Radiological Outcome of Patients with Splay Foot following First and Fifth Metatarsal Osteotomies Performed Simultaneously on the Same Foot

Abstract

a b s t r a c tIntroduction: There have been many operations documented for the treatment of hallux valgus and fifth metatarsal bunionette deformities in patients with splay foot carried out separately, with variable success rates. Our aim was to assess the radiological outcome following combined chevron osteotomy of the first and reverse chevron osteotomy of the fifth metatarsal in symptomatic patients with splay foot. To our knowledge, this procedure has not been described in the literature. Methods: Nine symptomatic patients (12 feet) were included in the study. The preoperative and postoperative angles were assessed on weight-bearing radiographs for statistical significance using nonparametric paired t tests. Results: The postoperative hallux valgus angles, intermetatarsal angles, first and fifth metatarsal head widths, and maximum distance between the first and fifth metatarsal heads decreased significantly (p < 0.05). Conclusion: The results suggest a very good radiological outcome in symptomatic patients following simultaneous first and fifth metatarsal osteotomies. All the angles measured postoperatively, except the distal metatarsal articular angle, showed a statistically significant reduction. IntroductionThe term 'splay foot' connotes an abnormal widening of the forefoot in relation to the heel. Clinically, the splay foot 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 part of the forefoot, there is varus deformity of the fifth toe with a relative valgus position of the fifth metatarsal and resultant bunionette formation. This deformity is often associated with metatarsalgia under the second metatarsal head because of its relative elongation in relation to the first metatarsal bone. Radiologically, splay foot is characterized by an intermetatarsal angle (IMA) between the first and second rays of greater than 12 degrees,