Surgical treatment of metatarsus adductus using a combined soft tissue and osseous approach

Children between 6 and 8 years of age with metatarsus adductus deformity have been considered to be in the gray zone for surgical correction. Should osseous or soft tissue procedures be implemented to reduce the adducted attitude of the metatarsals? The literature clearly describes one or the other and the intermediary chondrotomy procedure described by Johnson. The use of a combined approach has not been presented. The present authors offer a brief review of metatarsus adductus, and two case reports using a modified, combined approach. Two 7-year-old girls presented with bilateral resistant metatarsus adductus deformities. The authors contend that the first and fifth metatarsals are the major deforming forces in this age group, and may be corrected with base wedge osteotomies, while the central three metatarsals are more amendable to capsular and ligamentous releases. Advantages of soft tissue procedures on the central rays include avoidance of extensive dissection, creating less trauma and avoidance of the need for internal fixation. The obvious disadvantage is the inability to adequately reduce the deformity. This can be assessed intraoperatively. These authors, therefore, conclude that this modified surgical approach is a viable alternative to the previously described procedures for resistant metatarsus adductus.