[The efficacy assessment of cuboid and medial cuneiform bone wedge ostetomy in the treatment of metatarsus adductus].

Metatarsus adductus is usually a morphologic feature of the clubfoot or occurs as an isolated defect. Such deformation causes shortening of the medial foot column and lengthening of the lateral. The purpose of the study is a retrospective evaluation of long-term therapeutic effects in a group of patients, who underwent closing wedge cuboid osteotomy and opening wedge medial cuneiform osteotomy. Surgery was performed in 19 persons, procedure was applied to 26 feet, of which 3 presented congenital metatarsus adductus and 23 presented recurrent clubfoot. During ostoetomy we performed additional corrective procedures on soft tissues. Foot and gait deformation, pain associated with activities, presence of calluses on the lateral plantar surface of the foot, difficulty in footwear were evaluated before and after surgery on clinical examination. The pre- and post operative X-rays were used to determine: in AP view the Kite's angle and the angle between the calcaneal bone and the 5th metatarsalbone (forefoot adduction evaluation), in lateral view the Kite's angle, the angle between the calcaneal bone and the 1st metatarsal bone (forefoot supination evaluation) and the angle between the talus and the 1st metatarsal bone (cavus evaluation). An early recurrence of the deformation after the removal of wire fixation occurred in 2 patients. Late complications taking the form of adduction and supination of the forefoot occurred in 5 cases. In general recurrences of adduction of the metatarsus occurred in 27 % operated feet. Radiographic evaluation proved a significant statistical effect of the "plus-minus" osteotomy limited to the reduction of the adduction angle of the forefoot and not affect improvement of the supination of the forefoot and the foot excavation.