From the Guidelines
Metatarsus primus varus is a structural foot deformity that requires early intervention with proper footwear and orthotics to prevent progression, and in severe cases, surgical correction may be necessary to alleviate symptoms and improve quality of life. The clinical presentations of metatarsus primus varus include a visible bunion at the first metatarsophalangeal joint, pain with footwear, widening of the forefoot, difficulty finding comfortable shoes, and progressive deformity over time 1. Patients may report pain during walking, redness, swelling, and callus formation.
Management Options
Management begins with conservative approaches including:
- Wide-toed, low-heeled footwear to reduce pressure on the affected area
- Bunion pads or spacers to reduce pressure
- Custom orthotic devices to improve foot mechanics
- Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (400-800mg three times daily) for pain relief
- Physical therapy focusing on foot strengthening exercises and toe stretches to maintain joint mobility
For severe cases unresponsive to conservative treatment, surgical correction is considered, with options including:
- Distal or proximal metatarsal osteotomy
- Lapidus procedure (fusion of the first metatarsocuneiform joint)
- Bunionectomy The choice of surgical technique depends on the severity of the deformity, patient age, activity level, and underlying biomechanical factors 1.
Importance of Early Intervention
Early intervention with proper footwear and orthotics is crucial to prevent progression, as the condition results from a combination of genetic predisposition and environmental factors like constrictive footwear that exacerbate the natural tendency of the first metatarsal to deviate medially. Surgical correction, such as metatarsal osteotomy, may be considered in cases where non-surgical offloading interventions have failed, with a conditional recommendation in favor of the intervention based on moderate desirable effects and low certainty of evidence 1.
From the Research
Clinical Presentation of Metatarsus Primus Varus
- Metatarsus primus varus is a condition characterized by a medial deviation of the first metatarsal bone, often associated with hallux valgus 2.
- The condition can lead to pain and discomfort in the foot, particularly in the region of the metatarsal heads 3.
- Clinical examination may reveal horizontal or vertical malalignment of the metatarsal heads, insufficiency at the first metatarsal-phalangeal joint, and involvement of the second metatarsal bone 3.
Management Options for Metatarsus Primus Varus
- Conservative treatment options include orthoses, such as the Wheaton brace and Bebax shoe, which have been shown to be effective in correcting metatarsus adductus with fewer complications compared to other methods 4.
- Surgical treatment options, such as metatarsal osteotomy toward valgus near the base with internal fixation, have also been shown to be successful in treating metatarsus primus varus in adults 5.
- The choice of treatment depends on the severity of the condition and the presence of any underlying anatomical or functional disorders 2, 3.
Treatment Outcomes and Complications
- Studies have shown that conservative treatment options can achieve good correction of metatarsus adductus, but may be associated with complications such as skin irritation and discomfort 4.
- Surgical treatment options have been shown to be effective in treating metatarsus primus varus, but may be associated with complications such as infection and hardware failure 5.
- The use of digital pictures to assess forefoot adduction deformity severity has been shown to be a reliable measurement method, allowing for accurate monitoring of treatment outcomes 6.