Journal List > J Korean Foot Ankle Soc > v.21(1) > 1043446

Choi, Shin, and Suh: The Results of the First Ray Forefoot Osteotomy Using Low Profile Wedge Plate without a Bone Grafting for Pes Planus Correction

Abstract

Purpose:

We retrospectively analyzed the radiographic and clinical results after the first ray of forefoot osteotomy using low profile wedge plate without additional cancellous bone grafting for pes planus correction.

Materials and Methods:

Twenty-four patients were enrolled in this study. Medial cuneiform opening wedge osteotomy was performed in 12 patients (Cotton osteotomy, group C) and first metatarsal base osteotomy was performed in 12 patients (group MT).

Results:

On average, the wedge size was 5.61 mm (5∼6 mm). The mean time to radiographic union was 3.18 and 3.27 months in groups C and MT, respectively. Postoperative talonavicular coverage angle, talo-first metatarsal angle (anteroposterior), talo-first metatarsal angle (lateral), talo-calcaneal angle (lateral), medial cuneiform height, and American orthopaedic foot, as well as ankle society midfoot scale were significantly improved in both groups. Nonunion, delayed union or fixation failure was not presented in our series.

Conclusion:

We have shown that low profile wedge plate was effective in the case of first ray forefoot osteotomy for pes planus correction without any additional cancellous bone grafting.

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Figure 1.
Various types of low profile mini opening wedge plate used for pes planus deformity correction (Arthrex Inc., Naples, FL, USA).
jkfas-21-7f1.tif
Figure 2.
Preoperative weightbearing foot anteroposterior (A) and lateral (B) radiographs of a 37-year-old male patient with pes planus. (C, D) Immediate postoperative radiographs shows the correction of radiographic parameters. Note that the opening wedge gap in the medial cuneiform bone was remained empty without additional cancellous bone graft. (E, F) Radiographs at the final follow-up (1.5 years) show a stable maintenance with a radiographic union.
jkfas-21-7f2.tif
Figure 3.
Preoperative weightbearing foot anteroposterior (A) and lateral (B) radiographs of a 47-year-old female patient with pes planus and hallux valgus deformity. (C, D) Immediate postoperative radiographs shows the correction of radiographic parameters. Note that the opening wedge gap in the 1st metatarsal bone was remained empty without additional cancellous bone graft. (E, F) Radiographs at the final follow-up (1 year) show a stable maintenance with a radiographic union.
jkfas-21-7f3.tif
Table 1.
Patients’ Demographics in Each Group
Variable Group C (n=12) Group MT (n=12)
Mean age (yr) 37.1±13.18 43.14±14.25
Follow-up period (mo) 16.22±4.16 17.13±4.27
Male:female 4:8 3:9
Right:left 4:8 8:4

Values are presented as mean±standard deviation or number only. Group C: Cotton osteotomy, Group MT: 1st metatarsal base osteotomy.

Table 2.
Whole Radiologic and Clinical Parameters Related to Each Group
Variable Group C (n=12) Group MT (n=12)
Preop Postop Preop Postop
TNCA (°) 27.94±7.75 18.01±6.31 26.28±4.41 17.5±5.18
T1MTA (°) 24.34±5.85 18.05±5.44 26.33±4.41 19.7±4.82
Meary angle (°) ―13.64±3.32 1.83±2.26 ―12.23±1.62 1.68±2.52
TCA (°) 60.76±6.38 46.64±7.62 58.5±7.73 42.36±7.81
CPA (°) 8.13±3.23 16.25±4.62 7.31±2.66 15.1±2.11
MCH (mm) 14.52±3.22 18.12±2.24 15.55±2.31 18.78±2.95
Time to radiographic union (mo) 3.18±0.99 3.27±0.72
AOFAS score 61.76±5.23 88.21±6.56 62.57±5.14 88.52±2.45

Values are presented as mean±standard deviation. Group C: Cotton osteotomy, Group MT: 1st metatarsal base osteotomy, Preop: preoperative, Postop: postoperative, TNCA: talo-navicular coverage angle on anteroposterior (AP) radiograph, T1MTA: talo-1st metatarsal angle on AP radiograph, TCA: talo-calcaneal angle on lateral radiograph, CPA: calcaneal pitch angle on lateral radiograph, MCH: medial cuneiform height on lateral radiograph, AOFAS: American Orthopaedic Foot and Ankle Society.

Table 3.
Mean Correctional Power to Radiologic Parameters of Each Osteotomy
Variable Group C (n=12) Group MT (n=12) p-value
Δ TNCA (°) ―9.94±1.26 ―8.78±1.25 0.211
Δ T1MTA (°) ―6.29±3.16 ―6.63±2.39 0.437
Δ Meary angle (°) 15.47±2.27 13.91±3.28 0.991
Δ TCA (°) ―14.12±2.09 ―15.14±0.67 0.062
Δ CPA (°) 8.12±2.19 7.79±1.32 0.832
Δ MCH (mm) 3.60±1.12 3.23±0.81 0.76

Values are presented as mean±standard deviation. Group C: Cotton osteotomy, Group MT: 1st metatarsal base osteotomy, Δ: delta, an increment of a variable, TNCA: talo-navicular coverage angle on anteroposterior (AP) radiograph, T1MTA: talo-1st metatarsal angle on AP radiograph, TCA: talo-calcaneal angle on lateral radiograph, CPA: calcaneal pitch angle on lateral radiograph, MCH: medial cuneiform height on lateral radiograph.

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