Background: The role of hypermobility of the first tarsometatarsal
joint in the etiology of hallux valgus deformity is controversial.
Consequently, the need to include an arthrodesis of this joint in the surgical
treatment of hallux valgus has been questioned. We designed a study to
evaluate the role of arthrodesis of the first tarsometatarsal joint on the
outcome of surgical treatment of hallux valgus.
Methods: A prospective, blinded, randomized study was performed to
compare the results of a distal osteotomy of the first metatarsal (the Hohmann
procedure) with those of an arthrodesis of the first tarsometatarsal joint
combined with a soft-tissue procedure of the first metatarsophalangeal joint
(the Lapidus procedure) for correction of a symptomatic hallux valgus
deformity. One hundred and one feet of eighty-seven patients were included in
the study. Fifty feet had a Hohmann procedure, and fifty-one had a Lapidus
procedure. The mobility of the first tarsometatarsal joint was assessed in the
preoperative clinical examination. On the basis of this examination, two
subgroups were identified: sixty-eight feet with a hypermobile first
tarsometatarsal joint and thirty-three feet with a nonhypermobile first
tarsometatarsal joint. The patients were assessed clinically and
radiographically at two years after the operation.
Results: There was a significant improvement in the score on the
great toe metatarsophalangeal-interphalangeal scale of the American
Orthopaedic Foot and Ankle Society and in the pain score following both
procedures (p < 0.001). With the numbers available, no significant
difference between the two procedures or between the subgroups of feet with a
hypermobile first tarsometatarsal joint and those with a nonhypermobile joint
could be identified. The patient satisfaction rating did not differ either
between the two procedures or between the two subgroups. The radiographic
results of the two methods were also similar, except for shortening of the
first metatarsal, which was significantly greater (p < 0.001) in the
Hohmann group, and plantar flexion of the first metatarsal, which was greater
in the Lapidus group.
Conclusions: These short-term results were satisfactory and were
comparable with those in previous isolated reports on these two procedures. As
no significant differences between the two procedures or between the two
subgroups (feet with a hypermobile first tarsometatarsal joint and those with
a nonhypermobile joint) were found on clinical assessment, the theory that
patients with hallux valgus and a hypermobile first tarsometatarsal joint
should be managed with a Lapidus procedure was not supported.
Level of Evidence: Therapeutic study, Level I-1a
(randomized controlled trial [significant difference]). See Instructions to
Authors for a complete description of levels of evidence.