up of 37 +/- 6 months. Weight-bearing foot radiographs were analysed according to AOFAS guidelines and statistical evaluation was made with the Wilcoxon signed-rank test. RESULTS: The average AOFAS score improved significantly (p < 0.0001) from 55.2 +/- 15.2 points preoperatively to 86.6 +/- 15.2 points at follow-up. Preoperatively, all patients complained of pain (20.2 +/- 9.6 points) which had improved significantly (p < 0.0001) at the latest follow-up (37.3 +/- 5.7 points). The average hallux valgus angle (HVA) was 37 +/- 8 degrees preoperatively and improved significantly to 12 +/- 11 degrees at follow-up (p = 0.0001). The intermetatarsal angle (IMA) improved significantly from 18 +/- 2 degrees preoperatively to 8 degrees +/- 4 degrees after 37 +/- 6 months (p = 0.0002). The sesamoid position improved significantly from preoperative to follow-up (p = 0.0003). Radiographic evaluation of the patients indicated that all examined osteotomies had healed after 37 +/- 6 months. CONCLUSION: This prospective investigation at intermediate follow-up using currently available outcome measures suggests that the Ludloff osteotomy is a suitable procedure for the surgical correction of severe metatarsus primus varus (IMA > 15 degrees ) with hallux valgus deformity.

Adult↗
PubMed1989

Osteotomy of the first metatarsal base for metatarsus primus varus.

An opening wedge osteotomy of the first metatarsal base using either iliac crest bone or the removed exostosis as a graft was used to treat metatarsus primus varus in 22 feet of 15 patients. The preoperative intermetatarsal angle averaged 15 degrees, with the final angle averaging 8 degrees. All osteotomies healed in 3 months with excellent cosmetic and functional results and no difference between iliac crest and exostosis grafts. We conclude that an opening wedge osteotomy of the first metatarsal base is a satisfactory method for the correction of metatarsus primus varus.

Adolescent↗
PubMed1993

Management of metatarsus adductovarus.

A retrospective analysis of 795 patients treated for metatarsus adductovarus by a standardized outpatient approach by one of the authors (D.S.W.) from 1970 to 1983 was conducted to evaluate the efficacy of a straight metal bar and attached reverse last shoe protocol. Criteria for inclusion were developed excluding those milder cases in which spontaneous resolution was expected and indeed occurred. Nearly uniform excellent results were encountered, with a 99% likelihood of obtaining a fully corrected foot. Surgical intervention was deemed necessary in under 1% of cases seen. The authors also examined birth weights and rank in relation to metatarsus adductovarus. Those children with the deformity had a mean birth weight of 7.6 pounds, without statistical variance from normal average birth weights. We were unable to establish any statistical association with birth rank. In light of the results of this study, which compare favorably with serial casting, we recommend this approach as a more economical and less disruptive and cumbersome technique for parent, patient, and physician.

Adolescent↗
PubMed1993

The treatment of rigid metatarsus adductovarus with the use of a new hinged adjustable shoe orthosis.

A retrospective review of the early results of treatment of metatarsus adductovarus with a new hinged adjustable shoe orthosis, the Bebax shoe, is presented. The results in 120 cases (210 feet) are included in the study. Criteria for severity of the initial deformity were developed, and all cases of true clubfoot and those cases with prior treatment were excluded. The average age at institution of treatment was 4.5 months, and treatment time averaged 2.7 months (range 1-7 months). Overall, 96% of the cases were completely resolved with the use of the orthotic alone, 3% required additional casting, and 1% required a bar and shoes for complete correction of the deformity. No treatment complications were encountered except some minor problems with hinge loosening, particularly in the child of walking age. We believe that the Bebax shoe is a lightweight, convenient, safe, and both cost- and treatment-effective device in the management of metatarsus adductovarus.

Female↗
PubMed1991

Metatarsus primus varus. A statistical study.

A survey of 6000 schoolchildren discovered 36 cases of unilateral and 60 cases of bilateral hallux valgus, defined as a metatarsophalangeal angle of more than 14.5 degrees, measured on standing radiographs. Metatarsus primus varus was found not only in the early stages of hallux valgus but in the unaffected feet of children with unilateral hallux valgus. Adduction of the first metatarsal is not due to differential growth of the cortices of the first metatarsal nor is it a consequence of malalignment of the metatarsocuneiform joint. The intermetatarsal angle did not correlate with the angle of metatarsus adductus nor with the intercuneiform angle.

Anthropometry↗
PubMed1997

Radiographic analysis of metatarsus primus varus. 45 feet followed 15 months after distal metatarsal osteotomy and lateral soft-tissue release.

We analyzed standardized radiographs of 45 feet in 41 patients with symptomatic hallux valgus and an intermetatarsal angle of 17 (15-23) degrees 15 (9-24) months after distal metatarsal osteotomy and lateral soft-tissue releases. A mean reduction in the II-intermetatarsal angle of 12 degrees and hallux valgus angle of 24 degrees was found. On average, the metatarsus primus varus angle improved by 4 degrees, the I-intermetatarsal angle by 3 degrees and the inclination angle of the first cuneiform by 4 degrees. We conclude that this operation corrects the metatarsus primus varus, without substantially altering the alignment of the long axis of the first metatarsal.

Adult↗
PubMed1989

Correction of hallux valgus and metatarsus primus varus. Using the Cedell technique.

The Cedell procedure consists of: a proximal valgus osteotomy of the first metatarsal bone to correct the metatarsus primus varus, a soft tissue plasty at the first metatarsophalangeal joint with lateral release, and tightening of the medial capsule to correct the hallux valgus. A total of 45 operations in 31 patients (2 men and 29 women) were performed. Forty-one of these operations were followed. The average age at surgery was 24 years (range 16 to 43 years), and the average follow-up time was 23 months (range 8 to 56 months). The postoperative decrease in the intermetatarsal angle averaged 10 degrees, and the average decrease in the metatarsophalangeal angle was 26 degrees. Only a few postoperative complications were observed. At the time of follow up, 75% of the patients had no pain, 23% had only slight pain, and 2% had severe pain. Ninety-five percent were cosmetically satisfied with the operation. The Cedell operative technique has proved to be an effective procedure to correct the combined hallux valgus and metatarsus primus varus in younger patients.

Adolescent↗
PubMed1997

Iatrogenic metatarsus primus elevatus. Etiology, evaluation, and surgical management.

Iatrogenic metatarsus primus elevatus is an infrequent but devastating complication of first ray surgery. The authors address their clinical and radiographic evaluation of metatarsus primus elevatus, and describe a surgical treatment with emphasis on the sagittal plane Z-osteotomy. This osteotomy provides predictable and versatile correction for the treatment of iatrogenic deformities of the first metatarsal. It allows for plantarflexion and lengthening of the first metatarsal while avoiding an interpositional bone graft. The technical aspects of the procedure are thoroughly discussed.

Foot Deformities, Acquired↗
PubMed1999

High intraosseous pressure as a cause of lameness in a horse with a degloving injury of the metatarsus.

A 6-year-old Paint mare undergoing treatment for a degloving injury of the right metatarsus developed a non-weight-bearing lameness 19 days after admission. Diagnostic nerve blocks localized the source of pain to the area between the tarsus and the metatarsophalangeal joint. Radiography of the metatarsus and metatarsophalangeal joint, arthrocentesis of the metatarsophalangeal joint, and ultrasonography of the flexor tendons, flexor tendon sheath, and suspensory ligament failed to identify the cause of the lameness. The horse was anesthetized and intraosseous pressure was measured in the left and right third metatarsal bones, using a self-tapping cannulated screw attached to a pressure transducer. Pressure in the affected limb (46 mm Hg) was 3.5 times as high as pressure in the unaffected limb (13 mm Hg). The day after pressures were measured and fenestration was performed, signs of lameness were substantially improved. High intraosseous pressure in the affected limb was most likely secondary to edema, inflammation, and partial venous thrombosis, in combination with bone neovascularization, that impaired intraosseous venous drainage from the medullary cavity. Fenestration of the affected bone relieved the excessive pressure and allowed for resolution of pain.

Animals↗
PubMed2002

[Personal experience with the basal wedge closed osteotomy of the first metatarsus in hallux valgus].

PURPOSE OF THE STUDY: The authors present their philosophy of the surgical treatment of metatarsus primus varus by oblique basal closed osteotomy of 1st metatarsal, evaluate and generalize the results achieved also with regard to the age of patients. MATERIAL: The evaluation covers a group of patients operated on for the mentioned static defect since 1995 with a minimal interval of 12 months after the surgery. From this general group a subgroup has been subsequently singled out of children and adolescents up to the age of 18. The general group included 24 patients in which 31 surgeries were performed. The subgroup of children and adolescents comprised 10 patients in which the surgery was performed in 12 feet. METHODS: Monitored in both group was age, sex, osteotomy laterality, the presence of distal operation. Post-operative monitoring focussed on the following data: the time interval after the operation, subjective satisfaction, range of motion of Ist metatarsophalangeal joint, the incidence of complications. Evaluation covered post-operative correction of individual angles and the shortening of Ist metatarsal by comparison of pre- and post-operative radiograph. RESULTS: Evaluated in the whole group were 22 patients, in the group of children and adolescents 8 patients, with average time interval of 3 years after the operation. On the basis of the surgery average correction of intermetatarsal angle by 10.5 degrees was achieved in both groups, average correction of valgosity by 18 degrees in the basic group and by 10 degrees in the group of adolescents. DISCUSSION: The results are evaluated globally on the basis of specialized literature. The authors present their philosophy of the solution of the issues of metatarsus primus varus as a static defect by different surgical techniques, formulate a clear strategy of the use of distal surgery and discuss its efficiency in relation to the patient's age. CONCLUSION: Oblique basal closed osteotomy of Ist metatarsal within a comprehensive solution of the static defect of hallux valgus is recommended to the broad orthopaedic public as a surgery which in view of the authors can bring good results in children and adolescents. In adults they recommend to indicate this surgery in the mentioned cases in combination with a distal operation.

Adolescent↗
PubMed2004

Early and delayed orthotic treatment in congenital metatarsus varus: effectiveness of two types of orthoses.

AIM: The aim of this study was to evaluate the effectiveness of early or delayed orthotic treatment of congenital metatarsus varus and evaluate the efficacy of static vs dynamic anti-varus orthosis. METHODS: Twenty-five children (14 males, 11 females), of 81.3 days of age (range 1-189) (41 feet affected) were selected among 88 patients referred to our rehabilitation department for foot deformity. Children were assigned to 1 of 2 groups (dynamic or static orthosis) according to a simple randomization scheme. Patients were evaluated at diagnosis (T1), at the end of treatment (T2) and at a follow-up performed at least 2 years after the end of treatment (T3). Primary outcome was measured using the Bleck scale. The IOWA functional rating system questionnaire was performed at follow up evaluation. RESULTS: The Bleck scale showed that both static and dynamic orthoses were effective and that the best results were achieved with early treatment. The IOWA questionnaire showed that no child had residual deformities that interfered with daily activities. Nonetheless, the dynamic orthosis group had better scores in 4 sub-items related to parental satisfaction, foot function, heel position, and foot passive motion. CONCLUSIONS: Both static and dynamic orthoses are useful for correction of congenital metatarsus varus. Optimal results are achieved with early treatment.

Journal Article↗
PubMed1989

Plantarflexory base wedge osteotomy in the treatment of functional and structural metatarsus primus elevatus.

Plantarflexory base wedge osteotomy has proven to be a viable, rewarding treatment, where first metatarsal phalangeal joint pathology, as a result of metatarsus primus elevatus, is predicted or in its earliest forms. Although this topic was first addressed by Lambrinudi in 1938, it has received little notice in the literature, and its relevance is probably underestimated. In fact, the diagnosis of metatarsus primus elevatus with associated advancing degenerative joint disease is probably being missed in a significant number of patients. The early signs of this condition are often disregarded even by professionals and the patient frequently is told there is nothing wrong. Not until hallux limitus or hallux rigidus develops is concern demonstrated, at which point a joint preservation procedure is no longer viable. The recovery from plantarflexory base wedge osteotomy does require a longer time period before return to weight bearing as compared with more commonly performed foot surgeries. This must, however, be weighed against the consideration of a patient needing joint resection surgery at a later date, not infrequently in their late 30s or 40s. In fact, a significant patient population in the 35 to 45 age group exists, in whom one prefers to do neither an implant surgery nor a joint destructive surgery, but in whom the joint has been significantly damaged. Performing plantarflexory base wedge osteotomy in appropriately selected patients will re-establish normal function and preserve the first metatarsal phalangeal joint articular cartilage. This approach offers the benefit of arresting the joint destructive process and avoiding the need for a joint destructive procedure in a younger patient.

Humans↗
PubMedDate not supplied

Metatarsus adductus and hallux abducto valgus: their correlation.

Metatarsus adductus has long been suspected to contribute to hallux abducto valgus. This paper gives statistical evidence on the relationship between metatarsus adductus and hallux abducto valgus in an attempt to support this long held belief.

Foot Deformities, Congenital↗
PubMed1976

Metatarsus varus corrected by open wedge osteotomy of the first cuneiform bone.

The persistence of metatarsus adductus varus has been a problem in management. We have treated a series of selected patients with this problem and believe that our results have been better than with the procedure we have used in the past. Fowler has described a procedure which seems ideal for the patients in our series. Through personal communication the procedure and its application were discussed and the series was started eight years ago. Our series is small because our patients are responding to other forms of treatment at an earlier age. The few that do not respond are now considered for the operation described. The procedure is relatively simple to perform. Full correction should be obtained at the time of surgery. Casting is utilized to hold the correction and immobilize the extremity for healing. Our unsatisfactory results occurred because of errors in technique or poor selection of patients. We believe that this procedure should be considered in the older patient with metatarsus varus.

Adolescent↗
PubMedDate not supplied

Below-knee plaster cast for the treatment of metatarsus adductus.

Sixty-five infants with moderate (37 feet) or severe (48 feet) inflexible metatarsus adductus were treated with a below-knee plaster cast. The deformity was corrected in 6-8 weeks in all cases. At the 2- to 6-year follow-up (mean, 4 years), the correction was maintained in all children who had had a moderate deformity; of the 44 feet with severe deformity that were available for examination, six now had a moderate deformity, and one a severe deformity. All forefeet were flexible, and further treatment was unnecessary. Our results are similar to those for above-knee plaster casts. We conclude that a below-knee plaster cast is effective in the treatment of metatarsus adductus.

Casts, Surgical↗
PubMed1992

Syndrome of microcephaly, Brachmann-de Lange-like facial changes, severe metatarsus adductus, and developmental delay: mild Brachmann-de Lange syndrome?

We report on 4 individuals (3 sibs and their father) with a syndrome of growth retardation, microcephaly, minor facial anomalies reminiscent of a mild Brachmann-de Lange syndrome (BDLS), severe metatarsus adductus, developmental delay, and unusual dermatoglyphics. The syndrome, which seems to be inherited as an autosomal dominant trait with variable expressivity, resembles mild BDLS.

Adult↗