Proximal Opening Wedge Osteotomy With Distal Chevron Osteotomy of the First Metatarsal for the Treatment of Moderate to Severe Hallux Valgus.

Abstract

BACKGROUND::

The aim of this study was to assess radiographic and clinical outcomes after double osteotomy with proximal opening wedge first metatarsal osteotomy and first metatarsal distal chevron osteotomy in the treatment of moderate to severe hallux valgus.

METHODS::

33 patients (4 male, 29 female; 36 feet; average age 60.7 years) were included in the study. Radiographic and clinical outcome in terms of intermetatarsal angle (IMA), hallux valgus angle (HVA), distal metatarsal articular angle (DMAA), and the American Orthopaedic Foot & Ankle Society metatarsophalangeal-interphalangeal hallux score (AOFAS MTP-IP hallux score) were investigated at 6 weeks, 6 months, and after an average of 28 (range, 7-123) months postoperatively.

RESULTS::

Preoperative IMA, HVA, and DMMA showed statistically significant improvement ( P ≤ .05) from 19.1 ± 3.8 (8.9-27.3) degrees, 45.4 ± 8.7 (25.9-60.9) degrees, and 20.8 ± 8.9 (4.5-38.0) degrees to 6.0 ± 3.3 (0.4-12.2) degrees, 9.1 ± 8.9 (-6.7 to 39.0) degrees, and 6.4 ± 5.6 (-6.8 to 21.0) degrees at last follow-up, respectively. Postoperative AOFAS MTP-IP hallux score averaged 88.1 points. Overall, 10 complications were observed: hallux varus (3 feet), hallux valgus recurrence (3 feet), nonunion (1 foot), loss of fixation (1 foot), and wound infection (2 feet).

CONCLUSION::

Proximal opening wedge first metatarsal osteotomy with distal chevron osteotomy provided powerful correction of each component of moderate to severe hallux valgus but had a substantial rate of complications in terms of over- and undercorrection, nonunion, loss of fixation, and wound infection.

LEVEL OF EVIDENCE::

Level IV, case series.

• Authors: Matthias Braito, Dietmar Dammerer, Philipp Hofer-Picout, Gerhard Kaufmann
• Journal: Foot & ankle international (Foot Ankle Int) Vol. 40 Issue 1 Pg. 89-97 (Jan 2019) ISSN: 1944-7876 [Electronic] United States
• PMID: 30345808 (Publication Type: Journal Article)

Topics

• Adult
• Aged
• Aged, 80 and over
• Bone Plates
• Female
• Foot Bones (diagnostic imaging)
• Hallux Valgus (diagnostic imaging, surgery)
• Humans
• Male
• Middle Aged
• Osteotomy (adverse effects, methods)
• Postoperative Complications (epidemiology)
• Prospective Studies
• Radiography
• Treatment Outcome