Radiographic Recurrence of Deformity After Hallux Valgus Surgery in Patients With Metatarsus Adductus

Abstract

Background: Metatarsus adductus (MA) is a congenital condition that may lead to the development of hallux valgus (HV). The associated anatomic deformities may lead to recurrence of the HV in patients with MA. The goals of the study were to identify radiographic rates of recurrence of HV following surgery for HV in patients with MA. Methods: Between 2002 and 2013, 587 patients who underwent HV surgery were retrospectively identified. The radiographic parameters recorded included the hallux valgus angle (HVA), the intermetatarsal angle (IMA), and the metatarsus adductus angle (MAA) obtained from initial radiographs and at final follow-up. The MAA was considered abnormal if the value was greater than 20 degrees. Radiographic recurrence was defined as HV deformity >20 degrees. Results: The rate of radiographic recurrence of HV was 15% in patients without MA and 29.6% in patients with MA ( P < .05). In the group with MA, rate of deformity recurrence did not differ among the operative procedures performed (Lapidus, 28.5%; distal first metatarsal osteotomy, 29.4%; proximal first metatarsal osteotomy, 28.9%). Patients with severe MA (MAA > 31 degrees) were found to have a recurrence rate of 18%, whereas those with less severe MA (MAA < 31 degrees) were found to have a recurrence rate of 82%. Of the patients with severe MA who did not have radiographic recurrence of HV, 60% had undergone a Lapidus arthrodesis and realignment arthrodesis of the second/third tarsometatarsal joints. Conclusion: The rate of radiographic recurrence for patients with MA undergoing HV correction was ~30%. This finding was consistent with our hypothesis that MA increases the risk of radiographic recurrence of HV deformity irrespective of the procedure performed. We believe the lower rate of recurrence of HV among patients with severe MA deformities is suggestive that more complete management of the deformity is warranted. Level of Evidence: Level III, retrospective comparative series.