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.     

Percutaneous distal metatarsal osteotomy versus distal chevron osteotomy for correction of mild-to-moderate hallux valgus deformity

Purpose

A lot of procedures were described for managing hallux valgus deformity. Percutaneous metatarsal osteotomies have received increasing recognition in the previous decade. The proposed benefits revolve primarily around the shorter surgical time, lower incidence of complications, and higher patient satisfaction. However, there is insufficient evidence to determine whether this technique is comparable to traditional open approaches.

Materials and methods

A total of 64 consecutive feet (53 patients) with mild-to-moderate symptomatic hallux valgus were randomly assigned into two groups to compare the results of percutaneous distal metatarsal osteotomy (group I, 31 feet) and distal chevron osteotomy (group II, 33 feet). All patients were clinically assessed using the American Orthopedic Foot and Ankle Society (AOFAS) scoring system. Radiographical assessment was done using the hallux valgus angle (HVA) and intermetatarsal angle (IMA).

Results

The mean correction of HVA and IMA achieved in group I was 14.4° and 4.8°, respectively, while in group II, it was 13.1° and 3.9°, respectively. The mean AOFAS score improved from a pre-operative of 44.6 points to 90.2 points in group I, and from 47.5 points to 87.7 points in group II. In group I, 26/29 patients (89.6?%) were happy with the cosmetic results of the surgery, compared to 20/31 patients (64.5?%) in group II.

Conclusion

The results of this study support the idea that percutaneous distal metatarsal osteotomy yields good functional and radiological result and is associated with a high degree of postoperative patient satisfaction.     

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.     

The Scarf first metatarsal osteotomy in the correction of hallux valgus deformity

The correction of hallux valgus has been dramatically improved by the scarf 1^st metatarsal osteotomy, which brings great versatility for covering all the indications. Its strong fixation allows an early functional recovery; the long-term follow-up confirms the reliability of this procedure, which can be combined with other osteotomies and soft tissue procedures. However, the surgeon has to determine pre and intraoperatively the correction that has to be applied; this technique is not difficult but has to be performed accurately. This is the interest of this article, which emphasizes the technical features that have to be applied.     

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。     

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。     

Proximal opening wedge metatarsal osteotomy for correction of moderate to severe hallux valgus deformity using a locking plate

Purpose

Hallux valgus is a complex deformity of the first metatarsophalangeal joint, with varus angulation of the first metatarsal, valgus deviation of the great toe and lateral displacement of the sesamoids and the extensor tendons. The aim of the surgery is to achieve correction of the varus deviation of the 1st metatarsal which is considered by some as the primary intrinsic predisposing factor to hallux valgus deformity.

Methods

We retrospectively reviewed 85 patients (107 feet) who underwent an opening wedge osteotomy of the 1st metatarsal for correction of moderate to severe hallux valgus and metatarsus primus varus. A medially applied anatomic pre-contoured locking plate was used for fixation of the osteotomy.

Results

The mean IMA was decreased from 15.8 (range 12–22) degrees to 7.8 (range 0–12) degrees. The mean pre-operative HVA was 39 (range 21–52) degrees and the mean postoperative HVA was 11.8 (6–19) degrees. The pre-operative AOFAS score was 52 (SD 3.1) and the postoperative score was 85 (SD 5.2).

Conclusion

The proximal opening wedge metatarsal osteotomy is a safe, effective and reproducible technique for correction of moderate to severe hallux valgus deformity. The use of a locking plate provides enough control at the fragments, enhancing healing of osteotomy and maintenance of the correction even with a violated proximal lateral cortex.     

The metatarsal double osteotomy in the correction of hallux valgus with mini-invasive techniques

The mini invasive corrective surgery of static disorders of the forefoot is an undisputable progress because of its decreased morbidity with a simplified functional postoperative follow-up. These indications have been limited for a long time to mild deformities due to the creation of simple basi-metatarsal osteotomies or sub capital osteotomies of the first metatarsal thus limiting a more generalised application of these techniques in the more compound feet conditions. The combination of these two osteotomies allows to envisage the reaxation of major deformity but they can also apply in cases of mild or moderate deformities with additional metatarsus varus and angular deviation of the de metatarsal head with a DMAA >6°. The application of this double osteotomy is however delicate if one complies with the very principle of the mini invasive surgery which aims at preserving the possibility to return to an immediate postoperative weight-bearing on the forefoot with a final simple setting of the corrections by a strapping bandage, thus excluding any osteosynthesis. The risk to have a “floating” bone segment is high between the two osteotomies, with a secondary fracture deformity and a loss of the correction. To avoid these hurdles, we complied with a precise surgical timing, and with some technical rules, which allowed us to achieve the final expected result.     

Distal metatarsal osteotomy for hallux valgus

Distal osteotomy of the first metatarsal with a step lateral displacement has been used in the treatment of 34 feet with hallux valgus.Stability of the osteotomy is achieved by a dorsomedial capsulorrhaphy. Suturing through drilled holes or internal fixation were not necessary. One case was complicated by dorsal tilt of the head of the metatarsal bone and required revision.     

Scarf与第1跖骨双平面截骨治疗拇外翻畸形的病例对照研究

目的：比较Scarf截骨术与第1跖骨双平面截骨术（double metatarsal osteotomy,DMO）治疗中重度拇外翻的临床疗效。方法：回顾性分析2017年1月至2019年12月治疗的50例（81足）中重度拇外翻畸形患者,根据截骨方式不同分为Scarf截骨术（Scarf osteotomy,SO）组或DMO组。SO组26例（44足）,男1例,女25例;年龄48~65（55.50±4.67）岁;中度18例（30足）,重度8例（14足）。DMO组24例（37足）,男1例,女23例;年龄45~62（52.10±6.80）岁;中度14例（24足）,重度10例（13足）。手术前后在足部负重正位X线片上测量并比较拇外翻角（hallux valgus angle,HVA）、第1、2跖骨间角（intermetatarsal angle,IMA）及远端跖骨关节面角（distal metatarsal articular angle,DMAA）,第1跖骨相对长度（relative length of first metatarsal,RLFM）的变化情况。术前及末次随访时采用美国足踝外科协会（American Orthopaedic Foot and Ankle Society,AOFAS）拇趾、跖趾、趾间关节评分进行临床疗效评价。观察两组患者负重时间及并发症情况。结果：50例患者均获得随访,SO组随访时间12~36（20.50±6.22）个月,DMO组16~28（19.80±2.44）个月,两组随访时间比较,差异无统计学意义（P>0.05）。所有切口Ⅰ期愈合,术后（20.31±3.17）个月截骨均愈合,SO组术后1例出现获得性拇内收畸形,未出现转移跖痛;DMO组术后2例发生转移性跖痛。两组手术前后HVA、IMA、DMAA、AOFAS评分比较,差异无统计学意义（P>0.05）;术前两组RLFM比较,差异无统计学意义（P>0.05）,两组末次随访时RLFM比较,差异有统计学意义（P<0.05）。SO组部分负重时间及完全负重时间显著早于DMO组（P<0.05）。结论：Scarf截骨与第1跖骨双平面截骨均可有效治疗中重度拇外翻畸形,影像学及临床评估相似,但术后第1跖骨相对长度SO组较DMO组延长,Scarf截骨下地负重时间早于第1跖骨双平面截骨。     

Short- and long-term results for severe hallux valgus correction using a first metatarsal distal osteotomy

PurposeThe purpose of this study is to analyze the short- and long-term results of severe hallux valgus (HV) treated with a L-Reverse osteotomy.MethodsPatients treated with L-Reverse osteotomy for severe HV between the years 2006–2015 were included. Patients were evaluated preoperatively, at 3 months and 4 or more years postoperatively. Changes in the HV angle (HVA) and intermetatarsal angle (IMA) were measured. Clinical outcomes were assessed using the AOFAS score.Results28 patients were included. Pre-operative IMA changed from 18.1° (18–18.9°) to 7° (6.3–8.5°), and HVA from 38.5° (34.5–41.3°) to 10.0° (8.4–11.8°) at 3 month follow up (p < 0.005). Long term follow up was of 5.6 (4.9–6.4) years. IMA value was 7.5° (6.1°?8.1°) and HVA was 10.1° (6.7°?16.3°), with no statistical difference with initial correction (p = 0.14). Median AOFAS score was 92.7 (89–4–96.1).ConclusionL-Reverse osteotomy can achieve correction of HV severe deformities with good outcomes in long term follow up.Level of evidenceIII     

Distal metatarsal osteotomy for adolescent hallux valgus

This is a review of 55 metatarsal osteotomies for hallux valgus and metatarsus primus varus in patients under 15 years of age. The results were analysed after the patients were reviewed clinically and radiologically. Complications of the osteotomies and the factors that caused them are discussed. Poor results, irrespective of the type of osteotomy, were due to excessive shortening of the first metatarsal and/or dorsal tilting of the metatarsal head. In both instances there was persistent metatarsalgia.     

Proximal spherical metatarsal osteotomy for the foot with severe hallux valgus

BACKGROUND: A proximal spherical metatarsal osteotomy was devised to correct not only varus deviation of the first metatarsal, but also dorsiflexion. We expected to increase the medial longitudinal arch by adding plantar flexion at the osteotomy site. To investigate the limitations of this procedure for feet with severe hallux valgus, a followup study was performed on patients with preoperative hallux valgus angles greater than or equal to 40 degrees. MATERIALS AND METHODS: Forty-eight feet in 37 patients (10 male, 27 female) (60 years; range, 20 to 84 years) were investigated. Mean followup was 4 years and 1 month, ranging from 2 to 8 years. The spherical osteotomy was performed using a curved chisel. A distal soft tissue procedure was done at the same time. Twenty feet received combined operations for their combined deformities. RESULTS: While 81% of patients were satisfied with the results, 50% of those with preoperative hallux valgus angles greater than or equal to 50 degrees had postoperative hallux valgus angle greater than or equal to 20 degrees. In these patients, correction of metatarsus primus varus was good, but correction of valgus deviation of the hallux was fair. Mean correction toward plantar flexion was 1.5 degrees and no increase in arch height was achieved. CONCLUSION: The proximal spherical osteotomy could consistently achieve satisfactory results for the patients with hallux valgus angles less than 50 degrees. However, the corrections were worse in feet with more severe deformities. Furthermore, plantarflexion at the osteotomy site was offset by displacement at the first tarsometatarsal joint. If plantarflexion is indispensable, arthrodesis of the tarsometatarsal joint is recommended.     

The modified Ludloff osteotomy for correction of severe metatarsus primus varus with hallux valgus deformity

AIM: The present study investigates the clinical and radiological mid-term results of the modified Ludloff osteotomy, a proximal metatarsal osteotomy for surgical correction of severe metatarsus primus varus with hallux valgus deformity. METHOD: 70 feet in 67 patients from 25 to 78 years (average age 56 years) were included in this prospective study. The patients were evaluated with the American Orthopaedic Foot and Ankle Society (AOFAS) forefoot metatarsophalangeal interphalangeal score, which was used preoperatively and at an average follow-up of 37 +/- 6 months. Weight-bearing foot radiographs were analysed according to AOFAS guidelines and statistical evaluation was made with the Wilcoxon signed-rank test. RESULTS: The average AOFAS score improved significantly (p < 0.0001) from 55.2 +/- 15.2 points preoperatively to 86.6 +/- 15.2 points at follow-up. Preoperatively, all patients complained of pain (20.2 +/- 9.6 points) which had improved significantly (p < 0.0001) at the latest follow-up (37.3 +/- 5.7 points). The average hallux valgus angle (HVA) was 37 +/- 8 degrees preoperatively and improved significantly to 12 +/- 11 degrees at follow-up (p = 0.0001). The intermetatarsal angle (IMA) improved significantly from 18 +/- 2 degrees preoperatively to 8 degrees +/- 4 degrees after 37 +/- 6 months (p = 0.0002). The sesamoid position improved significantly from preoperative to follow-up (p = 0.0003). Radiographic evaluation of the patients indicated that all examined osteotomies had healed after 37 +/- 6 months. CONCLUSION: This prospective investigation at intermediate follow-up using currently available outcome measures suggests that the Ludloff osteotomy is a suitable procedure for the surgical correction of severe metatarsus primus varus (IMA > 15 degrees ) with hallux valgus deformity.     

第1跖骨基底斜行闭合截骨治疗中重度(足母)外翻畸形

[目的] 回顾性研究第1跖骨基底长斜行闭合截骨治疗足母外翻的临床效果.[方法]2007年2月～2008年11月间行第1跖骨基底长斜形截骨结合远端软组织松解内侧关节囊重叠缝合治疗<足母>外翻共21例24足,均属中重度足母外翻,第1、2跖间角均大于15°,行第1跖骨基底斜行闭合截骨螺钉内固定术.[结果]平均随访7.6个月,术前平均HVA、IM 1-2角分别为31.30°±6.68°和16.62°±2.65°,术后平均HVA、IM 1-2角分别为12.96°±7.15°和9.80°±2.43°,平均矫正HAV角19.6°、IM角8.2°,术前、术后平均有明显统计学差异(P<0.001),第1跖骨长度与第2跖骨长度比术前、术后分别为(89±6.7)%、(84±5.6)%,有明显统计学差异(P<0.05).[结论] 第1跖骨基底长斜形闭合截骨手术方法治疗中重度<足母>外翻畸形可以取得比较好的矫正结果.     

Angular correction and complications of proximal first metatarsal osteotomies for hallux valgus deformity

Purpose

Proximal first metatarsal osteotomies are recommended for the surgical treatment of moderate to severe hallux valgus deformity. This study aimed to compare correction of intermetatarsal and hallux valgus angles and complications of proximal crescentic, Ludloff, proximal opening wedge, proximal closing wedge, proximal chevron and other proximal first metatarsal osteotomies.

Methods

A systematic search for the keywords “(bunion OR hallux) AND (proximal OR crescentic OR basilar OR opening OR closing OR shelf OR Ludloff) AND osteotomy” in the online databases MEDLINE, Embase, CINAHL, Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews was performed.

Results

There was a mean correction of hallux valgus angle of 20.1° [confidence interval (CI) 18.7–21.4] and of intermetatarsal angle of 8.1° (CI 7.7–8.9). The overall complication rate reached 18.7 %.

Conclusions

The results of this study reveal higher corrective power of proximal osteotomies compared to meta-analysis data on diaphyseal osteotomies.     

Comparing proximal and distal metatarsal osteotomy for moderate to severe hallux valgus

Purpose

This study compared results of distal and proximal metatarsal osteotomy for moderate to severe hallux valgus in terms of radiographic correction and functional outcome.

Methods

We analyzed 125 moderate to severe hallux valgus surgeries. Patients were divided into two groups. Group 1 underwent distal metatarsal osteotomy, and group 2 underwent proximal metatarsal osteotomy. Patients were interviewed for functional scores before and one year after surgery. The anteroposterior (AP) weight-bearing radiography of the foot was taken before and one year after surgery.

Results

There were no significant differences in pain and function after one year in either group. Both groups experienced significant pain reduction and increase in all functional scores. There was significant improvement of hallux valgus and intermetatarsal angle corrections in group 2. There was less improvement in radiographic correction in group 1.

Conclusion

Either distal or proximal metatarsal osteotomy is an appropriate pain-relieving procedure and can increase functional outcome in moderate to severe hallux valgus. However, distal metatarsal osteotomy provides lower correction power.