Abstract
Research Type:
Level 4 – Case series
Introduction/Purpose:
A significant portion of hallux valgus (HV) patients have concomitant metatarsus adductus (MTA) deformities, with an approximate prevalence of 30% in patients undergoing HV corrective surgery. Failure to recognize and correct MTA when present in patients undergoing HV surgery has been reported to result in an increased risk of HV recurrence. This study evaluated the clinical, radiographic, and patient-reported outcomes in patients undergoing 1-2-3 TMT arthrodesis for correction of combined MTA and HV deformities with protected early return to weightbearing.
Methods:
This is an interim analysis of a 5-year, prospective multicenter study. Patients >14years with symptomatic HV (HVA >12°), MTA (Sgarlato MTA angle (MAA) >15°), and no prior HV surgery were eligible. Patients were treated utilizing a cut guide for MTA correction at the 2nd and 3rd TMT and positioning device and cut guide for 1st TMT HV correction. Locking plates were utilized for 1st, 2nd, and 3rd TMT arthrodesis. Patients underwent an early weightbearing protocol in a CAM boot. Outcomes included return to weightbearing, changes in radiographic measurements (IMA, HVA, TSP, MAA, and osseous foot width), non-union (defined as lucency and pain at the 1st, 2nd, or 3rd TMT joint), pain measured by visual analog scale (VAS), PROs via MOxFQ and PROMIS-29, and clinical complications.
Results:
Thirty-eight patients (mean [range] age: 41.3 [14-65] years) underwent the procedure of whom 28 and 18 completed 6- and 12-month visits, respectively. Mean (95% CI) time to protected weightbearing and return to unrestricted activity were 7.5 (4.3, 10.7) days and 3.7 (3.4, 4.1) months, respectively. Clinically significant improvements in radiographic measurements were maintained through 12 months (Table 1). Clinically significant improvements were observed at 6 and 12 months for VAS (mean (95% CI): 2.5 (1.0, 6.0) and 2.7 (1.0, 6.0), respectively), for MOxFQ Walking/Standing 26.8 (18.4, 35.2) and 26.3 (18.2, 34.3), respectively), and PROMIS-29 Physical Function 7.8 (4.6, 11.0) and 7.4 (3.8, 10.9), respectively). Two adverse events were reported and one hardware complication; none requiring surgical intervention. No patients experienced a non-union at 12 months.
Conclusion:
These early interim results support that an instrumented approach to MTA and HV 1-2-3 TMT arthrodesis is successful in correcting the MTA and HV deformity with early return to weightbearing and while demonstrating favorable clinical and patient-reported outcomes. Patients exhibited meaningful pain reduction and improvement in patient-reported outcomes after surgery and were able to return to full, unrestricted activities in less than 4 months, on average. Patients will continue to be followed for up to 60 months with additional evaluations for complications, maintenance of correction, and patient-reported outcomes.
Table 1, Radiographic Measures for Interim 1-Year Analysis of a Multicenter Prospective Study Assessing Radiographic and Patient Outcomes Following Combined Metatarsus Adductus and Hallux Valgus Correction with Early Weightbearing.
Mean pre-operative, initial follow-up, 6-month and 1-year radiographic measures for hallux valgus angle, intermetarsal angle, tibial sesamoid position, metatarsus adductus angle, forefoot osseous width measures, including mean change in values from pre-operative to most recent follow-up.