Combination of first metatarsophalangeal joint arthrodesis and proximal correction for severe hallux valgus deformity

Arthrodesis of the first metatarso-phalangeal (MTP-1) joint is a widely accepted procedure for the treatment of hallux valgus in patients with MTP-1 degeneration, severe or recurrent deformity, or inflammatory arthritis. This study aimed to evaluate if an additional more proximal correction was beneficial in cases with a severely increased intermetatarsal 1-2 angle (IMA 1-2).

A consecutive series of 18 feet (4 bilateral, all females; mean age, 61 years) with severe hallux valgus and an increased IMA 1-2 treated by MTP-1 fusion and an additional more proximal correction (Mau osteotomy or modified Lapidus procedure) was evaluated. Radiographs were analyzed for IMA 1-2 and hallux valgus angles (HVA), and for the position of the tibial sesamoid according to the AOFAS guidelines.

At a mean followup of 14 months, all patients were satisfied or very satisfied with the results of surgery. There were no intraoperative complications. The IMA 1-2 significantly improved from a mean of 18.8 degrees before surgery to 4.6 degrees at followup (p < 0.001) and the HVA from a mean of 49.9 degrees to 9.7 degrees (p < 0.001), respectively. Sesamoid position improved two grades on average. We found no difference between the Mau osteotomy and the modified Lapidus procedure.

The present results indicate that the combination of a more proximal procedure with a MTP-1 arthrodesis in cases of hallux valgus with severely increased IMA 1-2 has a high correction capability and achieved normal HVAs as well as normal IMAs 1-2. This technique appeared to be safe and clinically successful.