Surgical correction of the splayfoot: the Giannestras procedure

Clinically, the splayfoot is characterized by valgus of the great toe with bunion formation in association with a relative varus position of the first metatarsal. On the lateral side of the foot, there is varus of the fifth toe with a relative valgus position of the fifth metatarsal and resultant bunionette formation. Radiographically, splayfoot is characterized by an intermetatarsal angle between the first and second metatarsals of greater than 12 degrees, and an intermetatarsal angle between the fourth and fifth metatarsals of greater than 8 degrees. The Giannestras splayfoot procedure consists of excision of the bunion and bunionette, adductor tenotomy, opening-wedge osteotomy of the first and fifth metatarsal bases, and realignment of the first and fifth toes. One-hundred and sixteen splayfoot operations were performed in 72 patients, with an average follow-up of 5.2 years. Results were considered excellent in 33% (39 feet), good in 45% (52 feet), fair in 14% (16 feet), and poor in 8% (9 feet). The primary cause of a fair or poor result was collapse of the bone graft at the base of the first metatarsal, causing recurrent varus and symptomatic hallux valgus.