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At least 19 recordsLinked to original sources
PubMed1992

Metatarsus adductus and selected radiographic measurements of the first ray in normal feet.

Radiographic evaluation of hallux abducto valgus frequently involves the measurement of the metatarsus adductus angle, first-second intermetatarsal angle, hallux abductus angle, and proximal articular set angle. While the concept that there is a relationship between untreated metatarsus adductus and hallux abducto valgus deformity is not new, a quantifiable relationship between the metatarsus adductus angle and intermetatarsal angle, hallux abductus angle, and the proximal articular set angle in normal feet is relatively undocumented. The purpose of this study is to document relationships between the metatarsus adductus angle and the other three measurements, and to establish normal values for the intermetatarsal angle, hallux abductus angle, and proximal articular set angle within metatarsus adductus angle subgroups.

Adolescent↗
PubMedDate not supplied

Surgical treatment of metatarsus adductus using a combined soft tissue and osseous approach.

Children between 6 and 8 years of age with metatarsus adductus deformity have been considered to be in the gray zone for surgical correction. Should osseous or soft tissue procedures be implemented to reduce the adducted attitude of the metatarsals? The literature clearly describes one or the other and the intermediary chondrotomy procedure described by Johnson. The use of a combined approach has not been presented. The present authors offer a brief review of metatarsus adductus, and two case reports using a modified, combined approach. Two 7-year-old girls presented with bilateral resistant metatarsus adductus deformities. The authors contend that the first and fifth metatarsals are the major deforming forces in this age group, and may be corrected with base wedge osteotomies, while the central three metatarsals are more amendable to capsular and ligamentous releases. Advantages of soft tissue procedures on the central rays include avoidance of extensive dissection, creating less trauma and avoidance of the need for internal fixation. The obvious disadvantage is the inability to adequately reduce the deformity. This can be assessed intraoperatively. These authors, therefore, conclude that this modified surgical approach is a viable alternative to the previously described procedures for resistant metatarsus adductus.

Bone Wires↗
PubMedDate not supplied

Congenital metatarsus varus. A suggestion for a possible mechanism and relation to other foot deformities.

The pathogenesis of metatarsus varus was investigated by a series of dissections of 14 normal feet of stillborn or infants who died during the perinatal period. The deformity could not be produced without the surgical incisions described below. A valgus position of the hindfoot was produced by maximal dorsiflexion of the foot. The deformity of the fore part of the foot could not be produced even by extreme traction on the tibialis anterior tendon even after capsulotomy of the first tarsometatarsal joint. Only extensive capsulotomies in the tarsometatarsal joints distal to the joint of Chopart made it possible to displace the bones into the position analogous to metatarsus varus. It is suggested that metatarsus varus may be a deformity which occurs on a maximally dorsiflexed foot and that the primary mechanism of the forefoot deformity is a subluxation in the fore part of the foot. Secondary contractures of the soft tissues, and adaptive bone changes offer a possible explanation for lack of spontaneous recovery as well as the difficulties encountered in treating late cases.

Female↗
PubMed1987

Correction of juvenile hallux valgus deformity associated with metatarsus primus adductus using epiphysiodesis technique.

A 4.5-year follow-up retrospective study on the use of epiphysiodesis procedure for juvenile hallux valgus deformity and metatarsus primus adductus deformity shows a good reduction of deformity in nine patients with minimal change in one patient that can be explained due to the timing of the procedure. This is a minor operation for juvenile bunion deformities, using epiphyseal arrest techniques. The only complication to this procedure was one case with a noted metatarsus primus elevatus due to incomplete epiphyseal arrest from dorsal to plantar. This procedure has been found to be a safe and effective way of dealing with juvenile hallux valgus deformity when metatarsus primus adductus is the deforming force. It should be stated that in all cases a follow-up biomechanical examination and casting for orthotics took place and to date no complications, other than what has been previously mentioned, has occurred. I shall continue to perform this procedure where indicated and shall report my findings as they become available.

Adolescent↗
PubMedDate not supplied

Biplane cuneiform osteotomy for juvenile metatarsus primus varus.

An operation combining the procedures of Cotton and Fowler on the medial cuneiform has been used for the correction of juvenile metatarsus primus varus and is presented in this manuscript. The procedure consists of a biplanar opening wedge osteotomy of the medial cuneiform with insertion of a bone graft and internal fixation. This surgical approach evolves from the procedures of Cotton (a sagittal plane correction of the depressed distal medial column in pes planus), and Fowler (a transverse plane correction of the medial column for metatarsus adductus). The operation has been utilized at St. Anne's Hospitals and provides excellent reduction of the intermetatarsal angle, with realignment of an oblique metatarsal-cuneiform joint. The operation is done with the Hohmann osteotomy/bunionectomy for realignment of the metatarsophalageal joint to correct hallux valgus that exists with juvenile metatarsus primus varus.

Foot↗
PubMedDate not supplied

A radiographic study of infant metatarsus adductus treatment by serial casting.

Although many papers have been written on metatarsus adductus, few have used radiographic criteria for either the diagnosis of or in determining correction of metatarsus adductus. Most use objective clinical appearance as their sole criteria for diagnosis and correction. This paper establishes radiographic criteria for both the diagnosis and correction of metatarsus adductus.

Age Factors↗
PubMed1977

A new surgical technique for metatarsus primus varus correction with radical bunionectomy: a preliminary report.

Dr. Panacos has developed a new surgical technique for correction of metatarsus primus varus. His technique, which is indicated in moderate to severe metatarsus primus varus (when the intermetatarsal angle exceeds 15 degrees), makes use of a stabilizing implant at the first metatarsal-cuneiform joint. Although the procedure has been performed on a limited number of patients, the author believes it to be superior to the osteotomy for metatarsus primus varus correction.

Hallux Valgus↗
PubMed1989

Hallux valgus and metatarsus adductus: the surgical dilemma.

Hallux varus in the presence of metatarsus adductus is a complex clinical entity that requires careful evaluation and preoperative planning. The metatarsus adductus complicates the picture by accentuating the effect of the intermetatarsal angle and also creates compensatory pronation. Transpositional osteotomies of the first metatarsal are difficult to perform in patients with an adducted forefoot and mild increase in intermetatarsal angle. Surgical therapy generally requires aggressive osteotomies of the first ray to decrease its medial prominence. Total metatarsus adductus correction should be considered in patients with severe deformity.

Child↗
PubMed1988

Neonatal metatarsus adductus, joint mobility, axis and rotation of the lower extremity in preterm and term children 0-5 years of age.

A total of 484 premature children and a control group of 114 healthy term children underwent orthopaedic follow-up from birth to 5 years of age. At birth, metatarsus adductus was found to be more frequent in twins than in single infants (41% vs 16%; P less than 0.01), but occurred with equal frequency in single preterm and term infants (16% vs 12%). By 5 years of age, metatarsus adductus had resolved in all the term but only in 81% of the preterm children (P less than 0.05). In the preterm and term groups, knee axis (mean intermalleolar distance 22.0 mm vs 20.1 mm), tibial torsion (mean angle -1.2 degrees vs + 0.6 degrees) and angle of gait (mean angle + 1.5 degrees vs + 0.7 degrees) at 5 years were statistically insignificant. Hip function at 5 years was similar in normal preterm and term children but significantly decreased in preterm children with cerebral palsy, more so with regard to abduction (56 degrees vs 39 degrees, P less than 0.05) and extension (22 degrees vs 8 degrees, P less than 0.01). The difference between the sexes was insignificant in both the preterm and term groups.

Child, Preschool↗
PubMed1991

[Initial experience with the closed method of subcapital osteotomy of the 1st metatarsus in hallux valgus].

The authors summarize initial findings with Bösh's modification of Hohmann's subcapital osteotomy made by means of a cutter from a short dermal incision under X-ray control. The valgosity and rotation of the hallux are corrected by a lateral and possibly plantar shift and by derotation of the head of the metatarsus. The position of the head is ensured by supporting the medial exostosis by a wire inserted by the intramedullary route into the Ist metatarsus. The operation was performed in five female patients aged 37-60 years on nine feet. The results were evaluated after 10-13 months. For osteotomy conic cutters were used (diameter of base 2.1 mm and 5 mm) and a drill (3000 rotations per minute) from the small instrumentarium of SYNTHES Co. The Kirschner wire was removed after four weeks and fixation a with a plaster spica of the toe took, depending on healing, 7-12 weeks after operation. In all instances marked correction of the position of the toe occurred (reduction of the valgosity angle by 8-19 degrees). As to subjective evaluation, four patients evaluated the result as excellent, three as satisfactory, i.e. disappearance or marked reduction of complains and once as unsatisfactory with persisting pain and difficulties as regards footwear. After analysis of the first early results the authors recommend to indicate the operation in valgosity of the toe up to 35 degrees and minimal arthrosis, to perform the osteotomy in a strictly subcapital and extracapsular position and to reduce the period of fixation. The advantage of the method is that the metatarsophalangeal joint is not damaged, the operation is sparing, marked correction of the position of the toes is achieved, the time of operation is short and the scar is not visible.

Adult↗
PubMed1987

Surgical management of metatarsus adductus deformity.

This article is intended to provide the podiatric physician with a comprehensive overview of the surgical management of metatarsus adductus deformity. Both soft tissue and osseous procedures are reviewed including a practical discussion of the preferred incisional approaches, surgical techniques, and postoperative care. Current indication and concepts for each procedure are discussed. A comprehensive history and physical exam, with emphasis on the clinical evaluation and radiographic findings, are critical aspects in the management of the patient with metatarsus adductus. Selection of procedures will be based upon this information as well as chronological age and osseous maturity. When significant deformities in the rearfoot complex are present (that is, pes valgo planus, equinus), consideration should be given to surgical correction simultaneously with correction of the forefoot deformity or at a later stage.

Cartilage, Articular↗
PubMed1986

A reappraisal of metatarsus adductus and skewfoot.

The hypothesis that the treatment of adduction of the fore part of the foot in the child is altered by an associated deformity of the middle or the hind part, or both, was tested in a prospective study of eighty-four patients (124 feet). Radiographic classification delineated four configurations of adduction of the foot, based on varying relationships of the fore, middle, and hind parts of the foot. Twenty-two (43 per cent) of the feet with adduction of the fore part alone (simple metatarsus adductus) required no treatment, as compared with eighteen feet (24 per cent) with the other types of adduction (p less than 0.03). The patients with a complex skew-foot deformity required twice as long a period of cast treatment as those with simple metatarsus adductus (p = 0.0001). On evaluation at a minimum follow-up of two years, only one of the 124 feet had residual adduction of the fore part of the foot, as determined radiographically. It was also found that the use of the Denis-Browne bar was accompanied by an increased incidence of flat-foot deformity at follow-up.

Child, Preschool↗
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↗
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↗
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↗
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↗