2019 年 38 巻 2 号 p. 143-148
Objective: To treat hallux valgus (HV) accompanied by metatarsalgia, which may be associated with painful plantar callosities and metatarsophalangeal joint dislocation, the surgical procedure should be selected in accordance with patient's condition. To date, we have performed a modified Lapidus procedure with shortening for HV with metatarsalgia and combination metatarsal proximal osteotomy for shortening (CMOS) of the lesser toes. This report compared the postoperative outcomes of CMOS with those of cases without lesser toes symptoms and also comparatively investigated postoperative outcomes of surgery for HV.
Methods: The study included 82 feet in 66 patients with HV who underwent postoperative follow-up for at least one year. CMOS procedures were performed on 52 feet (40 patients) with lesser toes symptoms (C group), with a mean age at surgery of 64.2 years. There were 30 feet (26 patients) without lesser toes symptoms, with a mean age at surgery of 54.3 years. All patients underwent the modified Mann procedure (M group). We compared pre- and postoperative HV angles on plain radiographs of the foot using the Japanese Society for Surgery of the Foot (JSSF) Hallux Scale using the unpaired t-test.
Results: In the C group, the HV angle improved from 46.1 to 17.2 degrees and the JSSF score improved from 47.2 to 94.4 points. In the M group, the HV angle improved from 37.8 to 11.4 degrees and the JSSF score from 54.7 to 89.8 points. The only significant difference between the two groups was in the preoperative HV angle. Apart from the preoperative HV angle, C group results were not inferior to M group results on radiographical and clinical findings.
Conclusion: Surgical intervention for HV should be decided according to the presence of metatarsalgia. Our findings suggest that successful surgical treatment for HV depends on metatarsalgia and metatarsal bone shortening osteotomy.
