Combination of First Metatarsophalangeal Joint Arthrodesis and Proximal Correction for Severe Hallux Valgus Deformity

Abstract

Background: Arthrodesis of the first metatarso-phalangeal (MTP-1) joint is a widely accepted procedure for the treatment of hallux valgus in patients with MTP-1 degeneration, severe or recurrent deformity, or inflammatory arthritis. This study aimed to evaluate if an additional more proximal correction was beneficial in cases with a severely increased intermetatarsal 1–2 angle (IMA 1–2). Methods: A consecutive series of 18 feet (4 bilateral, all females; mean age, 61 years) with severe hallux valgus and an increased IMA 1–2 treated by MTP-1 fusion and an additional more proximal correction (Mau osteotomy or modified Lapidus procedure) was evaluated. Radiographs were analyzed for IMA 1–2 and hallux valgus angles (HVA), and for the position of the tibial sesamoid according to the AOFAS guidelines. Results: At a mean followup of 14 months, all patients were satisfied or very satisfied with the results of surgery. There were no intraoperative complications. The IMA 1–2 significantly improved from a mean of 18.8 degrees before surgery to 4.6 degrees at followup ( p < 0.001) and the HVA from a mean of 49.9 degrees to 9.7 degrees ( p < 0.001), respectively. Sesamoid position improved two grades on average. We found no difference between the Mau osteotomy and the modified Lapidus procedure. Conclusion: The present results indicate that the combination of a more proximal procedure with a MTP-1 arthrodesis in cases of hallux valgus with severely increased IMA 1–2 has a high correction capability and achieved normal HVAs as well as normal IMAs 1–2. This technique appeared to be safe and clinically successful. Level of Evidence: IV, Retrospective Case Series