Comparison of Intercuneiform 1-2 Joint Mobility Between Hallux Valgus and Normal Feet Using Weightbearing Computed Tomography and 3-Dimensional Analysis

2017 ◽  
Vol 39 (3) ◽  
pp. 355-360 ◽  
Author(s):  
Tadashi Kimura ◽  
Makoto Kubota ◽  
Naoki Suzuki ◽  
Asaki Hattori ◽  
Keishi Marumo
Keyword(s):  
Computed Tomography ◽  
Hallux Valgus ◽  
Lower Limbs ◽  
3D Analysis ◽  
Hallux Valgus Angle ◽  
Level Of Evidence ◽  
Intermetatarsal Angle ◽  
3 Dimensional ◽  
Valgus Angle ◽  
Medial Cuneiform

Background: An association has been reported between hallux valgus and hypermobility of the first ray, but subluxation of the intercuneiform 1-2 joint was also suspected in some cases. However, dynamics of the intercuneiform 1-2 joint has seldom been investigated. This study used weightbearing computed tomography (CT) and a 3-dimensional (3D) analysis system to evaluate displacement of the intercuneiform 1-2 joint, intercuneiform 2-3 joint, and second cuneonavicular joint due to weightbearing in hallux valgus and normal feet. Methods: Patients were 11 women with hallux valgus (mean age, 56 years; mean hallux valgus angle, 43 degrees; mean first-second intermetatarsal angle, 22 degrees) and 11 women with normal feet (mean age, 57 years; mean hallux valgus angle, 14 degrees; mean first-second intermetatarsal angle, 9 degrees). Each patient was placed supine with the lower limbs extended, and CT was performed under nonweightbearing and weightbearing conditions (load equivalent to body weight). 3D models reconstructed from CT images were used to compare displacement of the intermediate cuneiform relative to the medial cuneiform under nonweightbearing and weightbearing conditions. Results: Relative to the medial cuneiform, the middle cuneiform was displaced by 0.1 and 0.8 degrees due to dorsiflexion, 0.2 and 1.0 degrees due to inversion, and 0.7 and 0.7 degrees due to abduction in normal feet and feet with hallux valgus, respectively, with the latter having significantly greater dorsiflexion ( P = .0067) and inversion ( P = .0019). There was no significant intergroup difference at the intercuneiform 2-3 joint and second cuneonavicular joint. Conclusion: This study clarified the detailed load-induced displacement of the cuneiform 3-dimensionally. Compared with normal feet, hallux valgus feet had significantly greater mobility of the intercuneiform 1-2 joint, suggesting hypermobility of this joint. Level of Evidence: Level III, case-control study.

Weightbearing Computed Tomography and 3-Dimensional Analysis of Mobility Changes of the First Ray After Proximal Oblique Osteotomy for Hallux Valgus

2020 ◽  
pp. 107110072096247
Author(s):  
Tadashi Kimura ◽  
Makoto Kubota ◽  
Naoki Suzuki ◽  
Asaki Hattori ◽  
Mitsuru Saito
Keyword(s):  
Computed Tomography ◽  
Hallux Valgus ◽  
Metatarsal Osteotomy ◽  
Hallux Valgus Angle ◽  
Intermetatarsal Angle ◽  
Oblique Osteotomy ◽  
Valgus Angle ◽  
Significant Difference ◽  
Before And After ◽  
First Ray

Background: Hypermobility of the first ray has been evaluated using various methods and has conventionally been considered to be involved in the pathology of hallux valgus. We hypothesized that hypermobility of the first ray in hallux valgus could be decreased by simply correcting foot alignment without arthrodesis. This study sought to evaluate first-ray mobility using weightbearing computed tomography (CT) before and after proximal oblique osteotomy and also in healthy volunteer’s feet. Methods: Subjects were 11 feet of 11 patients with primary hallux valgus who underwent surgery with a plantarly applied anatomic precontoured locking plate and 22 feet of 11 matched healthy volunteers. We performed nonweightbearing and weightbearing (using a load equivalent to body weight) CT scans using an original loading device preoperatively and 1-1.5 years postoperatively. Three-dimensional displacement of the distal bone relative to the proximal bone was quantified for each joint of the first ray by comparing nonweightbearing and weightbearing CT images. Results: At baseline, there were significant differences in hallux valgus angle ( P < .001) and 1-2 intermetatarsal angle ( P < .001) between healthy volunteer’s feet and preoperative hallux valgus feet. Hallux valgus angle ( P < .001) and 1-2 intermetatarsal angle ( P < .001) differed significantly between before and after surgery. All first ray joint displacement under loading decreased postoperatively to within 2° of that in healthy volunteer’s feet and showed no significant difference between postoperatively hallux valgus feet and healthy volunteer’s feet ( P > .05). Conclusions: We found that first metatarsal osteotomy even without arthrodesis corrected deformity and decreased mobility of the first ray after hallux valgus surgery. Level of Evidence: Level III, case-control study.

Maintenance of Correction of the Modified Lapidus Procedure With a First Metatarsal to Intermediate Cuneiform Cross-Screw Technique

2019 ◽  
Vol 41 (4) ◽  
pp. 428-436 ◽  
Author(s):  
Travis M. Langan ◽  
Joseph M. Greschner ◽  
Roberto A. Brandão ◽  
David A. Goss ◽  
Clair N. Smith ◽  
...  
Keyword(s):  
Hallux Valgus ◽  
Case Series ◽  
Bony Union ◽  
Hallux Valgus Angle ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Intermetatarsal Angle ◽  
First Metatarsal ◽  
Tarsometatarsal Joint ◽  
Valgus Angle

Background: Recurrence of deformity remains a concern when fusing the first tarsometatarsal joint for correction of hallux valgus (HV). A recently described construct adds an additional point of fixation from the plantar medial first metatarsal to the intermediate cuneiform. The purpose of this study was to determine the maintenance of correction of the first and second intermetatarsal angle, hallux valgus angle, and tibial sesamoid position after undergoing a first tarsometatarsal joint arthrodesis using the proposed construct. Methods: A radiographic review was performed of patients with HV treated with a first tarsometatarsal joint arthrodesis with the addition of a cross-screw intermediate cuneiform construct. Three observers reviewed radiographic data, including preoperative weightbearing, first weightbearing, and final weightbearing plain-film radiographs. Initial improvement and maintenance of intermetatarsal angle, hallux valgus angle (HVA), and tibial sesamoid position were evaluated radiographically. A total of 62 patients met inclusion criteria and were included in the study. Mean follow-up time was 9.3 months (SD 6.7). Results: Bony union was achieved in 60 of 62 patients (96.7%). Two of 62 patients required revision surgery as a result of recurrence (3.3%). Final mean improvement of the intermetatarsal angle (IMA) was 6.8 degrees (±2.9 degrees), HVA was 14.8 degrees (±7.5 degrees), and tibial sesamoid position was 2.4 (±1.4) positions. Mean loss of IMA correction was 1.5 degrees (±1.6), HVA was 2.9 degrees (±4.8 degrees), and tibial sesamoid position was 0.8 (±0.8). Conclusion: This study showed that the cross-screw intermediate cuneiform construct for first tarsometatarsal joint arthrodesis had a good union rate, a low complication rate, and maintained radiographic correction. Level of Evidence: Level IV, retrospective case series.

Modified Austin Procedure for Correction of Hallux Valgus

1997 ◽  
Vol 18 (3) ◽  
pp. 119-127 ◽  
Author(s):  
Hans-Jörg Trnka ◽  
Alexander Zembsch ◽  
Hermann Wiesauer ◽  
Marc Hungerford ◽  
Martin Salzer ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Hallux Valgus ◽  
Metatarsophalangeal Joint ◽  
Metatarsal Head ◽  
Hallux Valgus Angle ◽  
First Metatarsophalangeal Joint ◽  
Intermetatarsal Angle ◽  
Soft Tissue Procedure ◽  
Valgus Angle

The Austin osteotomy is a widely accepted method for correction of mild and moderate hallux valgus. In view of publications by Kitaoka et al. in 1991 and by Mann and colleagues, a more radical lateral soft tissue procedure was added to the originally described procedure. From September 1992 to January 1994, 85 patients underwent an Austin osteotomy combined with a lateral soft tissue procedure to correct their hallux valgus deformities. Seventy-nine patients (94 feet) were available for follow-up. The average patient age at the time of the operation was 47.1 years, and the average follow-up was 16.2 months. The average preoperative intermetatarsal angle was 13.9°, and the average hallux valgus angle was 29.7°. After surgery, the feet were corrected to an average intermetatarsal angle of 5.8° and an average hallux valgus angle of 11.9°. Sesamoid position was corrected from 2.1 before surgery to 0.5 after surgery. The results were also graded according to the Hallux Metatarsophalangeal Interphalangeal Score, and the functional and cosmetic outcomes were graded by the patient. Dissection of the plantar transverse ligament and release of the lateral capsule repositioned the tibial sesamoid and restored the biomechanics around the first metatarsophalangeal joint. There was no increased incidence of avascular necrosis of the first metatarsal head compared with the original technique.

scholarly journals Radiographic Recurrence of Hallux Valgus Based on Osteotomy Location

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0021
Author(s):  
Andrew Federer ◽  
Travis Dekker ◽  
David Tainter ◽  
Jordan Liles ◽  
Mark Easley ◽  
...  
Keyword(s):  
Hallux Valgus ◽  
Weight Bearing ◽  
Surgical Correction ◽  
P Value ◽  
Single Individual ◽  
Hallux Valgus Angle ◽  
Intermetatarsal Angle ◽  
Valgus Angle ◽  
Significant Difference

Category: Bunion Introduction/Purpose: Hallux valgus (HV) is one of the most common deformities of the foot resulting in pain and lifestyle modification of the patient. Recurrence rates of 10-47% have been documented in single individual osteotomy series. Unfortunately, surgical correction and recurrence are often defined as changes related to normal radiographs and not actually as the magnitude of correction lost with follow-up. Currently there have not been studies evaluating the percentage of recurrence of intermetatarsal angle (IMA) and hallux valgus angle (HVA). As there is substantial difference in starting IMA and HVA, as well as amount of surgical correction, our goal was to evaluate the percentage loss of correction over time comparing preoperative, initial postoperative and minimum of 2-year follow up radiographs among three different surgical correction techniques. Methods: This is a retrospective chart review study that examines the weight-bearing radiographic measurements of patients undergoing hallux valgus corrective surgery at a single institution over 5 years. Fifty-three patients were divided into first tarsometatarsal arthrodesis (i.e. Lapidus), mid-diaphyseal osteotomies (i.e. scarf), and distal metatarsal osteotomies (i.e. chevron). The preoperative, initial postoperative, and final follow up weight-bearing radiographs were measured for intermetatarsal angle (IMA) and hallux valgus angle (HVA). Primary outcome was percentage of recurrence of IMA and HVA, with the difference in angles between preoperative and initial postoperative weight-bearing films being considered 100% correction. The percentage of recurrence between initial postoperative and most recent follow up was then calculated (Figure 1A). A one-way analysis of variance (ANOVA) test and post-hoc Tukey-Kramer tests were used to compare preoperative IMA and HVA and percentage recurrence of IMA and HVA at most recent follow up. Results: There was no significant difference between Lapidus (14.3deg) and mid-diaphyseal osteotomies (12.7deg) in preoperative IMA (p-value=0.26). There was a significant difference between Lapidus (-0.3deg) and mid-diaphyseal (2.8deg) osteotomies for degree of hallux valgus recurrence as measured by IMA between initial postoperative films and final 2-year follow up (p-value=0.009). Lapidus procedure showed a greater magnitude decrease in IMA degrees from preoperation to final follow up compared to distal osteotomy (p-value=0.037) and trended toward significance compared to mid-diaphyseal (p-value=0.056). Mid-diaphyseal osteotomies (30%) showed a statistically significant higher percentage of IMA recurrence compared to Lapidus (-11%) (p-value=0.0014) (Figure 1B). When comparing percentage recurrence of HVA, distal osteotomies had a significantly smaller rate of recurrence when compared to the diaphyseal osteotomies (p-value=0.030). Conclusion: Though Lapidus and mid-diaphyseal osteotomies were performed for patients with a similar preoperative IMA, mid-diaphyseal osteotomies had a significantly higher percentage of recurrence at 2-year follow up compared to Lapidus procedures. Moreover, Lapidus procedures trended toward greater overall of IMA correction compared to mid-diaphyseal osteotomies. When either a Lapidus or mid-diaphyseal osteotomy is indicated, a Lapidus procedure may result in decreased rate of radiographic recurrence of hallux valgus at 2 years.

scholarly journals Natural Progression of Radiographic Indices in Juvenile Hallux Valgus Deformity

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0031
Author(s):  
Seung Yeol Lee ◽  
Soon-Sun Kwon ◽  
Moon Seok Park ◽  
Kyoung Min Lee
Keyword(s):  
Hallux Valgus ◽  
Older Patients ◽  
Valgus Deformity ◽  
Hallux Valgus Angle ◽  
Intermetatarsal Angle ◽  
Younger Patients ◽  
Hallux Valgus Deformity ◽  
Metatarsal Angle ◽  
Valgus Angle ◽  
Metatarsus Adductus

Category: Bunion Introduction/Purpose: There is a lack of quantitative studies on the progression of juvenile hallux valgus deformity. Therefore, we performed this study to estimate an annual change of radiographic indices for juvenile hallux valgus. Methods: We reviewed medical records of consecutive patients under the age of 15 with juvenile hallux valgus who underwent weight-bearing foot radiographs more than twice, and were followed over a period of one year or more. A total of 133 feet from 69 patients were included. Hallux valgus angle, hallux interphalangeal angle, intermetatarsal angle, metatarsus adductus angle, distal metatarsal articular angle, anteroposterior talo-1st metatarsal angle, anteroposterior talo-2nd metatarsal angle, and lateral talo-1st metatarsal angle were measured and were used as a study criteria. The progression rate of hallux valgus angle was adjusted by multiple factors including the use of a linear mixed model with gender and radiographic measurements as the fixed effects and laterality and each subject as the random effect. Results: Our results demonstrate that the value of hallux valgus angle on the radiographs progressed as the patients grew older. The hallux valgus angle increased by 0.8° per year (p<0.001)(Figure). The distal metatarsal articular angle also increased by 0.8 per year (p=0.003). Conversely, hallux interphalangeal angle decreased by 0.2° per year (p=0.019). Progression of the intermetatarsal angle and metatarsus adductus angle with aging were not statistically significant. There was a difference in progression of radiographic indices between older patients (≥10 years) and younger patients (<10 years). The hallux valgus angle increased by 1.5° per year (p<0.001) in younger patients, progression of the hallux valgus angle in older patients was not statistically significant (p=0.869) as children grew up. Conclusion: These results suggest that the hallux valgus angle increased in patients with juvenile hallux valgus under 10 years old, unlike the patients aged 10 or older. We believed that our results can help surgeons to determine a treatment strategy that uses the growth potential to achieve correction of deformity such as lateral hemiepiphyseodesis of the 1st metatarsal to patients with juvenile hallux valgus.

Correlation of Hallux Valgus Surgical Outcome With AOFAS Forefoot Score and Radiological Parameters

2005 ◽  
Vol 26 (2) ◽  
pp. 122-127 ◽  
Author(s):  
David Thordarson ◽  
Edward Ebramzadeh ◽  
Murali Moorthy ◽  
Jessica Lee ◽  
Sally Rudicel
Keyword(s):  
Lower Extremity ◽  
Physical Examination ◽  
Hallux Valgus ◽  
Hallux Valgus Angle ◽  
Lower Extremity Function ◽  
Aofas Score ◽  
Intermetatarsal Angle ◽  
Valgus Angle ◽  
Sf 36 ◽  
Type Of Surgery

Background: The purpose of the study was to evaluate the effect of three different types of hallux valgus surgeries on patient function using validated questionnaires and to correlate the results with radiographic and physical examinations. This study presents the 2-year followup data of a previous prospective outcome study. Methods: One hundred and ninety-six patients were enrolled in this study and completed a baseline AAOS Lower Limb Outcomes Data Collection Questionnaire. They completed the same form at 6, 12, and 24 months after having one of three types of hallux valgus surgeries (106 chevron osteotomies, 72 modified McBride procedures, and 18 modified Lapidus procedures). This questionnaire included the Short Form-36 Health Survey (SF-36) as well as questions relating to lower extremity function. Additionally, physicians were asked to complete preoperative and postoperative questionnaires on each patient that included radiographic and physical examination data and the type of surgery done. Completed outcome surveys and radiographic data were available on 196 patients, and physical examination scores were available to assign an AOFAS score in 111 patients at 24-month followup. A one-way comparison was done after stratifying the results for the type of surgery, preoperative hallux valgus angle and 1-2 intermetatarsal angle, postoperative hallux valgus angle and 1-2 intermetatarsal angle, and the change in the angles. Results: Four of the 10 SF-36 scores (physical function, role-physical, bodily pain, and role-emotional) for the combined data improved by more than five points. For the AAOS lower extremity function scores, physical health and pain (68.5 to 81.6), satisfaction with symptoms (1.8 to 3.6), global foot and ankle (77.6 to 93.4), and shoe comfort (29.0 to 58.7) scores all increased significantly. The AOFAS score increased from 52.6 to 85.5 ( p < 0.001). Surprisingly, when comparing mild-to-moderate to severe deformities preoperatively and postoperatively using the absolute magnitude of the angular change in the hallux valgus or intermetatarsal angles, similar improvement was noted in AOFAS, SF-36, and AAOS lower extremity scores. The magnitude of preoperative deformity, postoperative residual deformity, and magnitude of correction also did not significantly change the amount of improvement in any of these scores. No significant differences were noted in the outcome scores among the three different surgeries. Conclusion: Patients who had hallux valgus surgery had significant improvements in four of their SF-36 scores, four of five of AAOS lower extremity scores, and AOFAS scores. The degree of deformity, amount of correction, or type of operation did not influence outcome.

scholarly journals The Role of Weight-Bearing Computed Tomography Scan in Hallux Valgus

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0035
Author(s):  
Sreenivasulu Metikala ◽  
Karim Mahmoud Khamis ◽  
George W. Fryhofer ◽  
Samir Mehta ◽  
Daniel C. Farber
Keyword(s):  
Computed Tomography ◽  
Hallux Valgus ◽  
Weight Bearing ◽  
Roc Curves ◽  
Musculoskeletal Radiology ◽  
Valgus Angle ◽  
Medial Cuneiform ◽  
Axial Ct ◽  
Α Angle ◽  
And Control

Category: Midfoot/Forefoot; Bunion Introduction/Purpose: Hyperpronation of the 1st metatarsal in hallux valgus (HV) is poorly understood by conventional weightbearing radiography. We aimed to evaluate this parameter using weightbearing computed tomography (WBCT) and understand its association with other standard measurements. Methods: Retrospective evaluation of WBCT and weightbearing radiographs (WBXR) was performed for 20 patients with hallux valgus (HV) feet and 20 controls with no such deformity. Axial CT images of both groups were compared for 1st metatarsal pronation angle (α angle) and tibial sesamoid subluxation (TSS) grades. The hallux valgus angle (HVA), first-second intermetatarsal angle (IMA), 1st metatarsal-medial cuneiform angle (MMCA), Meary’s angle, and calcaneal pitch (CP) angle of the study and control groups were compared on both WBXR and the corresponding 2D images of WBCT. All the measurements were independently studied by a dedicated musculoskeletal radiology fellow. Results: HV group demonstrated significantly higher values for TSS grade (p < 0.001) but not for α angle (p = 0.19) compared to controls. Pearson’s correlations of the α angle, in the HV group, revealed no significant linear relationship with TSS grades, IMA and MMCA, and only a moderate positive correlation with HVA as per WBXR (r = 0.38, p = 0.014) but not by WBCT (p = 0.084). Also, α angle performed within the range of a chance (AUC 0.64, 95% CI: 0.49 to 0.66) when measured by receiver operating characteristic (ROC) curves. Conclusion: The α angle - a measure of abnormal hyperpronation of the 1st metatarsal - is an independent factor that may co- exist with other parameters in HV, but in isolation has limited diagnostic utility. ‘Abnormal’ α angles may even be observed in individuals without HV deformity. An increase in the HVA, IMA, MMCA or TSS grade is not necessarily associated with a similar increase in the α angle and hence, the severity of HV deformity may not be judged on this parameter alone. The WBCT is a reliable method to assess hyperpronation and guide physicians during surgical management. [Table: see text][Table: see text]

scholarly journals Hallux valgus correction using Scarf-Osteotomy leads to shortening of the first metatarsal

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0032
Author(s):  
Christopher Lenz ◽  
Paul Borbas
Keyword(s):  
Hallux Valgus ◽  
Consecutive Series ◽  
Hallux Valgus Angle ◽  
Intermetatarsal Angle ◽  
First Metatarsal ◽  
Valgus Angle ◽  
Correction Technique ◽  
Second Metatarsal ◽  
First Ray ◽  
Akin Osteotomy

Category: Bunion Introduction/Purpose: In hallux valgus deformity less weight can be borne by the first ray which may lead to transfer metatarsalgia and lesser toe deformities. Depending on the exact configuration of the bone cuts during the scarf procedure, an iatrogenic shortening of the first metatarsal may occur which may diminish weightbearing ability of the first ray as well, causing transfer metatarsalgia. The aim of the present study was therefore to determine preoperative and postoperative changes in length of the first metatarsal by using different methods of measuring metatarsal length. Methods: A consecutive series of 118 feet in 106 patients (89% female, 11% male) was enrolled, who underwent correctional osteotomy (Scarf-with/without Akin-Osteotomy) from May 2015 to July 2017 at a single institution. Patients, who underwent additional shortening osteotomy of the metatarsals, were excluded. Average age at the time of surgery was 51 years (range, 14 to 83 years). Pre- and postoperative angle measurement of hallux valgus- and intermetatarsal angle was assessed at between six weeks and three months postoperatively on standardized weight-bearing radiographs in dorsoplantar plane. We also identified early complications in hallux valgus surgery. An assessment and comparison of different methods of measuring metatarsal length (length of first metatarsal, ratio first to second metatarsal, Coughlin method) postoperatively was performed to identify the amount of shortening with this technique. Results: Hallux valgus angle was statistically significant reduced by an average of 18.6° (28.3° preoperatively to 9.7° postoperatively, p < 0.001), intermetatarsal angle by 7.7° (12.8° to 5.1°, p < 0.001). Measuring the length of the first metatarsal, in all three methods a statistically significant reduction of the first metatarsal length could be detected. Mean absolute shortening of 1.8 mm was measured (p < 0.001). The ratio of the first metatarsal to the second metatarsal averaged -0.03 (p = 0.02). The mean relative lengthening of the second metatarsal, using the method described by Coughlin, was 0.42 mm (from 4.51 to 4.89 mm, p < 0.001) on average. Of those three methods, the Coughlin method showed the highest correlation. 6 minor complications were observed (5%). Conclusion: In the current study we could demonstrate a significant reduction of hallux valgus angle and intermetatarsal angle with hallux valgus correction using Scarf-/Akin-Osteotomy, with a low complication rate. However, statistically significant shortening of the first metatarsal could be detected as well. Further research is required to improve and establish a hallux valgus correction technique without shortening of the first metatarsal.

Influence of Metatarsal Head Displacement on Metatarsal Pressure Distribution after Hallux Valgus Surgery

Foot & Ankle ◽  
1993 ◽  
Vol 14 (2) ◽  
pp. 85-89 ◽  
Author(s):  
Axel Wanivenhaus ◽  
Wolfgang Brettschneider
Keyword(s):  
Pressure Distribution ◽  
Hallux Valgus ◽  
Load Distribution ◽  
Force Plate ◽  
Metatarsal Head ◽  
Hallux Valgus Angle ◽  
Lateral Direction ◽  
Intermetatarsal Angle ◽  
Head Displacement ◽  
Valgus Angle

We reviewed 63 feet after plain subcapital osteotomy for simultaneous correction of hallux valgus and metatarsus primus varus. Results were evaluated clinically and by radiographs and force plate measurements. Eighty-three percent of the patients were satisfied with their surgery. The hallux valgus angle was improved by 9.3° and the intermetatarsal angle by 6°. The osteotomy resulted in a displacement of the metatarsal head in the lateral direction(10 mm) and in the plantar direction (11.3 mm). Nor malization of the load distribution on the metatarsal head was achieved in the group with 11 to 15 mm of plantar displacement. Basedon our results, we recommend plain subcapital osteotomy for hallux valgus deformities with moderate metatarsus primus varus. After correction of the intermetatarsal angle and sufficient plantar displacement a physiological distribution of load on the metatarsal head can be expected.

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