Proximal metatarsal wedge osteotomy for metatarsus primus elevatus associated with rheumatoid forefoot deformity: a case report

Abstract

Metatarsus primus elevatus, described as dorsal elevation of the first metatarsal in relation to the lesser metatarsals, is rarely observed in patients with rheumatoid arthritis. We describe a patient with a symptomatic rheumatoid forefoot deformity accompanied by metatarsus primus elevatus, whose weight was not supported by the first metatarsal head. Instead, it was transferred to the first interphalangeal joint. The patient underwent proximal plantar flexion wedge osteotomy of the first metatarsal and distal shortening oblique osteotomies of the lateral metatarsals. At 1 year of follow-up, she was free from pain and her weight was supported on the head of the first metatarsal. This case suggests that proximal osteotomy of the first metatarsal could provide a good outcome when used to correct metatarsus primus elevatus with rheumatoid forefoot deformity.

Keywords:

• Metatarsus primus elevatus
• rheumatoid forefoot deformity
• joint-preserving surgery
• wedge osteotomy
• proximal metatarsal base

Conflict of interest

None.