The Role of Surgery in Management of Primary Metatarsus Adductus

Abstract

Background: Metatarsus adductus is the most common congenital foot deformity in children. Different bone surgical procedures were portrayed to treat severe cases of fixed metatarsus adduction. Objective: To establish a protocol for diagnosis and treatment of forefoot adduction deformity in metatarsus adductus, and to evaluate the results of double column osteotomy (closing wedge cuboid osteotomy and opening wedge medial cuneiform osteotomy) (i.e. lateral column shortening with medial column lengthening) in correction of the foot deformity. Patients and Methods: In this prospective study 16 patients with 17 feet with fixed metatarsus adductus were operated upon for forefoot adduction deformity in Zagazig University Hospitals since 2018. 10 boys and 6 girls from 4-12 years old. The right foot was operated upon in 7 patients and the left foot in 10 patients. All cases underwent double column osteotomy; closing wedge cuboid osteotomy and opening wedge medial cuneiform osteotomy. Results: According to the grading system applied in this study, there were twelve cases with excellent results (nearly 70%). There was no pain throughout the foot. The forefoot adduction deformity was completely corrected. There was no supination in all cases. All cases manifested no complaints of the footwear or braces. All cases were satisfied and their parents revealed gratification of the foot shape and gait. There were 3 good results (18%), 2 fair results (12%), and no poor result. Conclusion: Double column osteotomy (combined cuboid/cuneiform osteotomy) is a safe operation, which allows satisfying correction of forefoot adduction deformity in severe rigid metatarsus adductus.