The “AdductoValgus” Foot: Description of Deformity and Technique for Surgical Reconstruction

CATEGORY: Midfoot/Forefoot INTRODUCTION/PURPOSE: The literature is replete with descriptions of metatarsus adductus (pediatric patients) and metatarsus primus varus (adult patients) deformities along with recommendations for treatment. For adult deformities isolated to the first ray, a technique involving a cuneiform-metatarsal arthrodesis (e.g. Lapidus procedure) is often employed. There is a paucity of literature describing adult manifestations of adduction deformities involving multiple metatarsals. The senior author has treated a number of adult patients with these types of deformities. This case series is presented here with a description of the deformity and a technique for surgical reconstruction. METHODS: Five patients having undergone surgical reconstruction for symptomatic midfoot/forefoot deformities involving adduction of multiple metatarsals (and valgus metatarsophalangeal joints) were retrospectively reviewed. The first ray deformities were treated with arthrodesis of the first metatarsal to the medial cuneiform, along with a distal soft tissue release and medial eminence resection as appropriate. Lesser ray deformities were corrected with oblique osteotomies of the metatarsal shafts (and metatarsophalangeal joint capsulorraphies and/or pinning as appropriate). RESULTS: All patients went on to radiographic union of their arthrodeses and osteotomies. The midfoot (metatarsus adductus) deformities, and hallux valgus deformities, maintained correction compared to preoperative alignment. There were some lesser metatarsophalangeal joint valgus recurrences. There were no severe complications of deep infection or revision surgery. Conclusion: The “AdductoValgus” foot deformity presents in adult patients with adduction of multiple metatarsals and corresponding metatarsophalangeal joint valgus. The deformity can result in pain with mobility and difficulty with shoewear. Surgical reconstruction including first ray tarsometatarsal arthrodesis and osteotomies of the involved lesser metatarsals appears a viable option for deformity correction and symptomatic relief.