[Congenital insufficiency of the distal support function of the first ray of the foot].
Five patients with congenital deficiency of antero-medial support have been examined and treated at the Hôpital cantonal, Geneva. The main symptoms of these patients were global metatarsalgia and a dorsal bunion. All lesions were bilateral. Four of the patients had a localised dyslatia of the first ray, whereas one of them suffered from a nail patella syndrome. In two patients there was a hypoplastic first metatarsal, whereas in three others the first metatarsal was normal but too elevated under weight bearing. One patient responded well to conservative treatment. In three cases a lowering osteotomy of the first metatarsal bone with autologous bone graft was performed. The last patient was treated by arthrodesis between the first cuneiform and the first metatarsal for plantar-flexion the first ray. In one case it was necessary to transfer the long flexor of the great toe onto the first metatarsal according to Lapidus in combination with an arthrodesis of the great toe. One patient underwent an arthrodesis between the first cuneiform and the first metatarsal combined with an arthrodesis of the great toe. A Helal-type osteotomy on the second metatarsal was necessary in one case. The objective and subjective results were good or excellent. All treatments eliminated the painful symptoms, allowing all patients to resume a normal professional activity.