Lapidus arthrodesis combined with middle metatarsal base rotation osteotomy in treatment of hallux valgus with metatarsus adductus_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 SHANG Lin , Lü Zhiqiang , ZHAO Shijun , CHU Litao , LI Chenqi , GAO Fu , LU Junjie , ZHANG Wei

Department of Minimally Invasive Orthopedics, Zhengzhou Orthopedic Hospital, Zhengzhou Henan, 450052, P. R. China;

Corresponding?author：

SHANG Lin, Email: 453616978@qq.com

Keywords：

Hallux valgus; metatarsus adductus; Lapidus arthrodesis; osteotomy

DOI：

10.7507/1002-1892.202509084

Video：

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Objective To explore effectiveness of the Lapidus arthrodesis combined with the middle metatarsal base rotation osteotomy in the treatment of hallux valgus (HV) with metatarsus adductus (MA). Methods Between February 2023 and September 2024, 18 patients (18 feet) of HV with MA were underwent Lapidus arthrodesis combined with the middle metatarsal base rotation osteotomy. There were 5 males and 13 females with an age of 50-68 years (mean, 55.3 years). The foot deformity was characterized by severe HV, redness and swelling at the utricle, and the corpus callosum on the plantar side of the forefoot. The preoperative American Orthopaedic Foot and Ankle Society (AOFAS) score was 44.2±3.8 and visual analogue scale (VAS) score was 7.1±0.9 after walking 1 km. The AOFAS score and VAS score were adopted to evaluate the postoperative function of the foot. The hallux valgus angle (HVA), metatarsus adductus angle (MAA), intermetatarsal angle (IMA), and distal metatarsal articular angle (DMAA) were measured after operation. Results All incisions healed by first intention. All patients were followed up 12-26 months (mean, 18 months). At last follow-up, the AOFAS score and VAS score after walking 1 km were 84.2±3.9 and 2.0±0.8, respectively, showing significant differences when compared with preoperative scores (P<0.05). Imaging review showed that the osteotomy sites all healed, with a healing time of (10.25±2.15) weeks. At last follow-up, the HVA, MAA, IMA, and DMAA were significantly lower than preoperative ones (P<0.05). During follow-up, all patients exhibited diffuse swelling of the feet, 10 patients experienced stiffness in the great toe, 1 foot showed numbness caused by medial plantar cutaneous nerve injury, and 1 foot of skin irritation caused by internal fixation. Conclusion For HV with MA, the Lapidus arthrodesis combined with middle metatarsal base rotation osteotomy can effectively correct deformity and relieve pain.

Citation： SHANG Lin, Lü Zhiqiang, ZHAO Shijun, CHU Litao, LI Chenqi, GAO Fu, LU Junjie, ZHANG Wei. Lapidus arthrodesis combined with middle metatarsal base rotation osteotomy in treatment of hallux valgus with metatarsus adductus. Chinese Journal of Reparative and Reconstructive Surgery, 2026, 40(4): 578-583. doi: 10.7507/1002-1892.202509084 Copy

1.	Barg A, Harmer JR, Presson AP, et al. Unfavorable outcomes following surgical treatment of hallux valgus deformity: a systematic literature review. J Bone Joint Surg (Am), 2018, 100(18): 1563-1573.
2.	Menz HB, Roddy E, Thomas E, et al. Impact of hallux valgus severity on general and foot-specific health-related quality of life. Arthrit Care Rre, 2010, 63(3): 396-404.
3.	Aiyer AA, Shariff R, Ying L, et al. Prevalence of metatarsus adductus in patients undergoing hallux valgus surgery. Foot Ankle Int, 2014, 35(12): 1292-1297.
4.	Ota T, Nagura T, Kokubo T, et al. Etiological factors in hallux valgus, a three-dimensional analysis of the first metatarsal. J Foot Ankle Res, 2017, 10: 43. doi: 10.1186/s13047-017-0226-1.
5.	Simons P, Fr?ber R, Loracher C, et al. First tarsometatarsal arthrodesis: an anatomic evaluation of dorsomedial versus plantar plating. J Foot Ankle Surg, 2015, 54(5): 787-792.
6.	Myerson MS, Fisher RT, Burgess AR, et al. Fracture dislocations of the tarsometatarsal joints: end results correlated with pathology and treatment. Foot Ankle, 1986, 6(5): 225-242.
7.	祁印澤, 唐廣君, 李昕宇, 等. Scarf截骨治療跖內收型青少年踇外翻的早期療效. 中華骨科雜志, 2024, 44(5): 302-307.
8.	馬占華, 潘旭月, 吳俊德, 等. 第1跖趾關節融合結合外側足趾旋轉Weil截骨治療重度跖內收型拇外翻. 中國骨傷, 2022, 35(12): 1127-1131.
9.	藍聲遠, 李星辰, 徐向陽, 等. 多根跖骨截骨矯形術與第一跖趾關節融合術治療嚴重跖骨內收踇外翻的療效比較. 中國修復重建外科雜志, 2025, 39(10): 1246-1250.
10.	常鑫, 張云龍, 楊杰, 等. 第一跖列三平面截骨聯合其余跖骨基底截骨治療中重度跖內收型踇外翻的早期療效. 中國修復重建外科雜志, 2020, 34(1): 37-40.
11.	Maringolo L, Pereira V, Maciel E, et al. Preliminary results of the correction of metatarsus adductus associated with severe hallux valgus. J Foot Ankle, 2019, 13(1): 63-69.
12.	Willems A, Houkes CM, Bierma-Zeinstra SMA, et al. How to assess consolidation after foot and ankle arthrodesis with computed tomography. A systematic review. Eur J Radiol, 2022, 156: 110511. doi: 10.1016/j.ejrad.2022.110511.
13.	Coughlin MJ, Shurnas PS. Hallux rigidus. Grading and long-term results of operative treatment. J Bone Joint Surg (Am), 2003, 85(11): 2072-2088.
14.	Shinohara M, Yamaguchi S, Ono Y, et al. Anatomical factors associated with progression of hallux valgus. Foot Ankle Surg, 2021, 28(2): 240-244.
15.	朱志濤, 王玲, 周鼎, 等. 踇外翻與第1跖列解剖功能特征的關系及其干預的研究進展. 中華骨與關節外科雜志, 2025, 18(9): 849-854.
16.	Aiyer A, Shub J, Shariff R, et al. Radiographic recurrence of deformity after hallux valgus surgery in patients with metatarsus adductus. Foot Ankle Int, 2016, 37(2): 165-171.
17.	Kim J, El Masry S, Srikumar S, et al. Association between postoperative medial-middle intercuneiform joint widening and recurrence rates in hallux valgus treated with modified Lapidus procedure. Foot Ankle Int, 2024, 45(12): 1349-1358.
18.	Shah M, Stirling B, Jackson JB, et al. Utilization of the modified Lapidus procedure for correction of moderate to severe hallux valgus deformity with increased distal metatarsal articular angle. Foot Ankle Spec, 2024, 17(4): 352-357.
19.	Boffeli TJ, Sorensen T, Gorman C, et al. A novel manipulation technique for Lapidus fusion in correction of hallux valgus deformity with underlying metatarsus adductus: a case series. J Foot Ankle Surg, 2022, 61(2): 222-226.
20.	Conti MS, Caolo KC, Ellis SJ, et al. Radiographic and clinical outcomes of hallux valgus and metatarsus adductus treated with a modified Lapidus procedure. Foot Ankle Int, 2021, 42(1): 38-45.
21.	Mansur NSB, Fayed A, Chinelati R, et al. Allograft bone-block plantarflexion first tarsometatarsal arthrodesis: short-term outcomes. Foot Ankle Int, 2025, 46(11): 1248-1258.
22.	孫寧, 楊曉松, 李恒, 等. Akin截骨術在拇外翻矯形中的療效分析. 生物骨科材料與臨床研究, 2025, 22(1): 44-48.
23.	de César PC, Torres AC, Oliani CHP, et al. Influence of the length ratio between second and third metatarsals after modified Weil osteotomy on clinical outcomes. J Foot Ankle Surg, 2022, 61(5): 1007-1012.
24.	Wei B, Lau BC, Amendola A. Surgical anatomy of the medial cuneiform (Cotton) osteotomy. Foot Ankle Orthop, 2019, 4(4): 2473011419885344. doi: 10.1177/2473011419885344.
25.	Fleischer AE, Klein EE, Bowen M, et al. Comparison of combination Weil metatarsal osteotomy and direct plantar plate repair versus Weil metatarsal osteotomy alone for forefoot metatarsalgia. J Foot Ankle Surg, 2020, 59(2): 303-306.
26.	孫寧, 王學文, 武勇, 等. 拇外翻術中局部應用氨甲環酸緩解術后腫脹的早期療效. 北京大學學報(醫學版), 2025, 57(1): 172-177.
27.	Burg A, Tal Frenkel R, Nyska M, et al. Treating hallux valgus associated metatarsus adductus by minimally invasive surgery: a simple solution for a difficult problem. J Foot Ankle Surg, 2022, 61(5): 1091-1097.
28.	尚林, 呂志強, 趙士君, 等. 經皮Chevron聯合Akin截骨術治療重度踇外翻的效果分析. 中華整形外科雜志, 2025, 41(12): 1301-1309.
29.	尚林, 趙士君, 楚利濤, 等. 第1跖楔關節融合術聯合外側跖骨基底截骨固定治療嚴重跖骨內收型踇外翻的效果分析. 中華創傷骨科雜志, 2026, 28(1): 75-79.
30.	Benavente Valdivia JC, Reategui Villegas D. Midterm outcomes of the modified Lapidus arthrodesis using the Phantom^? Intramedullary Nail System for the treatment of hallux valgus. Foot Ankle Surg, 2024, 30(7): 576-581.

1. Barg A, Harmer JR, Presson AP, et al. Unfavorable outcomes following surgical treatment of hallux valgus deformity: a systematic literature review. J Bone Joint Surg (Am), 2018, 100(18): 1563-1573.
2. Menz HB, Roddy E, Thomas E, et al. Impact of hallux valgus severity on general and foot-specific health-related quality of life. Arthrit Care Rre, 2010, 63(3): 396-404.
3. Aiyer AA, Shariff R, Ying L, et al. Prevalence of metatarsus adductus in patients undergoing hallux valgus surgery. Foot Ankle Int, 2014, 35(12): 1292-1297.
4. Ota T, Nagura T, Kokubo T, et al. Etiological factors in hallux valgus, a three-dimensional analysis of the first metatarsal. J Foot Ankle Res, 2017, 10: 43. doi: 10.1186/s13047-017-0226-1.
5. Simons P, Fr?ber R, Loracher C, et al. First tarsometatarsal arthrodesis: an anatomic evaluation of dorsomedial versus plantar plating. J Foot Ankle Surg, 2015, 54(5): 787-792.
6. Myerson MS, Fisher RT, Burgess AR, et al. Fracture dislocations of the tarsometatarsal joints: end results correlated with pathology and treatment. Foot Ankle, 1986, 6(5): 225-242.
7. 祁印澤, 唐廣君, 李昕宇, 等. Scarf截骨治療跖內收型青少年踇外翻的早期療效. 中華骨科雜志, 2024, 44(5): 302-307.
8. 馬占華, 潘旭月, 吳俊德, 等. 第1跖趾關節融合結合外側足趾旋轉Weil截骨治療重度跖內收型拇外翻. 中國骨傷, 2022, 35(12): 1127-1131.
9. 藍聲遠, 李星辰, 徐向陽, 等. 多根跖骨截骨矯形術與第一跖趾關節融合術治療嚴重跖骨內收踇外翻的療效比較. 中國修復重建外科雜志, 2025, 39(10): 1246-1250.
10. 常鑫, 張云龍, 楊杰, 等. 第一跖列三平面截骨聯合其余跖骨基底截骨治療中重度跖內收型踇外翻的早期療效. 中國修復重建外科雜志, 2020, 34(1): 37-40.
11. Maringolo L, Pereira V, Maciel E, et al. Preliminary results of the correction of metatarsus adductus associated with severe hallux valgus. J Foot Ankle, 2019, 13(1): 63-69.
12. Willems A, Houkes CM, Bierma-Zeinstra SMA, et al. How to assess consolidation after foot and ankle arthrodesis with computed tomography. A systematic review. Eur J Radiol, 2022, 156: 110511. doi: 10.1016/j.ejrad.2022.110511.
13. Coughlin MJ, Shurnas PS. Hallux rigidus. Grading and long-term results of operative treatment. J Bone Joint Surg (Am), 2003, 85(11): 2072-2088.
14. Shinohara M, Yamaguchi S, Ono Y, et al. Anatomical factors associated with progression of hallux valgus. Foot Ankle Surg, 2021, 28(2): 240-244.
15. 朱志濤, 王玲, 周鼎, 等. 踇外翻與第1跖列解剖功能特征的關系及其干預的研究進展. 中華骨與關節外科雜志, 2025, 18(9): 849-854.
16. Aiyer A, Shub J, Shariff R, et al. Radiographic recurrence of deformity after hallux valgus surgery in patients with metatarsus adductus. Foot Ankle Int, 2016, 37(2): 165-171.
17. Kim J, El Masry S, Srikumar S, et al. Association between postoperative medial-middle intercuneiform joint widening and recurrence rates in hallux valgus treated with modified Lapidus procedure. Foot Ankle Int, 2024, 45(12): 1349-1358.
18. Shah M, Stirling B, Jackson JB, et al. Utilization of the modified Lapidus procedure for correction of moderate to severe hallux valgus deformity with increased distal metatarsal articular angle. Foot Ankle Spec, 2024, 17(4): 352-357.
19. Boffeli TJ, Sorensen T, Gorman C, et al. A novel manipulation technique for Lapidus fusion in correction of hallux valgus deformity with underlying metatarsus adductus: a case series. J Foot Ankle Surg, 2022, 61(2): 222-226.
20. Conti MS, Caolo KC, Ellis SJ, et al. Radiographic and clinical outcomes of hallux valgus and metatarsus adductus treated with a modified Lapidus procedure. Foot Ankle Int, 2021, 42(1): 38-45.
21. Mansur NSB, Fayed A, Chinelati R, et al. Allograft bone-block plantarflexion first tarsometatarsal arthrodesis: short-term outcomes. Foot Ankle Int, 2025, 46(11): 1248-1258.
22. 孫寧, 楊曉松, 李恒, 等. Akin截骨術在拇外翻矯形中的療效分析. 生物骨科材料與臨床研究, 2025, 22(1): 44-48.
23. de César PC, Torres AC, Oliani CHP, et al. Influence of the length ratio between second and third metatarsals after modified Weil osteotomy on clinical outcomes. J Foot Ankle Surg, 2022, 61(5): 1007-1012.
24. Wei B, Lau BC, Amendola A. Surgical anatomy of the medial cuneiform (Cotton) osteotomy. Foot Ankle Orthop, 2019, 4(4): 2473011419885344. doi: 10.1177/2473011419885344.
25. Fleischer AE, Klein EE, Bowen M, et al. Comparison of combination Weil metatarsal osteotomy and direct plantar plate repair versus Weil metatarsal osteotomy alone for forefoot metatarsalgia. J Foot Ankle Surg, 2020, 59(2): 303-306.
26. 孫寧, 王學文, 武勇, 等. 拇外翻術中局部應用氨甲環酸緩解術后腫脹的早期療效. 北京大學學報(醫學版), 2025, 57(1): 172-177.
27. Burg A, Tal Frenkel R, Nyska M, et al. Treating hallux valgus associated metatarsus adductus by minimally invasive surgery: a simple solution for a difficult problem. J Foot Ankle Surg, 2022, 61(5): 1091-1097.
28. 尚林, 呂志強, 趙士君, 等. 經皮Chevron聯合Akin截骨術治療重度踇外翻的效果分析. 中華整形外科雜志, 2025, 41(12): 1301-1309.
29. 尚林, 趙士君, 楚利濤, 等. 第1跖楔關節融合術聯合外側跖骨基底截骨固定治療嚴重跖骨內收型踇外翻的效果分析. 中華創傷骨科雜志, 2026, 28(1): 75-79.
30. Benavente Valdivia JC, Reategui Villegas D. Midterm outcomes of the modified Lapidus arthrodesis using the Phantom^? Intramedullary Nail System for the treatment of hallux valgus. Foot Ankle Surg, 2024, 30(7): 576-581.

Chinese Journal of Reparative and Reconstructive Surgery

Lapidus arthrodesis combined with middle metatarsal base rotation osteotomy in treatment of hallux valgus with metatarsus adductus

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