Plantarflexory Osteotomy for a Plantar Flexed First Ray? A Cross-sectional Study of the Relationship between Frontal Plane Forefoot Deformity and Lateral Intermetatarsal Angle in 190 Patients

Many surgeons consider performing plantarflexory osteotomy when a lateral weightbearing radiograph shows an elevated first metatarsal. In our study, we clinically evaluated the first metatarsal position in terms of the forefoot-to-rearfoot relationship and radiographically evaluated the lateral intermetatarsal angle in 190 patients. We divided the subjects into forefoot varus, valgus, and neutral groups and compared their mean lateral intermetatarsal angle. The mean lateral intermetatarsal angle for those with forefoot varus, valgus, and neutral was 1.4° ± 3.10°, 1.3° ± 3.30°, and 0.4° ± 2.67°, respectively. Neither analysis of variance nor post hoc tests showed any significant difference among the groups. We hypothesized that the ground reacting force alters the first ray position on the weightbearing radiographs; thus, it would not be advisable to rely solely on this angular measurement for surgical decision-making.