Correcting Arthrodesis of First Tarsometatarsal Joint in the Treatment of Hallux Valgus

D.V. Prozorovskiy, R.I. Buznytskiy, К.К. Romanenko, А.V. Ermovskiy

Abstract


Background. Transversal-spread deformation of forefeet with hallux valgus has large prevalence in society: 75–82 % in women and 4 % — in men. The aim of the study was to analyze the results of surgical treatment in patients with hallux valgus and in combination with hypermobility of the first tarsometatarsal joint at implementation of correcting Lapidus arthrodesis. Materials and methods. Under our supervision, there were 12 patients (24 feet) with the transversal-spread deformation of forefeet and hallux valgus with the presence of hypermobility of the first tarsometatarsal joint. The average age of patients was 43.8 years (27–60 years). A middle period of supervision in a postoperative period is 25 months (from 6 months to 3.5 years). All patients underwent standard clinical (determination of hypermobility of the first tarsometatarsal joint) and roentgenologic studies. To perform Lapidus arthrodesis, the next criteria are served as indications: corner of М1/М2 more than 20° and the presence of hypermobility at the first tarsometatarsal joint. Clinical evaluation of the results of treatment was performed using AOFAS score scale. Results. According to the AOFAS scale, in 11 (91.7 %) patients treatment outcomes were considered as good, and in 1 (8.3 %) patient — as satisfactory. The improvement of the average score makes 33 points. During the final control examination, the average corner correction in M1/M2 was 13.3°. The arthrodesis of the first tarsometatarsal joint was achieved in all cases. At the same time, 1 (8.3 %) patient had delayed consolidation, which resulted in the need to continue the unloading of the anterior feet with walking in the Barouk shoe up to 3 months after surgery. The value of the hallux valgus correction was on the average 29.5°. One (8.3 %) patient had a partial recurrence of hallux valgus, up to 25° of М1/Р1 corner that finds explanation in the large size of initial deformation and insufficient correction of М1/М2 corner. Conclusions. Correcting arthrodesis of the first tarsometatarsal joint is the effective method of the treatment for forefoot deformation with severe hallux valgus and hypermobility of the first tarsometatarsal joint. Methodology of Lapidus arthrodesis allows to correct all basic components of deformation in hallux valgus and to minimize the possible recurrence of deformation with hypermobility of the first tarsometatarsal joint unlike the traditional correcting osteotomies of the first metatarsus bone due to breaking one of meaningful links of pathogenesis of deformation. Stabilization of the resected first tarsometatarsal joint using H-shaped plate with angular stability in the treatment of hallux valgus provides the early mobilization of the patient in the Barouk shoe and allows to avoid bulky casts and sizable orthopedic orthesis.

Keywords


correcting arthrodesis of the first tarsometatarsal joint; Lapidus arthrodesis; hallux valgus treatment

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DOI: https://doi.org/10.22141/1608-1706.6.17.2016.88626

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