Helal Metatarsal Osteotomy in Apert Foot

Background: Apert syndrome is a rare condition characterized by a craniosynostosis associated with complex bilateral malformations of the hands and feet. Although correction of syndactyly of the extremities is largely described, just a few authors have focused their attention on the gradual subluxation of the second metatarsal head during child growth, with hyper pressure, hyperkeratosis on the plantar surface and acute pain leading to walking impairment. The aim of this study is to describe our experience with the Helal metatarsal osteotomy technique on this group of patients. An oblique osteotomy performed dorsal to plantar, proximal to distal on the subluxed metatarsal bone is carried out. No internal bone fixation is needed, but a fundamental hypercorrective bandage is placed under the plantar surface. Immediate full weight-bearing, 24 hours after surgery, is highly recommended. Methods: Seventeen feet of 12 patients were treated between 2003 and 2018. Corrective osteotomy was performed on a single bone in 13 patients, on 2 bones in 3 patients, and on 3 bones on 1 patient. The mean follow-up was 5 years, with a physical examination once a year. Results: No complication such as infection or delayed wound healing was registered. X-rays taken 3 weeks after surgery showed complete bone consolidation and a correction of the previous plantarflexed position of the metatarsal with consistent reduction of pressure and pain for every patient who was able to wear normal shoes again after surgery. Conclusion: The Helal metatarsal osteotomy is a safe, reproducible, and feasible technique that should be considered in cases of painful metatarsal head plantar subluxation in Apert feet. Level of Evidence: Level IV.