CME OnDemand: 2022 AOFAS Annual Meeting-Comparison of Clinical and Radiographic Outcomes Between Modified Lapidus and Proximal Reverse Chevron Metatarsal Osteotomy in Hallux Valgus Concomitant with Metatarsus Adductus

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

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This study compared the clinical and radiographic outcomes of two surgical procedures, proximal reverse chevron metatarsal osteotomy (PCMO) and modified Lapidus, in the treatment of hallux valgus (HV) concomitant with metatarsus adductus (MA). MA is a common congenital foot deformity characterized by adduction of the metatarsals at the tarsometatarsal joints. The influence of MA on HV is not fully understood, and there are no established management strategies for it.<br /><br />The study included 53 patients (58 feet) with moderate to severe HV and MA. Group 1 underwent PCMO and Akin osteotomy, while Group 2 underwent modified Lapidus procedure and Akin osteotomy. Clinical and radiographic assessments were conducted before surgery, at 6 and 12 months after surgery, and yearly thereafter.<br /><br />The results of the study showed that patients treated with modified Lapidus procedure had higher improvement in clinical and radiographic outcomes, higher satisfaction rates, and lower recurrence rates compared to those treated with PCMO. The modified Lapidus procedure was effective in correcting pronation of the first metatarsal and reducing foot width.<br /><br />In terms of complications, the study found that the recurrence rate was higher in the PCMO group, defined as a final HV angle greater than 20° or an increase in the HV angle greater than 10° on follow-up radiographs. The study recommended the modified Lapidus procedure for patients with MA and large preoperative HV angles, as it provides more powerful correction.<br /><br />Overall, this study suggests that the modified Lapidus procedure may be a preferable surgical option for HV concomitant with MA, as it results in better clinical and radiographic outcomes and higher patient satisfaction. Further research and long-term follow-up are needed to validate these findings.

Asset Subtitle

Jung-Won Lim, MD, Jemin Im, Hong-Geun Jung, MD, PhD

Keywords

clinical outcomes

radiographic outcomes

surgical procedures

proximal reverse chevron metatarsal osteotomy

modified Lapidus

hallux valgus

metatarsus adductus

congenital foot deformity

management strategies

Akin osteotomy