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Boffeli TJ, Sorensen T, Gorman C, et al. A Novel Manipulation Technique for Lapidus Fusion in Correction of Hallux Valgus Deformity With Underlying Metatarsus Adductus: A Case Series. J Foot Ankle Surg. 2021;doi: 10.1053/j.jfas.2020.04.029.
Boffeli, T. J., Sorensen, T., Gorman, C., Messerly, C., & Chang, H. C. (2021). A Novel Manipulation Technique for Lapidus Fusion in Correction of Hallux Valgus Deformity With Underlying Metatarsus Adductus: A Case Series. The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons, . https://doi.org/10.1053/j.jfas.2020.04.029
Boffeli, Troy J, et al. "A Novel Manipulation Technique for Lapidus Fusion in Correction of Hallux Valgus Deformity With Underlying Metatarsus Adductus: A Case Series." The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons vol. (2021). doi: https://doi.org/10.1053/j.jfas.2020.04.029
Boffeli TJ, Sorensen T, Gorman C, Messerly C, Chang HC. A Novel Manipulation Technique for Lapidus Fusion in Correction of Hallux Valgus Deformity With Underlying Metatarsus Adductus: A Case Series. J Foot Ankle Surg. 2021 Jun 22; doi: 10.1053/j.jfas.2020.04.029. Epub 2021 Jun 22. PMID: 34963517.
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J Foot Ankle Surg. 2021 Jun 22; doi: 10.1053/j.jfas.2020.04.029. Epub 2021 Jun 22.

A Novel Manipulation Technique for Lapidus Fusion in Correction of Hallux Valgus Deformity With Underlying Metatarsus Adductus: A Case Series.

The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons

Troy J Boffeli, Tyler Sorensen, Catlea Gorman, Collin Messerly, Howard C Chang

Affiliations

  1. Residency Director, Regions Hospital/HealthPartners Institute, St. Paul, MN.
  2. Fellow, Weil Foot, Ankle & Orthopedic Institute Advanced Surgical Fellowship, Chicago, IL. Electronic address: [email protected].
  3. Attending Surgeon, Flagstaff Bone & Joint, Flagstaff, AZ.
  4. Fellow, Northern California Reconstructive Foot and Ankle Fellowship, Redding, CA.
  5. Resident, Regions Hospital/HealthPartners Institute, St. Paul, MN.

PMID: 34963517 DOI: 10.1053/j.jfas.2020.04.029

Abstract

Underlying metatarsus adductus (MA) is commonly seen in patients with hallux valgus (HV) deformity, with implications regarding procedure selection and hallux valgus recurrence. Lapidus, or first tarsometatarsal fusion, is commonly performed allowing reduction in intermetatarsal angle (IMA) but this procedure has not been established as an approach to provide partial correction of MA deformity. Retrospective assessment of preoperative and postoperative metatarsus adductus angle (MAA), IMA and hallux abductus angle (HAA) in patients treated with Lapidus fusion for HV. Significance was determined via paired t test with a p value of <.05. All cases involved manual transverse plane manipulation to reduce both IMA and MAA during screw insertion. Intermetatarsal angle and Engel's angle were measured on preoperative AP radiographs to determine the presence of underlying MA in patients undergoing Lapidus fusion for HV. Ten weeks and 1 year postoperative radiographs were measured to determine degree of correction of IMA, HAA, and MAA. Thirty-four patients met inclusion criteria, which is approximately 46% of our sample population. The average preoperative IMA was 19.4˚ (range 12-32) and the average postoperative IMA was 9.7˚ (range 6-14). The average preoperative Engel's angle was 27.4˚ (range 24-34) and the average postoperative Engel's angle was 22.6˚ (range 15-28) with mean improvement in MA of 6.6˚. Of the 34, 27 (79.4%) patients had a normal Engel's angle at 10 weeks postoperatively. All measures of change met level of significance (p < .05). Of the 34 patients, 21 had radiographs taken beyond the 1 year mark (average 53 weeks). These patients were found to have an average Engel's angle of 23.0˚, which is not statistically significantly different from their 10 week measurements. Of the 21 patients, 17 (81%) maintained normal Engel's angle past 1 year. Metatarsus adductus varies regarding degree of reducibility and complicates preoperative angular measurement and correction of HV. Based on these findings, we recommend Lapidus fusion using this specified manipulation technique to obtain comprehensive transverse plane correction.

Copyright © 2021 the American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Keywords: hallux valgus; lapidus; metatarsus adducutus

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