Comparison of Radiographic Outcomes and Risk of First Metatarsal Shortening Between different Hallux Valgus...

Area of Science:

• Orthopedic surgery
• Foot and ankle reconstruction
• Biomechanical analysis of bone shortening

Background:

• Hallux valgus prevalence is high, particularly in Asia (up to 22%).
• Iatrogenic transfer metatarsalgia is a known complication of hallux valgus correction due to excessive first metatarsal shortening.
• First metatarsal shortening exceeding 4.0 mm is associated with increased risk of complications.

Purpose of the Study:

• To compare the risk of first metatarsal shortening among different surgical techniques for symptomatic hallux valgus.
• To evaluate radiologic and clinical outcomes of META, Lapidus, and scarf procedures.
• To identify surgical methods that minimize first metatarsal shortening and associated complications.

Main Methods:

• Retrospective study at a single tertiary hospital.
• Inclusion of patients who underwent minimally invasive metaphyseal extra-articular transverse and Akin osteotomy (META), Lapidus, or scarf procedures.
• Radiologic outcome measures included hallux valgus angle (HVA), intermetatarsal angle (IMA), and first metatarsal shortening (Maestro method); clinical outcomes assessed by visual analog scale (VAS).

Main Results:

• All three techniques (META, Lapidus, scarf) significantly improved VAS, HVA, and IMA (P < .05).
• META and Lapidus procedures resulted in significantly less first metatarsal shortening compared to the scarf procedure (P < .05).
• Seven cases (scarf group) exhibited first metatarsal shortening > 4 mm, while none occurred in the META and Lapidus groups.

Conclusions:

• META, Lapidus, and scarf procedures effectively correct hallux valgus deformity.
• The scarf procedure carries the highest risk of significant first metatarsal shortening, potentially leading to transfer metatarsalgia.
• Caution is advised during scarf procedures to minimize first metatarsal shortening.