The Effect of Dwyer's Osteotomy and the 1st Metatarsal Osteotomy for Cavovarus Correction on Radiographic Parameters

Jun Young Choi; Seong Mu Cha; Ji Woong Yeom; Jin Soo Suh

doi:10.14193/jkfas.2016.20.1.27

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Choi, Cha, Yeom, and Suh: The Effect of Dwyer's Osteotomy and the 1st Metatarsal Osteotomy for Cavovarus Correction on Radiographic Parameters

Original Article

J Korean Foot Ankle Soc 2016;20(1):27-31.

Published online: 10 March 2016

DOI: https://doi.org/10.14193/jkfas.2016.20.1.27

The Effect of Dwyer's Osteotomy and the 1st Metatarsal Osteotomy for Cavovarus Correction on Radiographic Parameters

Jun Young Choi, Seong Mu Cha^*, Ji Woong Yeom^*, Jin Soo Suh^*

W Institute for Foot and Ankle Disease and Trauma, W Hospital, Daegu, Korea

^*Department of Orthopedic Surgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea

Corresponding Author: Jin Soo Suh Department of Orthopedic Surgery, Inje University Ilsan Paik Hospital, 170 Juhwa-ro, Ilsanseo-gu, Goyang 10380, Korea Tel: 82-31-910-7968, Fax: 82-31-910-7967, E-mail: sjs0506@paik.ac.kr

Received 3 January 2016 Revised 21 January 2016 Accepted 2 February 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

Several techniques have been introduced for correction of pes cavovarus deformity. We retrospectively reviewed and compared the data of patients who underwent 1st metatarsal osteotomy alone, Dwyer's osteotomy alone, and 1st metatarsal osteotomy combined with Dwyer's osteotomy to determine the effect on radiographic parameters.

Materials and Methods

Data on 28 cases in 27 consecutive patients recruited from 2006 to 2014 who underwent 1st metatarsal osteotomy alone (group F), Dwyer's osteotomy alone (group H), or 1st metatarsal osteotomy followed by Dwyer's osteotomy (group HF) with a minimum 1-year follow-up were reviewed retrospectively.

Results

Calcaneal pitch angle on the standing foot lateral radiographs was significantly decreased after the operation in groups H and HF whereas Meary angle was decreased in groups F and HF. Hindfoot alignment angle and ratio on the hindfoot alignment view were improved in groups H and HF. Maximal medial cuneiform height reduction was observed in group HF. 1st ray was significantly shortened in groups F and HF.

Conclusion

Combined forefoot and hindfoot operation took the largest correction power of all radiologic parameters.

Keywords: Foot deformities, Osteotomy, Radiology

References

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Figure 1.

(A∼C) Preoperative radiographs show increased Meary angle (16^o) calcaneal pitch angle (33^o) and hindfoot varus. (D∼F) Postoperative radiographs show improvement of Meary angle (8^o) and calcaneal pitch angle (24^o) and hindfoot varus with simultaneous forefoot and hindfoot correction.

Table 1.

Patients’ Demography of H, F, and HF Groups

	Group H (n=8)	Group F (n=5)	Group HF (n=15)
Age (yr)	45.36±24.37	44.82±16.25	38.73±19.30
Follow-up (mo)	20.30±4.12	22.93±2.21	22.23±3.45

Values are presented as mean±standard deviation.

Group H: the group taken hindfoot correction only, Group F: the group taken forefoot correction only, Group HF: the group taken hindfoot and forefoot correction simultaneously.

Table 2.

Whole Radiologic and Clinical Parameters Related to Each Group

Parameter	Group	Preoperative	Postoperative	p-value
1st ray length on AP radiographs (mm)	H	60.81±8.46	60.35±6.94	0.58
	F	60.62±7.45	57.73±3.39	0.01
	HF	64.73±5.16	61.27±6.48	0.01
1st ray length on lateral radiographs (mm)	H	44.11±6.24	42.62±7.24	0.44
	F	50.62±6.31	45.53±4.29	0.005
	HF	48.73±4.22	45.22±5.42	0.01
Medial cuneiform height (mm)	H	33.11±7.21	30.42±4.12	0.01
	F	35.82±6.25	32.93±3.28	0.01
	HF	38.33±4.26	34.22±5.42	0.01
Meary angle (^o)	H	15.65±7.53	13.38±6.16	0.42
	F	13.62±7.67	9.62±6.06	0.005
	HF	14.27±7.09	8.84±6.76	0.001
Calcaneal pitch angle (^o)	H	37.36±5.64	26.85±6.24	0.005
	F	35.20±6.32	34.80±5.42	0.84
	HF	36.95±9.66	22.06±7.45	0.005
Hindfoot alignment angle (^o)	H	―12.31±7.05	―4.13±2.55	0.01
	F	―11.47±5.63	―11.18±5.02	0.88
	HF	―12.02±2.60	―5.60±2.94	0.01
Hindfoot alignment ratio	H	0.65±0.17	0.47±0.16	0.01
	F	0.64±0.19	0.63±0.21	0.64
	HF	0.66±0.13	0.45±0.11	0.01
AOFAS score	H	49.63±5.15	79.13±15.59	0.005
	F	47.60±6.58	80.80±8.90	0.005
	HF	45.80±5.63	81.36±10.29	0.005

Values are presented as mean±standard deviation.

Group H: the group taken hindfoot correction only, Group F: the group taken forefoot correction only, Group HF: the group taken hindfoot and forefoot correction simultaneously.

AP: anteroposterior, AOFAS: American Orthopaedic Foot and Ankle Society.

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