Abstract
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.
Similar content being viewed by others
References
Coughlin MJ, Mann RA (2007) Hallux valgus. Surgery of the foot and ankle, vol 1, 8th edn. Mosby, Philadelphia
Coughlin MJ, Shurnas PS (2003) Hallux valgus in men. Part II: First ray mobility after bunionectomy and factors associated with hallux valgus deformity. Foot Ankle Int 24:73–78
Mann RA, Rudicel S, Graves SC (1992) Repair of hallux valgus with a distal soft-tissue procedure and proximal metatarsal osteotomy. A long-term follow-up. J Bone Joint Surg Am 74:124–129
Easley ME, Trnka HJ (2007) Current concepts review: hallux valgus part II: operative treatment. Foot Ankle Int 28(6):748–758
Dreeben S, Mann RA (1996) Advanced hallux valgus deformity: long-term results utilizing the distal soft tissue procedure and proximal metatarsal osteotomy. Foot Ankle Int 17:142–144
Thordarson DB, Leventen EO (1992) Hallux valgus correction with proximal metatarsal osteotomy: two-year follow-up. Foot Ankle Int 13(321–6)
Lucijanic I, Bicanic G, Sonicki Z, Mirkovic M, Pecina M (2009) Treatment of hallux valgus with three-dimensional modification of Mitchell’s osteotomy: technique and results. J Am Podiatr Med Assoc 99(2):162–172
Robinson AH, Bhatia M, Eaton C, Bishop L (2009) Prospective comparative study of the scarf and Ludloff osteotomies in the treatment of hallux valgus. Foot Ankle Int 31(10):955–963
Saragas NP (2009) Proximal opening-wedge osteotomy of the first metatarsal for hallux valgus using a low profile plate. Foot Ankle Int 30(10):967–980
Adam SP, Choung SC, Gu Y, O’Malley MJ (2011) Outcomes after scarf osteotomy for treatment of adult hallux valgus deformity. Clin Orthop Relat Res 469(3):854–859
Bai LB, Lee KB, Seo CY, Song EK, Yoon TR (2010) Distal chevron osteotomy with distal soft tissue procedure for moderate to severe hallux valgus deformity. Foot Ankle Int 31(8):683–688
Saro C, Andrén B, Wildemyr Z, Felländer-Tsai L (2007) Outcome after distal metatarsal osteotomy for hallux valgus: a prospective randomized controlled trial of two methods. Foot Ankle Int 28(7):778–787
Deenik A, van Mameren H, de Visser E, de Waal Malefijt M, Draijer F, de Bie R (2008) Equivalent correction in scarf and chevron osteotomy in moderate and severe hallux valgus: a randomized. controlled trial. Foot Ankle Int 29(12):1209–1215
Kitaoka HB, Alexander IJ, Adelaar RS, Nunley JA, Myerson MS, Sanders M (1994) Clinical rating system for the ankle and hindfoot, midfoot, hallux and lesser toes. Foot Ankle Int 15(7):349–353
Roles NC, Maudsley RH (1972) Radial tunnel syndrome: resistant tennis elbow as a nerve entrapment. J Bone Joint Surg Br 54(3):499–508
Ware JE, Kosinski M, Keller SD (1996) A 12 item short form health survey: construction of scales and preliminary tests of reliability and validity. Med Care 34(220–33)
Coughlin MJ (1996) Hallux valgus. J Bone Joint Surg Am 78(6):932–966
Okuda R, Kinoshita M, Yasuda T, Jotoku T, Kitano N, Shima H (2009) Postoperative incomplete reduction of the sesamoids as a risk factor for recurrence of hallux valgus. J Bone Joint Surg Am 91(7):1637–1645
Austin DW, Leventen E (1981) A new osteotomy for hallux valgus: a horizontally directed “V” displacement osteotomy of the metatarsal head for hallux valgus and primus varus. Clin Orthop 157(25–30)
Sammarco VJ (2007) Surgical strategies: mau osteotomy for correction of moderate and severe hallux valgus deformity. Foot Ankle Int 28(7):857–864
McBride ED (1967) The McBride bunion hallux valgus operation. J Bone Joint Surg Am 49:1675–1683
Ferrari J, Higgins JP, Prior TD (2009) WITHDRAWN: interventions for treating hallux valgus (abductovalgus) and bunions. Cochrane Database Syst Rev 15(2):CD000964
Coughlin MJ, Jones CP (2007) Hallux valgus: demographics, etiology, and radiographic assessment. Foot Ankle Int 28(7):759–777
Wang X, Jiang JY, Ma X, Huang JZ, Gu XJ (2009) Management of the second and third metatarsal in moderate and severe hallux valgus. Orthopedics 32(12):892
Garrido IM, Rubio ER, Bosch MN, González MS, Paz GB, Llabrés AJ (2008) Scarf and Akin osteotomies for moderate and severe hallux valgus: clinical and radiographic results. Foot Ankle Surg 14(4):194–203
De Lavigne C, Rasmont Q, Hoang B (2011) Percutaneous double metatarsal osteotomy for correction of severe hallux valgus deformity. Acta Orthop Belg 77(4):516–521
Sammarco GJ, Idusuyi OB (2001) Complications after surgery of the hallux. Clin Orthop Relat Res 391:59–71
Potenza V, Caterini R, Farsetti P, Forconi F, Savarese E, Nicoletti S, Ippolito E (2009) Chevron osteotomy with lateral release and adductor tenotomy for hallux valgus. Foot Ankle Int 30(6):512–516
Trnka HJ, Zembsch A, Easley ME, Salzer M, Ritschl P, Myerson MS (2000) The chevron osteotomy for correction of hallux valgus. Comparison of findings after two and five years of follow-up. J Bone Joint Surg Am 82(10):1373–1378
Okuda R, Kinoshita M, Yasuda T, Jotoku T, Shima H (2008) Proximal metatarsal osteotomy for hallux valgus: comparison of outcome for moderate and severe deformities. Foot Ankle Int 29(7):664–670
Okuda R, Kinoshita M, Yasuda T, Jotoku T, Kitano N, Shima H (2007) The shape of the lateral edge of the first metatarsal head as a risk factor for recurrence of hallux valgus. J Bone Joint Surg Am 89(10):2163–2172
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Chuckpaiwong, B. Comparing proximal and distal metatarsal osteotomy for moderate to severe hallux valgus. International Orthopaedics (SICOT) 36, 2275–2278 (2012). https://doi.org/10.1007/s00264-012-1656-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00264-012-1656-9