Clinical value of fifth metatarsal osteotomy in hallux valgus with concomitant bunionette deformity: a symptom-based comparative study.

BACKGROUND

Hallux valgus is frequently accompanied by bunionette deformity, which may contribute to lateral forefoot pain and increased forefoot width. Although fifth metatarsal osteotomy is an established treatment for symptomatic bunionette deformity, the necessity of this procedure in patients with asymptomatic deformity remains unclear.

PURPOSE: This retrospective cohort study aimed to evaluate the clinical necessity of symptom-based fifth metatarsal osteotomy in patients with hallux valgus and concomitant bunionette deformity.

STUDY

DESIGN

Retrospective comparative cohort study.

METHODS

Eighty-one feet in 70 patients who underwent hallux valgus corrective surgery between July 2020 and December 2024 were included, with a mean follow-up period of 16.9 ± 6.8 months. Patients with bunionette-related symptoms, including lateral forefoot pain or shoe conflict localized to the fifth metatarsal head despite conservative treatment, underwent additional fifth metatarsal osteotomy, whereas asymptomatic patients did not. Radiographic parameters and patient-reported outcomes using the Self-Administered Foot Evaluation Questionnaire were assessed preoperatively and at final follow-up.

RESULTS

Both groups demonstrated significant postoperative improvements in radiographic alignment and questionnaire subscale scores. Final clinical outcomes did not differ significantly between the groups. The first-to-fifth intermetatarsal angle was significantly smaller postoperatively in the osteotomy group. In the osteotomy group, a greater preoperative fourth-to-fifth intermetatarsal angle was positively associated with greater summed improvement across the SAFE-Q subscales after correction for multiple testing.

CONCLUSION

This study suggests that symptom-based selection for fifth metatarsal osteotomy provides satisfactory outcomes while avoiding unnecessary procedures in asymptomatic cases with radiographic bunionette deformity.

LEVEL OF CLINICAL EVIDENCE: 3.