Opening first metatarsal osteotomy and resection arthroplasty of the first MPJ in the treatment of first ray insufficiency associated with degenerative hallux valgus☆

Abstract 

Background

Opening wedge proximal metatarsal osteotomy combined with first metatarsophalangeal arthroplasty can be used to correct first metatarsus primus varus with a high intermetatarsal angle and a short first metatarsal.

Methods

147 feet in 138 patients with degenerative first metatarsophalangeal arthrosis, ≥15° of metatarsus primus varus and, a short first metatarsal were included. Preoperative and postoperative clinical, radiographic, and subjective outcome measurements were taken (Scale AOFAS).

Results

The mean first intermetatarsal angle decrease was 7.79±1.43° and the mean increase in first metatarsal length was 2.88±0.45mm. The pre-intervention mean values were 52.6 points in the AOFAS scale, and an overall result of 92.95 obtained after surgery (P<0.001).

Conclusions

The opening proximal first metatarsal osteotomy without internal fixation and with first metatarsophalangeal resection arthroplasty can correct severe hallux valgus with an intermetatarsal angle ≥15° and a short first metatarsal, achieving low rate of complications.

Keywords: Hallux valgus, Metatarsal osteotomy, Intermetatarsal angle, First ray insufficiency, Bunion