First metatarsocuneiform arthrodesis and Reverdin-Laird osteotomy for treatment of hallux valgus: an...

The authors present a retrospective study of 14 patients (20 feet) treated with first metatarsocuneiform arthrodesis and Reverdin-Laird osteotomy and distal soft tissue alignment for hallux valgus associated with hypermobility of the first ray and an increased proximal articular set angle. The purpose of this study was 3-fold: (1) to determine clinical outcome of this procedure combination, (2) to evaluate the effect of this procedure on the radiographic parameters of hallux valgus, and (3) to determine the degree of first ray shortening. At a mean 50.1 months postoperatively, patients were evaluated according to the American Orthopedic Foot and Ankle Society's Hallux-First Metatarsophalangeal-Interphalangeal Clinical Rating Scale. Preoperative and follow-up radiographs were compared for changes in the following measurements: 1-2 intermetatarsal angle (IMA), hallux abduction angle (HAA), proximal articular-set angle (PASA), and metatarsal protrusion distance (MPD). Statistical analysis using the Student t test showed a significant increase in total scores from a mean 43.6 to 92.6 of 100. A significant decrease was found in the IMA from a mean 16.9 degrees to 7.1 degrees, in the HAA from a mean 37.1 degrees to 5.2 degrees, in the PASA from a mean 20.3 degrees to 3.4 degrees (P <.001), and a significant change in the was found in the MPD of 7.7 mm (P <.001). Given the high rating scale scores, first ray shortening did not appear to hamper our patients' clinical outcome.