Abstract
Purpose
To correct hallux valgus deformities in patients with a greater pronation of the first metatarsal, we designed a novel proximal triple derotational metatarsal osteotomy (PTDMO), which could be used to achieve three-dimensional correction of hallux valgus deformities at the proximal metatarsal level.
Methods
We prospectively evaluated the radiographic and clinical outcomes of 13 consecutive cases underwent PTDMO between November 2018 and May 2020. The minimum follow-up for inclusion was 12 months. The hallux valgus angle (HVA), first-to-second intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA), relative length of the second metatarsal, and medial sesamoid position on the weight bearing foot anteroposterior radiographs, and the degree of the first metatarsal pronation on forefoot axial radiographs were measured pre-operatively, at six weeks post-operatively, and at the final follow-up. The American Orthopaedic Foot and Ankle Society (AOFAS) score and Foot Ankle Outcome Scores (FAOS) were measured.
Results
In the comparison of pre-operative and final follow-up parameters, HVA, IMA, and DMAA were significantly improved post-operatively (all, P < 0.001). The relative length of the second metatarsal did not differ significantly post-operatively (P = 0.724). The medial sesamoid was significantly reduced (P = 0.01), and the first metatarsal pronation decreased by 10.16° (P = 0.034). Regarding clinical parameters, the AOFAS score and FAOS in all categories significantly improved post-operatively (all, P < 0.001).
Conclusion
PTDMO resulted in satisfactory radiographic and clinical outcomes with respect to deformity correction and pain relief, with significant post-operative reduced pronation of the first metatarsal.
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Data availability
All data generated or analyzed during this study are included in this published article.
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Acknowledgements
In remembrance of Woon Hyuk Lee (1982–2020), Jun Young Choi is grateful for his help with analyzing data and English editing.
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JY Choi wrote the article with organizing the data, participated in the design of the study, and performed the statistical analysis. JS Suh conceived the study, and participated in its design and coordination and helped to draft the manuscript. JH Cho participated in the writing the article in English. SJ Park sorted the involved patients with a review of medial record.
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Level of evidence: IV, case series
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Choi, J.Y., Suh, J.S., Cho, J.H. et al. Outcome of proximal triple derotational metatarsal osteotomy for three-dimensional correction of hallux valgus deformity. International Orthopaedics (SICOT) 45, 3101–3110 (2021). https://doi.org/10.1007/s00264-021-05170-7
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DOI: https://doi.org/10.1007/s00264-021-05170-7