Clinical results with the Ludloff osteotomy for correction of adult hallux valgus

BACKGROUND: Biomechanically, the Ludloff osteotomy fixed with lag screw compression has been shown to be more rigid than proximal crescentic and other proximal first metatarsal osteotomies for correction of symptomatic hallux valgus with a moderate to severe increase in the first intermetatarsal angle. The Ludloff osteotomy may, therefore, have a lower incidence of dorsal malunion and transfer metatarsalgia than other proximal first metatarsal osteotomies, such as the crescentic or chevron. METHODS: We reviewed the results of 82 consecutive cases of moderate to severe hallux valgus deformities corrected with the Ludloff oblique metaphyseal-diaphyseal osteotomy of the first metatarsal combined with a distal soft-tissue procedure and medial eminence resection. RESULTS: Follow-up was possible in 70 cases (85%) at an average of 30 months (range, 18 to 42 months). Preoperatively, the mean hallux valgus and first intermetatarsal angles were 31 degrees and 16 degrees, respectively. Postoperatively, these values improved to an average of 11 degrees and 7 degrees. In the sagittal plane, the first metatarsal was plantarflexed by an average of 1 mm, and there were no symptomatic transfer lesions of the second metatarsal. The mean AOFAS hindfoot score improved from 54 to 91 points. Complications included prominent hardware requiring removal (5), hallux varus (4), delayed union (3), superficial infection (3), and neuralgia (3). CONCLUSIONS: The use of the Ludloff oblique first metatarsal osteotomy resulted in excellent correction of the first intermetatarsal angle in patients with moderate to severe hallux valgus. With the plane of the osteotomy and rigidity of fixation, immediate ambulation was possible with minimal risk of dorsiflexion malunion of the first metatarsal.     

The effect of first ray shortening in the development of metatarsalgia in the second through fourth rays after metatarsal osteotomy

BACKGROUND: The aims of this study were to determine the severity of metatarsalgia of the second through fifth rays after shortening of the first ray for correction of hallux valgus deformity and patient satisfaction of the cosmetic results. METHODS: Two hundred and forty metatarsal osteotomies (Wilson osteotomy as modified by Lindgren and Turan) were evaluated 4.19+/-1.29 years postoperatively. The procedure involved a slightly oblique subcapital osteotomy of the first metatarsal and fixation with one screw. RESULTS: The average decrease in the hallux valgus angle was 26+/-5 degrees, the 1-2 intermetatarsal angle was 8.4+/-4 degrees, and the average shortening of the first metatarsal was 3.8+/-1.8 mm. Positive correlations were found between metatarsalgia of the second through fourth rays and first ray shortening (p<0.001 second ray, p<0.001 third ray, and p<0.001 fourth ray); there was no correlation between the fifth ray and first ray shortening. No correlation was found between a decrease in the hallux valgus angle or 1-2 intermetatarsal angle and metatarsalgia in the second through fifth rays. A positive correlation was detected between postoperative foot alignment and decrease in the hallux valgus (p<0.001) and a negative correlation between postoperative foot alignment and first ray shortening (p<0.01). No correlation was noted between postoperative foot alignment and the 1-2 intermetatarsal angle. CONCLUSION: Excessive shortening of the first metatarsal should be avoided to decrease the occurrence of postoperative transfer metatarsalgia. We found a greater patient satisfaction with foot alignment in patients who had a greater decrease in the hallux valgus angle and less shortening of the first ray.     

The modified Wilson osteotomy for hallux valgus

The modified Wilson osteotomy for hallux valgus is a double oblique osteotomy through the metatarsal shaft. The distal fragment is displaced laterally and plantarward. The lateral displacement corrects the varus position of the metatarsal, while the plantar displacement prevents the distal fragment from tilting dorsally into a metatarsus elevatus deformity that could produce metatarsalgia. Seventy-four cases of hallux valgus treated by this method were reviewed five years postoperatively. Sixty-six cases (89%) were graded as satisfactory and eight (11%) as unsatisfactory. Roentgenographic analysis in 61 cases showed the operation had reduced the hallux valgus angle by an average of 15 degrees and the intermetatarsal angle by an average of 4 degrees. The operation shortened the first metatarsal by an average of 5 mm. Although this caused callosities on the forefoot, it did not produce metatarsalgia. The operation is technically uncomplicated and yields a high percentage of satisfactory results.     

A Comparison of the Crescentic and Mau Osteotomies for Correction of Hallux Valgus

We retrospectively compared crescentic and Mau osteotomies used to treat a total of 39 cases of hallux abductovalgus. Follow-up was possible in 10 of the crescentic cases (mean 228 days) and 24 of the Mau cases (mean 245 days). Preoperatively, the mean first intermetatarsal and hallux abductus angles were 17.5 degrees and 35.4 degrees , respectively, in the crescentic group; and 16.6 degrees and 31.3 degrees , respectively, in the Mau group. Postoperatively, these same radiographic angles were 11.7 degrees and 18.9 degrees , respectively, in the crescentic group; and 9.8 degrees and 12.9 degrees , respectively, in the Mau group, and these differences were not statistically significant. Complications included metatarsus primus elevatus (crescentic 7, Mau 2), lesser metatarsal transfer lesion (crescentic 1, Mau 0), nonunion (crescentic 5, Mau 1), revisional surgery (crescentic 0, Mau 1), and transarticular hardware (crescentic 3, Mau 0). The incidence of complications in the crescentic group was 60%, whereas that in the Mau group was 37.5%; this difference was not statistically significant (P = .276). Analysis by the type of complication revealed statistically significant differences between the crescentic and Mau groups in regard to metatarsus primus elevatus (70% versus 8.3%, P = .001), transarticular hardware (30% versus 0%, P = .02), and nonunion (50% versus 4.2%, P = .006). In conclusion, crescentic and Mau osteotomies satisfactorily corrected the first intermetatarsal and hallux abductus angles in patients that fit our inclusion criteria, although the incidence of postoperative metatarsus primus elevatus, delayed union, and transarticular hardware placement, was higher in the crescentic osteotomy group. Level of Clinical Evidence: 2.     

Surgical treatment for hallux valgus with painful plantar callosities

We retrospectively reviewed the results of a distal soft-tissue procedure and proximal crescentic osteotomy of the first metatarsal combined with a proximal shortening osteotomy of the second and/or third metatarsal. This was in patients who had hallux valgus with painful plantar callosities. The review covered seven years of procedures (1989-1996) in 12 patients (14 feet) averaging 53 years of age. Average follow-up was 52 months. All patients had pain at the first metatarsophalangeal joint and had metatarsalgia preoperatively. At follow-up, 11 feet had no pain at the first metatarsophalangeal joint, and three had some improvement of pain. Ten feet had no metatarsalgia, two had improvement of metatarsalgia, and two feet had transfer lesions postoperatively and required reoperation. The angle of hallux valgus averaged 40 degrees preoperatively and 13 degrees postoperatively. The intermetatarsal angle averaged 18 degrees preoperatively and 6 degrees postoperatively. Mean decreases in length of the second and third metatarsal after surgery were 5.4 mm and 4.8 mm, respectively. Our results suggested that this combined procedure for hallux valgus with painful plantar callosities may be successful, in carefully selected patients.     

The Mitchell bunionectomy: a prospective study of 60 consecutive cases utilizing single K-wire fixation.

The authors prospectively evaluated 45 patients (60 feet) affected by hallux valgus and treated with a distal metatarsal osteotomy. The surgical procedure consisted of a modified Mitchell osteotomy, in which fixation was achieved with a Kirschner wire that was driven into the proximal osteotomy fragment and buttressed the distal one. Early weightbearing was allowed without a cast. Follow-up averaged 25 months. The mean American Orthopedic Foot and Ankle Society clinical hallux score increased from 44.6/100 preoperatively to 83.2/100. Radiographic evaluation showed that mean metatarsophalangeal and intermetatarsal angles decreased respectively from 31.7 degrees to 16.9 degrees, and from 15.4 degrees to 8.6 degrees. Short-term loss of correction occurred in three cases (4%). Six feet (10%) had unrelieved metatarsalgia that was related to excessive shortening of the first metatarsal and/or inappropriate orientation of the metatarsal head. Stabilization of the Mitchell osteotomy with a Kirschner wire proved safe and effective for the surgical correction of mild to moderate hallux valgus.     

Early results of distal metatarsal osteotomy through minimally invasive approach for mild-to-moderate hallux valgus

A prospective study was performed on 24 patients to evaluate the early results of our experience with minimally invasive distal metatarsal osteotomy to treat mild-to-moderate hallux valgus deformities in adults. After failure of conservative treatment and persistence of footwear-related pain, a percutaneous distal first metatarsal osteotomy was performed, stabilized by a Kirschner wire, followed by immediate weight bearing. At final follow-up, clinical assessment showed that 31 of 36 patients were satisfied with their results. At a mean of 21 months, weight-bearing foot radiographs showed significant change compared with the preoperative status : the average corrections of hallux valgus angle and first intermetatarsal angle achieved were 13.10 and 5.40, respectively (p < 0.001). No cases showed nonunion, malunion, overcorrection, transfer metatarsalgia or osteonecrosis. The technique appeared in this study to be an effective, safe and simple option for correction of a painful mild-to-moderate hallux valgus deformity.     

Scarf osteotomy for hallux valgus deformity: an intermediate followup of clinical and radiographic outcomes

BACKGROUND: The scarf osteotomy is a versatile and reproducible procedure for the correction of moderate to severe hallux valgus deformity (intermetatarsal angle 12 to 20 degrees hallux valgus angle 20 to 46 degrees). METHODS: We evaluated the results of 27 consecutive scarf osteotomies at an average followup of 16.1 months. Radiographic parameters, foot pressure analysis, and AOFAS scores were analyzed before and after surgery. RESULTS: Hallux valgus angles improved from 34.5 to 16.9 degrees, intermetatarsal angles improved from 15.4 to 10.1 degrees, AOFAS scores improved from 54.5 to 86.5. There was no change between the preoperative and postoperative relative lengths of the first and second metatarsals, defined as the difference between the first and second metatarsal lengths. The measurement was based on the anteroposterior standing radiographs and measured by a line intersecting the midway point at the diaphyseal-metaphyseal junction of the metatarsal and extending from the most proximal to distal aspects of the bone. The angle of Meary (talo-first metatarsal angle) did not change, except in one patient. Foot pressure analysis showed no evidence of transfer metatarsal lesions. The complication rate was 1.1% including superficial infection and recurrence. CONCLUSIONS: The scarf osteotomy provides a predictable and effective correction of moderate to severe hallux valgus deformities.     

Radiographic results after percutaneous distal metatarsal osteotomy for correction of hallux valgus deformity

BACKGROUND: The goal of the study was to evaluate the short-term radiographic results and complications of a percutaneous distal metatarsal osteotomy for hallux valgus. METHODS: From June, 2005, until October, 2005, a percutaneous distal first metatarsal osteotomy was performed in 13 consecutive patients. All patients had mild to moderate hallux valgus deformities preoperatively. The mean postoperative followup was 130 (range 50 to 207) days. The radiographs were reviewed for hallux valgus angle, 1-2 intermetatarsal angle, nonunion, malunion, and osteonecrosis. RESULTS: The mean 2 weeks postoperative hallux valgus angle demonstrated a statistically significant (p < 0.0001) improvement from 25 (16 to 33) degrees preoperatively to 5 (-1 to 12) degrees postoperatively. Nine patients (69%) demonstrated dorsally angulated alignment of the first metatarsal at the first postoperative examination averaging 10.8 (6 to 15) degrees that increased to 15.9 (10 to 22) degrees at final followup. One patient developed cystic changes within the metatarsal head consistent with osteonecrosis. One patient developed a nonunion with no evidence of radiographic healing at most recent followup of 180 days. Five patients (38%) had recurrent hallux valgus defined as a final angle of greater than 15 degrees. CONCLUSIONS: Percutaneous distal metatarsal osteotomy for hallux valgus is associated with an unacceptable rate of complications, specifically, osteonecrosis, nonunion, malunion, and recurrence. The intraoperative correction was routinely lost after removal of the intramedullary Kirschner wire, leading to a high rate of recurrence of hallux valgus deformity as well as dorsal elevation of the capital fragment.     

Postoperative Angular Changes According to Weightbearing in Patients With Moderate to Severe Hallux Valgus

Hallux valgus is a progressive angular deformity of the big toe, the degree of which is aggravated in weightbearing stance. Hallux valgus and intermetatarsal angles on postoperative weightbearing images are usually larger than those of intraoperative fluoroscopic and immediate postoperative non-weightbearing images. Here, we hypothesized that various angular parameters of hallux valgus would increase postoperatively with weightbearing. A total of 66 feet (58 patients) of moderate to severe hallux valgus were reviewed on consecutive plain foot anteroposterior radiographs. The changes of hallux valgus, intermetatarsal, hallux valgus interphalangeal, and distal metatarsal articular angles were compared. Hallux valgus and intermetatarsal angles were significantly increased with weightbearing postoperatively (p < .001). Hallux valgus interphalangeal and distal metatarsal articular angles did not show significant changes with weightbearing (p > .5). Hallux valgus and intermetatarsal angles were increased with weightbearing after hallux valgus surgery. Mean angular changes were 5.3 and 2.7 degrees, respectively. These values should be considered in the preoperative planning and intraoperative correction processes.     

Basal closing wedge osteotomy for correction of hallux valgus and metatarsus primus varus: 10- to 22-year follow-up

Between 1974 and 1985, 59 patients (83 feet) underwent basal closing wedge osteotomy in combination with a bunionectomy and a lateral soft tissue release for correction of hallux valgus and metatarsus primus varus at this institution. Of the original 59 patients, 42 patients (60 feet) with at least 10 years of follow-up (average, 194 months; range, 144-266 months) were available for this study. Results were analyzed by review of the medical records and plain radiographs, a standardized clinical questionnaire, and physical examination. Of the 60 feet, patients rated outcomes as excellent or good in 51 feet (85%) and rated cosmesis as excellent or good in 44 feet (73%). Radiographically at final follow-up, hallux valgus and intermetatarsal angles averaged 19.9 degrees (range, 0-40 degrees) and 6.7 degrees (range, 0-18 degrees), respectively. The sesamoid position was corrected from an average preoperative grade of 2.6 to a grade of 0.9 at final follow-up. The average shortening of the first metatarsal was 5 mm. The disadvantages of the closing wedge osteotomy are that it is technically demanding and it entails the risk of shortening, dorsal malalignment, and metatarsalgia. In the current study, long-term complications included hallux varus deformity (16 feet), dorsal malalignment (15 feet), and metatarsalgia (14 feet). Despite good correction of the intermetatarsal angle and sesamoid position, the clinical results and the incidence of complications after basal closing wedge osteotomy were not as favorable as those reported for other procedures in the literature. Therefore, alternative procedures, such as the basal crescentic osteotomy or the basal chevron osteotomy, should be used.     

Percutaneous double metatarsal osteotomy for correction of severe hallux valgus deformity

Double osteotomy of the first metatarsal is an option in treatment of severe hallux valgus deformity. Good short-term results have been reported with percutaneous surgery in hallux valgus with moderate deformity. We report short-term results with percutaneous double osteotomy of the first metatarsal in severe deformities. This is a prospective study of 6 patients with severe hallux valgus deformity who were treated with percutaneous double osteotomy of the first metatarsal (proximal closing wedge and distal chevron osteotomy) in 2008. They were assessed preoperatively and one year and two years after surgery, with clinical and radiological AOFAS MTP-IP score. All patients were satisfied. The AOFAS score improved from 34 to 84. The postoperative radiological assessment showed significant improvement, compared with preoperative values of the intermetatarsal and hallux valgus angles. No complications were encountered. Post-operative stiffness of the first MT joint was observed but resolved after physiotherapy. This preliminary study showed that correction of severe hallux valgus deformity by percutaneous double osteotomy can achieve good clinical and radiological results. A larger number of cases with a longer follow-up is needed to firmly demonstrate the advantages of this technique compared with classical open surgical techniques in the treatment of severe hallux valgus deformities.     

Maintenance of Correction of First Metatarsal Closing Base Wedge Osteotomies Versus Modified Lapidus Arthrodesis for Moderate to Severe Hallux Valgus Deformity

A retrospective radiographic review of 57 feet was conducted to compare maintenance of correction of the modified Lapidus arthrodesis with the first metatarsal closing base wedge osteotomy for moderate to severe hallux valgus deformity. Radiographic parameters were measured on the preoperative, early postoperative, and greater than 11-month postoperative weightbearing radiographs. These measurements included the intermetatarsal angle, the hallux abductus angle, and the tibial sesamoid position. The patients who underwent the closing base wedge osteotomy had an average initial intermetatarsal correction of 10.4 degrees; for the modified Lapidus arthrodesis, it was 7.6 degrees. The patients who underwent the closing base wedge osteotomy had an average loss of intermetatarsal correction of 2.55 degrees from early to late postoperative radiographs; for the modified Lapidus arthrodesis, it was 1.08 degrees. Our results demonstrated that the modified Lapidus arthrodesis maintains correction to a greater degree than the first metatarsal closing base wedge osteotomy with statistical significance (P = .0039). Both the modified Lapidus arthrodesis and the first metatarsal closing base wedge osteotomy are effective procedures with respect to degree of radiographic correction for moderate to severe hallux valgus deformities.     

Reverdin手术联合第一跖骨近端截骨治疗(足母)外翻

目的 :探索一种治疗外翻效果较满意的术式。方法 :作者对外翻的传统术式进行了思考 ,运用Reverdin手术联合第一跖骨近端截骨治疗外翻。自 1997年 10月～ 2 0 0 0年 9月 ,13例患者 ,2 1足接受此种手术治疗。术中常规松解软组织及切除内侧骨赘后 ,以Reverdin术式对跖骨头内翻截骨校正近端关节固定角 ,第一跖骨近端外翻截骨校正跖骨内翻畸形。结果 :随访 6个月～ 3年半 ,优 9例 16足 ,良 3例 4足 ,差 1例 1足 ,优良 95 .2 % ,无跖骨头坏死和截骨处不愈合。术前外翻角平均 3 5° ,术后为 11° ,第一跖骨间角术前平均 19° ,术后为 5 .8° ,近端关节固定角术前平均18° ,术后为 2°。结论 :外翻矫形应根据畸形情况及其病理改变选择手术方式。本手术方式矫形满意 ,但需严格掌握其手术适应证。     

Treatment of hallux valgus with an increased distal metatarsal articular angle: evaluation of double and triple first ray osteotomies

During a 12-year period in which 878 hallux valgus corrections were performed, 18 patients (21 feet) with symptomatic hallux valgus deformity and an increased distal metatarsal articular angle (DMAA) underwent periarticular osteotomies (double or triple first ray osteotomies). They were studied retrospectively at an average follow-up of 33 months. The surgical technique comprised a closing wedge distal first metatarsal osteotomy combined with either a proximal first metatarsal osteotomy or an opening wedge cuneiform osteotomy (double osteotomy). When a phalangeal osteotomy was added, the procedure was termed a "triple osteotomy." The average age of the patients at the time of surgery was 26 years. At final follow-up, the average hallux valgus correction measured 23 degrees and the average 1-2 intermetatarsal angle correction was 9 degrees. The DMAA averaged 23 degrees preoperatively and was corrected to an average of 9 degrees postoperatively. One patient developed a postoperative hallux varus deformity, and one patient developed a malunion, both of which required a second surgery. A hallux valgus deformity with an increased DMAA can be successfully treated with multiple first ray osteotomies that maintain articular congruity of the first metatarsophalangeal joint.     

Moderate to severe hallux valgus deformity: correction with proximal crescentic osteotomy and distal soft-tissue release

Between 1991 and 1995, 96 patients (114 feet) were treated with a proximal crescentic metatarsal osteotomy and distal soft-tissue procedure for moderate to severe hallux valgus deformity [intermetatarsal (IM) angle > 15°, or hallux valgus (HV) angle > 30°]. At an average follow-up of 26 months, 8 men and 62 women (86 feet) with a mean age of 53.2 years were retrospectively reviewed. The HV angle averaged 41.1° preoperatively and 14.6° postoperatively. The respective values for the IM angle were 17.8° and 7.8°. Neither the average metatarsal shortening of 3 mm nor the dorsal angulation at the osteotomy site seen in 9% of cases evidenced any clinical significance at follow-up. Patient satisfaction was excellent or good in 91%, and the mean Mayo Clinic Forefoot Score (total 75 points) improved from 37.2 to 61.1 points. Complications included 8 cases of hallux varus and 5 cases of hardware failure. Based on this first study exclusively focusing on moderate to severe hallux valgus deformity, we conclude that proximal first metatarsal osteotomy in combination with a lateral soft-tissue procedure is effective in correcting moderate to severe symptomatic hallux valgus deformity with metatarsus primus varus (IM angle > 15° or HV angle > 30 °). Received: 28 July 1999     

The Spike Osteotomy for Hallux Valgus: A Clinical and Radiological Evaluation

A distal metatarsal osteotomy with soft tissue correction is a frequently performed operation to correct mild to moderate hallux valgus deformity. This is a prospective study of 28 feet in 25 patients who underwent spike osteotomy of the first metatarsal with medial capsulorraphy for symptomatic hallux valgus. The osteotomy is a distal metatarsal osteotomy with a spike fashioned in the plantar and lateral quarter of the proximal fragment and impacted into the trough created in the center of the distal fragment, providing lateral and plantar shift of the distal fragment. The American Orthopaedic Foot and Ankle Society's rating scale was used for functional assessment, and a visual analog scale gauged pain. The average follow-up was 27 months. The rating scale score improved from a mean preoperative value of 39/100 to 84/100. Twenty-six feet had complete pain relief, whereas 2 feet had a lesser degree of persistent metatarsalgia. A review of preoperative and postoperative radiographs showed that the hallux valgus angle improved from a mean 36 degrees preoperatively to 18 degrees postoperatively. Likewise, the mean 1 to 2 intermetatarsal angle improved from 13 degrees to 7.3 degrees. There was no incidence of avascular necrosis. Fourteen patients (16 feet) rated the outcome as excellent, 10 (11 feet) as good, and 1 patient with asymptomatic mild hallux varus deformity rated the result as fair. These results demonstrate that the spike osteotomy is a suitable operation for treatment of mild to moderate hallux valgus.     

Hallux valgus: Indications and technique of proximal chevron osteotomy combined with distal soft tissue release

Acquired hallux valgus deformity arises from progressively changing relationships of the bones in the first ray of the foot. Ligamentous laxity develops at the medial capsule of the first metatarsophalangeal (MTP) joint and the lateral capsule of the first metatarsocuneiform joint. The adductor hallucis tendons and the transverse metatarsal ligament tether the sesamoid bones and the base of the proximal phalanx of the great toe while the intermetatarsal angle (IMA) increases. These deforming forces are addressed by the distal soft tissue release in the first web space and the soft tissue plication at the medial aspect of the first MTP joint. The addition of the proximal chevron osteotomy of the first metatarsal shaft permits complete correction of the increased hallux valgus and intermetatarsal angles. The improved stability of the proximal chevron osteotomy over other types of osteotomies theoretically reduces the incidence of delayed transfer metatarsalgia. This article will show the anatomy of acquired hallux valgus, as well as the theories and techniques behind the authors' method of surgical correction.     

经皮微创截骨术联合8字绷带和分趾垫外固定治疗中度拇外翻

目的:探讨经皮微创截骨术联合“8”字绷带和分趾垫外固定治疗中度拇外翻的临床疗效。方法:自2019年8月至2021年1月采用经皮微创截骨术联合“8”字绷带和分趾垫外固定治疗中度拇外翻患者23例,失访1例,最终纳入22例(30足),男4例6足,女18例24足,年龄27～66 (50.59±11.95)岁。比较术前和术后6个月患足拇外翻角(hallux valgus angle,HVA),第1、2跖骨间角(intermetatarsal angle,IMA),跖骨跨度(第1、5跖骨头之间的距离)和软组织宽度变化情况,并采用美国足踝外科协会踝-后足评分标准(American Orthopaedic Foot and Ankle Society,AOFAS)进行临床疗效评价,采用视觉模拟评分(visual analogue scale,VAS)评价足部自觉疼痛情况。结果:22例患者获得随访,时间5.7～6.4(6.13±0.85)个月。患者第1跖骨截骨处均获得骨性愈合,足趾外观畸形得到纠正,术后患足未出现跖骨头缺血性坏死、转移性跖骨痛等并发症。术后6个月患足HVA、IMA、跖骨跨度、软组织宽度、...     

第1跖骨基底截骨结合Chevron-Gerbert手术治疗严重(足母)外翻畸形

目的 探讨第1跖骨基底截骨结合Chevron-Gerbert手术治疗严重(足母)外翻畸形的临床疗效.方法 2004年6月至2008年8月利用第1跖骨基底截骨结合Chevron-Gerbert手术治疗重度(足母)外翻患者37例(66足),男性5例(10足),女性21例(38足);年龄21～76岁,平均58岁.术前、术后、随访时均拍摄足部负重位正、侧位X线片,测量(足母)外翻角、第1、2跖骨间角、近侧关节固定角.比较术前、术后6周、末次随访时(足母)外翻相关各角度的X线测量值,并结合美国足踝外科协会(AOFAS)的Maryland评分法观察疗效.结果 本组患者26例(48足)得到随访,随访时间1～4年,平均2.3年.末次随访时(足母)外翻角较术前纠正25.6°±3.8°,第1、2跖骨间角较术前纠正8.6°±2.4°,近侧关节固定角较术前纠正4.7°±4.2°.根据AOFAS百分评分法评定,优15例(28足)、良8例(16足)、可3例(4足),优良率为91.7%.结论 利用第1跖骨基底截骨结合Chevron-Gerbert手术治疗严重(足母)外翻畸形的临床疗效良好,但有手术相对复杂、需行多段截骨及内固定等缺点.