Comparison of Clinical and Radiographic Outcomes Between Modified Lapidus and Proximal Reverse Chevron Metatarsal Osteotomy in Hallux Valgus Concomitant with Metatarsus Adductus

Abstract

Category: Midfoot/Forefoot; Bunion Introduction/Purpose: Operative treatment of hallux valgus (HV) in the setting of metatarsus adductus (MA) is reported to be difficult and poorer radiographic outcomes. Reduced space between the first and second metatarsals makes it difficult to translate the first metatarsal head laterally. This study aimed to compare the clinical and radiographic outcomes between HV with MA patients treated with modified Lapidus procedures and those with reverse proximal chevron metatarsal osteotomy (PCMO). Methods: The study included the patients of HV with MA (58 feet). 16 feet (Group 1) had been treated with modified Lapidus procedures by the senior author from December 2012 to November 2019. 42 feet (Group 2) had been treated with PCMO from February 2012 to March 2017. For the clinical assessment, visual analog scale (VAS) pain scores, AOFAS scores, and patients' postoperative satisfaction were evaluated. Radiographic assessment was performed with HV angle (HVA), intermetatarsal angle (IMA), and the first- to fifth-metatarsal width (1-5 MTW). Results: The mean follow-up duration was 16.8 (range, 12-54) months in Group 1, and 31.8 (range, 24-62) months in Group 2. The mean pain VAS score and AOFAS score improved from preoperative to the final follow-up in both group, however, Group 1 showed more significant improvement in clinical outcomes (ΔVAS: 6.0+-1.9 (Group 1) vs 5.1+-2.1(Group 2) (p=0.024), ΔAOFAS: 40.8+-11.5 (Group 1) vs 30.0+-11.3 (Group 2) (p=0.031)). As to radiographic assessment, Group 1 also showed more significant improvement in HVA and IMA (ΔHVA: 39.1+-9.1 (Group 1) vs 27.5+-9.8 (Group 2) (p<0.001), ΔIMA: 13.1+-3.0 (Group 1) vs 9.4+-4.5 (Group 2) (p=0.004). Conclusion: This study demonstrated that the HV patients with concomitant MA that treated with modified Lapidus procedures showed more significant clinical and radiographic improvement than those with PCMO. For the management of the HV patients accompanying MA in the setting of large preoperative HVA, modified Lapidus procedures would be good surgical option.