Clinical and Radiological Evaluation of Results of Surgical Correction of Forefoot Adduction by Cuneiform and Cuboid Osteotomy Using Radiological Forefoot Measurements

Background: Forefoot adduction is a relatively common problem. It is usually mild or it can be effectively managed conservatively. Severe deformities may require surgical treatment. The aim of the study was to perform a clinical and radiologic evaluation of forefoot adduction correction using medial cuboid and cuneiform osteotomy with a transposed wedge.

Material and methods: This is a retrospective study involving 16 patients who underwent 20 procedures. Mean age at surgery was 6 years (3-13). Clinical evaluation was based on measurements of forefoot deviation and patients'/care-givers' subjective opinion. The radiologic parameters assessed comprised the first ray angle, talar-first metatarsal angle, calcaneal-fifth metatarsal angle, talocalcaneal angle, metatarsus adductus angle, and Kilmartin's angle. Results were then compared in children below and above 6 years of age. The mean duration of follow-up was 4.6 years (2-9).

Results: The clinical and subjective outcome was rated as good in 16 procedures and satisfactory in 4. The talar-first metatarsal angle, calcaneal-fifth metatarsal angle, metatarsus adductus angle, and Kilmartin's angle were significantly reduced, while the talocalcaneal and first ray angle remained unchanged. A significantly better correction of metatarsus adductus and talar-first metatarsal angle was achieved In children below 6 years of age compared to older patients.

Conclusions: 1. Medial cuneiform and cuboid osteotomy with a transposed wedge improves both clinical and radiological parameters, especially in children under the age of 6. 2. Besides the metatarsus adductus angle, the talar-first meta-tarsal, calcaneal-fifth metatarsal and Kilmartin's angles appear to be good radiologic indicators of correction.