Basal medial opening wedge first metatarsal osteotomy stabilized with a low profile wedge plate

Twenty patients underwent 25 basal medial opening wedge osteotomies of the first metatarsal stabilized using a low-profile wedge plate in combination with a distal soft tissue release, distal metatarsal osteotomy and Akin osteotomy as required for correction of a hallux valgus deformity. The mean clinical and radiographic follow-up was 12.2 months. Pre- and post operative radiographs available in 15 cases showed that the median hallux valgus angle (HVA), intermetatarsal angle (IMA) and distal metatarsal articular angle (DMAA) were corrected from 45.5 to 13.1, 17.7 to 9.2 and 243 to 10.0 degrees respectively (p < 0.001). Final radiographic assessment for the whole series showed a median final HVA and IMA of 14.1 and 9.1 respectively. Radiographic union was noted in all but one case which was asymptomatic. One wound infection was treated with oral antibiotics, one hallux varus deformity required soft tissue reconstruction and there was one recurrence. The outcome was reported as good or satisfactory by the patients for 20 of 25 feet. Three patients reported stiffness in the first MTP joint, which improved with joint injection and manipulation. Two plates were removed for prominence. The basal medial opening wedge osteotomy stabilized with a low profile wedge plate was an effective addition for correcting a moderate to severe hallux valgus deformity as part of a double or triple first ray osteotomy.     

Effect of increasing distal medial closing wedge metatarsal osteotomies on the distal metatarsal articular angle

The recognition, definition, and management of the congruent hallux valgus deformity continue to evolve. To correct the skeletal deformity and maintain joint congruity, many authors have emphasized the importance of extra-articular procedures. One such procedure is a distal medial closing wedge osteotomy of the first metatarsal. Unfortunately, there are few guidelines to help determine the pre- and intraoperative size of the medial wedge to obtain the desired correction of the distal metatarsal articular angle (DMAA). The purpose of this study was to quantify the effects of increasing distal medial closing wedge osteotomies on the DMAA in an in vitro cadaver model. In this study, a closing wedge osteotomy was performed 2 cm proximal to the articular surface, removing wedges measuring 2 mm, 4 mm, and 6 mm in width. The mean preoperative DMAA was 8.5 degrees, and the mean postoperative DMAAs after 2-mm, 4-mm, and 6-mm closing wedge osteotomies were -2.6 degrees, -10.2 degrees, and -20.2 degrees, respectively. The data showed that for every 1 mm of closing wedge osteotomy, the DMAA decreased by 4.7 degrees +/- 0.6 degrees. These results can be used for pre- and intraoperative planning when surgically correcting a congruent hallux valgus deformity with a distal medial closing wedge osteotomy of the first metatarsal. Additional information obtained from this cadaver study includes (1) increased shortening of the first metatarsal and (2) incongruity produced at the joint after the medial-based osteotomy. The amount of shortening of the first metatarsal correlated directly with the size of the medial-based wedge. The second point indicates that a lateral soft-tissue release may still be required when using this method of reorienting the DMAA.     

Is Double Metatarsal Osteotomy Superior to Proximal Chevron Osteotomy in Treatment of Hallux Valgus With Increased Distal Metatarsal Articular Angle?

We compared the results of proximal chevron osteotomy and double metatarsal osteotomy for hallux valgus with an increased distal metatarsal articular angle (DMAA). From October 2008 to December 2012, first metatarsal osteotomies were performed in 64 patients (69 feet) with symptomatic hallux valgus associated with an increased DMAA. Proximal chevron with Akin osteotomy and lateral soft tissue release was performed in 46 feet (PCO group); double metatarsal osteotomy and Akin osteotomy without lateral soft tissue release was performed in 23 feet (DMO group). Clinical assessments were performed using the American Orthopaedic Foot and Ankle Society (AOFAS) scale and visual analog scale (VAS). The hallux valgus angles, intermetatarsal angles, sesamoid positions, metatarsus adductus angles, and DMAAs were compared at different postoperative times. Postoperative shortening of first the metatarsal and complications were compared. The mean AOFAS scale and VAS scores showed significant improvement in both groups after surgery; however, no significant difference was observed between the 2 groups. The immediate postoperative hallux valgus angle and sesamoid position were significantly larger in DMO group; however, no intergroup difference was observed at the last follow-up visit, with the hallux valgus angle gradually increasing in the PCO group. The postoperative DMAA was significantly smaller in the DMO group. The mean shortening of the first metatarsal after surgery was significantly larger in the DMO group than in the PCO group. Transfer metatarsalgia developed in 1 foot (2.2%) in the PCO group and 2 feet (8.7%) in the DMO group. Partial avascular necrosis of the metatarsal head with advanced arthritis of the first metatarsophalangeal joint developed in 1 foot (4.3%) in the DMO group. In conclusion, no differences in the clinical and radiographic results were observed between the 2 groups for hallux valgus deformity with an increased DMAA.     

Principles of first metatarsal osteotomies.

Summarizing all the data while choosing the suitable procedure for hallux valgus deformity leads to classification of 3 main categories, which are based on the intermetatarsal angle (Table 1). Mild deformity has less than 15 degrees intermetatarsal angle, intermediate deformity has 15 degrees to 20 degrees intermetatarsal angle, and severe deformity has more than 20 degrees [table: see text] intermetatarsal angle. Every category may be divided further into low degree of DMAA (8 degrees) or high degree of DMAA (> 15 degrees). When choosing the correct procedure, the length of the first metatarsal has to be considered. In short first metatarsals, base angular osteotomies lead to further shortening of the metatarsal. Displacement osteotomies are preferred. In mild deformity, a distal osteotomy can be performed. If a mild deformity has a high DMAA, it can be corrected by a distal rotated chevron osteotomy. Intermediate deformity with a normal DMAA can be corrected by displacement osteotomies, and high DMAA can be corrected by rotated scarf of double osteotomy, which includes a base osteotomy to correct the intermetatarsal angle and a distal osteotomy, such as Riverdin, to correct the DMAA. Severe deformity can be corrected only by angular osteotomies. Inherently, these osteotomies increase the DMAA; they can be performed only in normal DMAA. Only a base angular osteotomy and distal rotation osteotomy can correct high levels of DMAA in severe intermetatarsal angles.     

第一跖骨双截骨矫正重度口外翻畸形

 目的 探讨第一跖骨双截骨矫正重度外翻畸形的手术疗效。方法 回顾性分析2008年1月至2011年12月,采用第一跖骨双截骨术治疗并获得随访的62例(87足)第一跖骨远端关节面角(distal metatarsal articular angle, DMAA)增大的重度外翻患者资料,男9例(14足),女53例(73足);年龄28～70岁,平均56岁。术前X线片示外翻角(hallux valgus angle,HVA)平均为48.6°,第一、二跖骨间角(intermetatarsal angle,IMA)平均为19.8°,DMAA平均为22.1°。术前根据患者畸形情况制定手术方案,截骨部位、角度、截骨量均依据术前测量值操作。比较术前、术后及取内固定前HVA、IMA、DMAA的变化,同时采用美国足踝外科协会(AOFAS)趾-跖趾-趾间关节功能评分标准评价疗效。结果 62例(87足)获得随访,随访时间为10～57个月,平均21个月。术后6个月, HVA 14.6°±1.2°, IMA 7.9°±0.7°,DMAA 7.7°±0.9°,矫形效果均满意。术后出现僵硬2例,皮神经损伤2例,转移性跖痛1例,无一例发生畸形明显复发、骨不愈合及跖骨坏死。术后AOFAS评分由术前平均(28.4±9.1)分达到术后1年的(91.8±1.8)分;49足为优,31足为良,7足为可,优良率为92.0%(80/87)。结论 第一跖骨双截骨术可有效矫正DMAA增大的重度外翻畸形,患者术后可早期部分负重,并发症少,手术疗效佳。     

双平面截骨术治疗合并跖骨远端关节面角增大的重度■外翻

目的总结双平面截骨术治疗合并跖骨远端关节面角(distal metatarsal articular angle,DMAA)增大的重度[足母]外翻疗效。方法回顾性分析2014年6月-2017年12月收治并获完整随访的64例(94足)合并DMAA增大的重度[足母]外翻患者临床资料。患者均接受双平面截骨术(跖骨远端Reverdin截骨术+跖骨近端开放楔形截骨术)联合Akin截骨术及软组织手术。男10例(15足),女54例(79足);年龄26~66岁,平均44.5岁。单侧34例,双侧30例。参照美国矫形足踝协会(AOFAS)Maryland跖趾关节评分系统评分为(54.3±7.4)分,疼痛视觉模拟评分(VAS)为(6.0±2.0)分。比较手术前后AOFAS Maryland跖趾关节评分系统评分及VAS评分,以及[足母]外翻角(hallux valgus angle,HVA)、第1-2跖骨间角(first-second intermetatarsal angle,1-2IMA)、DMAA、第1跖骨长度(first metatarsal length,FML)。结果术后切口均Ⅰ期愈合。患者均获随访,随访时间12~15个月,平均13.2个月。4足发生并发症,其中[足母]僵硬、内侧切口边缘皮肤感觉麻木、转移性跖痛、第1跖骨头坏死各1足。术后1年AOFAS Maryland跖趾关节评分为(89.2±7.4)分,与术前比较差异有统计学意义(t=18.427,P=0.000);其中优78足、良12足、中3足、差1足,优良率为95.7%。VAS评分为(1.5±2.0)分,较术前明显改善(t=10.238,P=0.000)。X线片复查显示术后3个月截骨均达骨性愈合。术后6个月及1年HVA、1-2IMA、DMAA与术前比较,差异均有统计学意义(P<0.05);术后1年FML与术前比较,差异无统计学意义(t=0.136,P=0.863)。结论双平面截骨术可以显著改善合并DMAA增大的重度[足母]外翻患者临床症状以及影像学参数,术后并发症少。     

Biplanar chevron osteotomy

Results of biplanar chevron osteotomy performed on patients with mild-to-moderate hallux valgus deformity with an increased distal metatarsal articular angle (DMAA) are shown. The study included clinical data of 32 patients (54 feet) who had completed a 2-year follow-up, and radiological data of these 32 and other 29 patients (50 feet) for a total of 61 patients (104 feet, 53 right and 51 left). There were 59 females and two males with ages varying from 11 to 66 years. According to the AOFAS Hallux Rating, the preoperative average score (50) improved to 90 (average score after the surgery). The hallux valgus angle was improved from an average of 25 degrees to 14 degrees, the first intermetatarsal angle from 12 degrees to 8 degrees and the DMAA from 15 degrees to 5 degrees. At the end of treatment, 94% of patients were classified as having grade 0 or 1 sesamoid lateral sub-luxation. Given improvement in angles and 90% of patients satisfied with an average AOFAS postoperative score of 90, the technique seems indicated for treatment of symptomatic hallux valgus deformity with increased DMAA.     

The minimally invasive hallux valgus correction (S.E.R.I.)

Introduction Distal metatarsal osteotomies have been described for surgical treatment of hallux valgus with good results. The aim of this study is to review the results of 299 consecutive hallux valgus cases treated by minimally invasive distal metatarsal osteotomy, S.E.R.I. (Simple, Effective, Rapid, Inexpensive). Materials and methods 299 feet in 190 patients (109 bilateral), aged between 35 and 70 years (mean age: 53 years) affected by hallux valgus were studied. A 1 cm medial incision at the metatarsal neck, and a complete osteotomy, using an oscillating saw were performed. With the naked eye all characteristics of the deformity were corrected by displacement of the metatarsal head (HVA, IMA, DMAA, dorsal or plantar displacement). The osteotomy was stabilized by a 2 mm Kirschner wire. Immediate weight bearing was allowed with gauze bandage and Talus shoes for 4 weeks. All patients were checked at an average follow-up of 4 years. Results All osteotomies healed no avascular necrosis of the metatarsal head or pseudoarthrosis of the osteotomy was observed. Mean preoperative AOFAS score was 43 and 88 at follow-up. The mean preoperative HVA was 33, while at follow-up it was 16 (P < 0.05), mean preoperative IMA was 13, while at follow-up it was 7 (P < 0.05), mean preoperative DMAA was 20, while at follow-up it was 8 (P < 0.05). Conclusion S.E.R.I. osteotomy has been simple, effective, rapid and inexpensive in correcting hallux valgus deformity. Clinical and radiographic findings showed an adequate correction of the deformity.     

Therapie des kindlichen Hallux valgus

Hallux valgus deformities in children and adolescents are attributed to various malformations. Meticulous assessment of clinical and radiological findings as well as age-dependent progress of hallux malalignment has to be taken into consideration to work out an individual therapeutic concept. Conservative treatment includes both night splints and exercises. Surgical therapy has to be strictly based on objective criteria, i.e. the size of the first intermetatarsal angle and correction of the distal metatarsal articular angle. Moderate deformities can be corrected with three-dimensional distal metatarsal osteotomy. Severe hallux valgus deformities often require a double metatarsal osteotomy to address the intermetatarsal angle and the distal metatarsal articular angle. In cases of additional hallux valgus interphalangeus further osteotomy of the proximal phalanx (triple osteotomy) is necessary.     

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.     

Does preoperative deformity diminish radiographic outcome after hallux valgus correction with scarf osteotomy?: A retrospective study of 102 cases

BackgroundScarf osteotomy is a frequently used technique to correct moderate to severe hallux valgus deformities. Recurrence of a deformity is a commonly reported complication after surgery. The aim of our study was to evaluate the impact of preoperative deformity on radiological outcome in terms of postoperative loss of correction after scarf osteotomy.Methods102 patients, in which a hallux valgus deformity was corrected with an isolated scarf osteotomy were included. Weightbearing radiographs were analyzed preoperatively, postoperatively, after 6 weeks and after three months (mean 10.9 months SD 17.2 months). The following radiological parameters were used for analysis: the intermetatarsal angle (IMA), the hallux valgus angle (HVA), the distal metatarsal articular angle (DMAA), position of the sesamoids, first metatarsal length, and first metatarsophalangeal joint congruity.ResultsSignificant correction of IMA, HVA, DMAA, sesamoid position and joint congruity was achieved (p < 0.001). The IMA improved from 15.8 ± 2.3 to 4.3 ± 2.8°, the HVA from 32.6 ± 6.8 to 9.1 ± 7.2, and the DMAA from 11.4 ± 6.9 to 8.4 ± 5.2°, respectively. In contrast to DMAA, throughout followup we could detect loss of correction for HVA and for IMA amounting 6.3° ± 5.8 and 3.8° ± 2.8 respectively. Loss of HVA correction revealed a significant correlation with preoperative DMAA, but not with the other preoperative radiological parameters.ConclusionsPreoperative deformity does not correlate with postoperative loss of correction after scarf osteotomy, except DMAA.Clinical relevanceOur results may be helpful in counseling patients regarding recurrence of hallux valgus deformity after scarf osteotomy.Level of evidenceTherapeutic, Level IV, retrospective case series.     

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.     

Treatment of adolescent hallux valgus with the first metatarsal double osteotomy: the denver experience

The 1 metatarsal double osteotomy is described as an effective procedure for the treatment of severe adolescent hallux valgus (AHV) with low recurrence and complication rates. No study to date has evaluated the functional clinical outcome after 1st metatarsal double osteotomy. The purpose of this paper is to report the results at our institution in the treatment of severe AHV with 1st metatarsal double osteotomy. We performed a review of all patients (N = 9, 14 feet) treated at our institution with 1st metatarsal double osteotomy. We reviewed pre- and postoperative hallux valgus (HVA), 1st-2nd intermetatarsal (IMA), and distal metatarsal articular angles (DMAA) and calculated the average angular correction. Functional outcome was measured via the AOFAS Hallux Metatarsophalangeal-Interphalangeal (HMI) scale as well as the duPont Bunion Rating Score (BRS). The average patient was 15 years old at the time of surgery with an average of 27 months follow-up. The mean angular correction was 21.54 degree, 9.25 degree, and 6.21 degree for HVA, IMA, and DMAA, respectively. Ninety percent of the patients reported good to excellent results. We had 2 complications for an overall rate of 14%. The 1st metatarsal double osteotomy is an effective and reliable technique for treatment of severe adolescent hallux valgus. Stiffness of the 1st MTPJ is the major determinant of patient satisfaction.     

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。     

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.     

The Reverdin-Isham procedure for the correction of hallux abducto valgus. A distal metatarsal osteotomy procedure

The Reverdin-Isham Procedure is a distal metatarsal osteotomy procedure that has stood the test of time and has revolutionized the correction of simple to severe hallux abducto valgus deformities. This procedure, a modification of the classic Reverdin bunionectomy, modifies the osteotomy cut of Reverdin by performing a medial wedge osteotomy through the head of the first metatarsal. In this modification, the osteotomy is performed at an oblique angle from dorsal distal to plantar proximal through the head of the first metatarsal, preserving the entire articular surface of the first metatarsal head. The result of this osteotomy places the articular surface of the first metatarsal into alignment with the shaft of the first metatarsal, thereby correcting the structural deformity of hallux abducto valgus at the first MPJ. This modification, using the advances of minimal incision surgery, is a procedure that is highly successful, permits immediate ambulation, causes minimal disability, allows early return to productive activities, and is cost effective.     

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.     

Early results of the modified Simmonds-Menelaus procedure for adolescent hallux valgus

Adolescent hallux valgus is a common problem, and there is no agreement about the best surgical technique to use to correct this deformity. Excellent results have been reported with a distal soft tissue procedure and an associated osteotomy at the base of the first metatarsal. The current study reports the early results of using an incomplete osteotomy at the base of the first metatarsal. No hardware was used to fix the osteotomy, and the postoperative immobilization was shorter. The study included 20 feet in 11 female patients. All osteotomies healed primarily without complications. The average preoperative hallux valgus of 31.2 degrees was reduced to 17.8 degrees at a minimum of 2 years follow-up. The average intermetatarsal angle improved from 13.5 degrees in the preoperative period to 11.3 degrees. Using the duPont bunion rating score as an outcome assessment, the authors had 4 excellent and 16 good results.     

Percutaneous distal metatarsal osteotomy for correction of hallux valgus

BACKGROUND: Distal osteotomy of the first metatarsal is indicated for the surgical treatment of mild-to-moderate hallux valgus deformity. The aim of this study was to evaluate the results of a subcapital distal osteotomy of the first metatarsal with use of a percutaneous technique. METHODS: From 1996 to 2001, 118 consecutive percutaneous distal osteotomies of the first metatarsal were performed for the treatment of painful mild-to-moderate hallux valgus in eighty-two patients. The patients were assessed with a clinical and radiographic protocol at a mean of 35.9 months postoperatively. The American Orthopaedic Foot and Ankle Society (AOFAS) hallux-metatarsophalangeal-interphalangeal scale was used for the clinical assessment. RESULTS: The patients were satisfied following 107 (91%) of the 118 procedures. The mean score on the AOFAS scale was 88.2 +/- 12.9 points. The postoperative radiographic assessments showed a significant change (p < 0.05), compared with the preoperative values, in the mean hallux valgus angle, first intermetatarsal angle, distal metatarsal articular angle, and sesamoid position. The valgus deformity recurred after three procedures (2.5%), the first metatarsophalangeal joint was stiff but not painful after eight (6.8%), and a deep infection developed after one (0.8%). The infection resolved with antibiotic therapy. CONCLUSIONS: The percutaneous technique proved to be reliable for the correct execution of a distal linear osteotomy of the first metatarsal for the correction of a painful mild-to-moderate hallux valgus deformity. The clinical results appear to be comparable with those obtainable with traditional open techniques, with the additional advantages of a minimally invasive procedure, a substantially shorter operating time, and a reduced risk of complications related to surgical exposure.     

Correlation of Loss of Correction With Postoperative Radiological Factors After Distal Chevron Osteotomy in Dependence of Concomitant Akin Osteotomy

Loss of correction is frequently observed following hallux valgus correction and is associated with recurrence of a hallux valgus deformity. The purpose of this study was to correlate loss of correction and radiological parameters following distal chevron (Group C) and combined chevron/akin (Group AC) osteotomy. A total of 859 feet were included for analysis and grouped according to treatment with a distal chevron osteotomy alone or a combined chevron/akin osteotomy. Radiographs were evaluated preoperatively, postoperatively, after 6 weeks, 3 months and, if available, at long term follow-up with a mean of 34.2 (range 7.5-155.3) months. With the exception of the proximal to distal phalangeal articular angle (PDPAA), preoperative deformity was comparable between both groups. Significant correction of all examined parameters (p < .001) was seen. Loss of correction at 6 weeks with minor deterioration until follow-up was also detected, with group AC somewhat better than Group C. A strong correlation with loss of correction was found for the postoperative hallux valgus angle (HVA) (p < .002), intermetatarsal angle (IMA) (p < .001), distal metatarsal articular angle (DMAA) (p < .002), positioning of the sesamoids (p < .002) and joint congruity (p < .035) in Group C and for the DMAA (p < .033) and HVA (p < .046) in Group AC. Multiple postoperative radiological parameters correlated with loss of correction following distal chevron osteotomy. In Group AC only postoperative HVA and DMAA determined loss of correction. Correction of the deformity in Group AC showed greater stability.