Absolute contraindication for Evan's osteotomy?

Absolute contraindication for Evan's osteotomy?

• A. Pes planus
• B. Hallux valgus
• C. Metatarsus varus
• D. Metatarsus adductus

Answer: (D)

Evan's osteotomy is a corrective procedure aimed at realigning the first metatarsal to correct hallux valgus by translating the distal portion of the first metatarsal laterally. The success of this operation depends on the forefoot being able to balance after the correction and not having a global adduction of the forefoot. Metatarsus adductus creates inward deviation of the entire forefoot, not just the first ray. Because the whole forefoot is prognathous medially, an isolated first metatarsal osteotomy cannot realign the forefoot as a whole. Even after the correction of the first metatarsal, the adducted forefoot persists, leading to inadequate correction, malalignment of the sesamoids, and poor functional outcome. This is why metatarsus adductus is considered an absolute contraindication for Evan's osteotomy. Pes planus and metatarsus varus can complicate the plan and may require additional procedures, but they do not by themselves rule out Evan's osteotomy. Hallux valgus is exactly what this osteotomy is used to treat, so it is not a contraindication.

Evan's osteotomy is a corrective procedure aimed at realigning the first metatarsal to correct hallux valgus by translating the distal portion of the first metatarsal laterally. The success of this operation depends on the forefoot being able to balance after the correction and not having a global adduction of the forefoot.

Metatarsus adductus creates inward deviation of the entire forefoot, not just the first ray. Because the whole forefoot is prognathous medially, an isolated first metatarsal osteotomy cannot realign the forefoot as a whole. Even after the correction of the first metatarsal, the adducted forefoot persists, leading to inadequate correction, malalignment of the sesamoids, and poor functional outcome. This is why metatarsus adductus is considered an absolute contraindication for Evan's osteotomy.

Pes planus and metatarsus varus can complicate the plan and may require additional procedures, but they do not by themselves rule out Evan's osteotomy. Hallux valgus is exactly what this osteotomy is used to treat, so it is not a contraindication.