R Jawish1. 1. Service de Chirurgie Pédiatrique, Hôpital Intercommunal de Créteil.
Abstract
MATERIAL AND METHODS: Open wedge osteotomy of the first cuneiform was used for correction of metatarsus varus primus. The osteotomy interested the medial, dorsal and plantar face of the first cuneiform, but lateral cortex should be carefully left intact, it is used like a hinge for opening the osteotomy. This procedure is carried out when varus of the tarsometatarsal joint is superior to 20 degree, it is reduced to its normal value, between 5 and 10 degree. Osteotomy is stabilized with bone graft. In resistant metatarsus adductus, closed wedge osteotomy of the cuboid has been added to correct the varus deformity of the fore foot, it allowed lateral swing of the forefoot: the bone excised from cuboid is used to stabilized medial osteotomy. Twelve children, aged 5 to 15 years, underwent medial open wedge osteotomy of the first cuneiform for correction of 16 feet including 8 hallux valgus, 6 serpentine feet, defined as adductus of the forefoot and valgus of the hindfoot, and 2 clubfeet. In all hallux valgus it was associated with release of all contracted lateral structures and in three cases, shortening of the proximal phalanx. In serpentine feet and clubfeet closed wedge osteotomy of cuboid has been added. RESULTS: Results have been studied with follow up ranging between 18 months and 5 years. In 8 cases of hallux valgus, one case showed recurrence; failure was related to technical deficiency, because the lateral cortex of the first cuneiform was cut accidently leading to over lengthening of the first column. In 6 resistant metatarsus varus and 2 clubfeet, we didn't find any recurrence at term of our follow up. DISCUSSION: In all cases, growth of metatarsals hasn't been disturbed at term of our follow up and tarsometatarsal joint remained well corrected, because proximal epiphyseal plate of metatarsal was normally positioned and saved from damage.
MATERIAL AND METHODS: Open wedge osteotomy of the first cuneiform was used for correction of metatarsus varus primus. The osteotomy interested the medial, dorsal and plantar face of the first cuneiform, but lateral cortex should be carefully left intact, it is used like a hinge for opening the osteotomy. This procedure is carried out when varus of the tarsometatarsal joint is superior to 20 degree, it is reduced to its normal value, between 5 and 10 degree. Osteotomy is stabilized with bone graft. In resistant metatarsus adductus, closed wedge osteotomy of the cuboid has been added to correct the varus deformity of the fore foot, it allowed lateral swing of the forefoot: the bone excised from cuboid is used to stabilized medial osteotomy. Twelve children, aged 5 to 15 years, underwent medial open wedge osteotomy of the first cuneiform for correction of 16 feet including 8 hallux valgus, 6 serpentine feet, defined as adductus of the forefoot and valgus of the hindfoot, and 2 clubfeet. In all hallux valgus it was associated with release of all contracted lateral structures and in three cases, shortening of the proximal phalanx. In serpentine feet and clubfeet closed wedge osteotomy of cuboid has been added. RESULTS: Results have been studied with follow up ranging between 18 months and 5 years. In 8 cases of hallux valgus, one case showed recurrence; failure was related to technical deficiency, because the lateral cortex of the first cuneiform was cut accidently leading to over lengthening of the first column. In 6 resistant metatarsus varus and 2 clubfeet, we didn't find any recurrence at term of our follow up. DISCUSSION: In all cases, growth of metatarsals hasn't been disturbed at term of our follow up and tarsometatarsal joint remained well corrected, because proximal epiphyseal plate of metatarsal was normally positioned and saved from damage.