Advertisement

Archives of Orthopaedic and Trauma Surgery

, Volume 132, Issue 11, pp 1539–1546 | Cite as

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

  • Yasser A. Radwan
  • Ali M. Reda Mansour
Orthopaedic Surgery

Abstract

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.

Keywords

Hallux valgus Percutaneous Osteotomy 

References

  1. 1.
    Coughlin M (1996) Hallux valgus. J Bone Joint Surg Am 78(6):932–966PubMedGoogle Scholar
  2. 2.
    Thordarson D, Rudicel S, Ebramzadeh E et al (2001) Outcome study of hallux valgus surgery: an AOFAS multi-centre study. Foot Ankle Int 22:956–959PubMedGoogle Scholar
  3. 3.
    Bock P, Kristen K, Kröner A et al (2004) Hallux valgus and cartilage degeneration in the first metatarsophalangeal joint. J Bone Joint Surg Br 86(5):669–673PubMedCrossRefGoogle Scholar
  4. 4.
    Austin D, 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 Relat Res 157:25–30PubMedGoogle Scholar
  5. 5.
    Green M, Dorris M, Baessler T et al (1993) Avascular necrosis following distal Chevron osteotomy of the first metatarsal. J Foot Ankle Surg 32:617–622PubMedGoogle Scholar
  6. 6.
    Jones K, Feiwell L, Freedman E et al (1995) The effect of chevron osteotomy with lateral capsular release on the blood supply to the first metatarsal head. J. Bone Joint Surg Am 77(2):197–204PubMedGoogle Scholar
  7. 7.
    Schneider W, Aigner N, Knahr K et al (2004) Chevron osteotomy in hallux valgus. Ten-year results of 112 cases. J Bone Joint Surg Br 86(7):1016–1020PubMedCrossRefGoogle Scholar
  8. 8.
    Kuhn M, Lippert F, Phipps M et al (2005) Blood flow to the metatarsal head after chevron bunionectomy. Foot Ankle Int 26:526–529PubMedGoogle Scholar
  9. 9.
    Lee H, Chung J, Chu I et al (2010) Comparison of distal chevron osteotomy with and without lateral soft tissue release for the treatment of hallux valgus. Foot Ankle Int 31:291–295PubMedCrossRefGoogle Scholar
  10. 10.
    Bösch P, Wanke S, Legenstein R (2000) Hallux valgus correction by the method of Bosch: a new technique with a seven-to-ten-year follow-up. Foot Ankle Clin 5:485–498PubMedGoogle Scholar
  11. 11.
    Magnan B, Pezz`e L, Rossi N et al (2005) Percutaneous distal metatarsal osteotomy for correction of hallux valgus. J Bone Joint Surg Am 87(6):1191–1199PubMedCrossRefGoogle Scholar
  12. 12.
    Magnan B, Bortolazzi R, Samaila E et al (2006) Percutaneous distal metatarsal osteotomy for correction of hallux valgus. Surgical technique. J Bone Joint Surg Am 88(Suppl 1):135–148PubMedCrossRefGoogle Scholar
  13. 13.
    Bauer T, De lavigne C, Biau D et al (2009) Percutaneous hallux valgus surgery. Prospective multicenter study of 189 cases. Orthop Clin N Am 40(4):505–514CrossRefGoogle Scholar
  14. 14.
    Roukis T (2009) Percutaneous and minimum incision metatarsal osteotomies: a systematic review. J Foot Ankle Surg 48(3):380–387PubMedCrossRefGoogle Scholar
  15. 15.
    Siclari A, Decantis V (2009) Arthroscopic lateral release and percutaneous distal osteotomy for hallux valgus: a preliminary report. Foot Ankle Int 30:675–679PubMedCrossRefGoogle Scholar
  16. 16.
    Kitaoka H, Alexander I, Adelaar R et al (1994) Clinical rating systems for the ankle-hind foot, midfoot, hallux, and lesser toes. Foot Ankle Int 15:349–353PubMedGoogle Scholar
  17. 17.
    Smith RW, Reynold JC, Steward MJ (1984) Hallux valgus assessment: report of Research committee of the American Orthopaedic Foot and Ankle Society. Foot Ankle Int 5:92–103Google Scholar
  18. 18.
    Isham S (1991) The Reverdin–Isham procedure for the correction of hallux abducto valgus. A distal metatarsal osteotomy procedure. Clin Podiatr Med Surg 8(1):81–94PubMedGoogle Scholar
  19. 19.
    Wilson JD, Baines J, Siddique, Fleck R (2009) The effect of sesamoid position on outcome following scarf osteotomy for hallux abducto valgus. Foot Ankle Surg 15(2):65–68PubMedCrossRefGoogle Scholar
  20. 20.
    Esemenli T, Yildirim Y (2003) Lateral shifting of the first metatarsal head in hallux valgus surgery: effect on sesamoid reduction. Foot Ankle Int 24(12):922–926PubMedGoogle Scholar
  21. 21.
    Resch S, Stenstrom A, Reynisson K, Jonsson K (1994) Chevron osteotomy for hallux valgus not improved by additional adductor tenotomy. A prospective, randomized study of 84 patients. Acta Orthop Scand 65:541–544PubMedCrossRefGoogle Scholar
  22. 22.
    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):1637–1645PubMedCrossRefGoogle Scholar
  23. 23.
    Kadakia A, Smerek J, Myerson M (2007) Radiographic results after percutaneous distal metatarsal osteotomy for correction of hallux valgus deformity. Foot Ankle Int 28:355–360PubMedCrossRefGoogle Scholar
  24. 24.
    Huang PJ, Lin YC, Fu YC, Yang YH, Cheng YM (2011) Radiographic evaluation of minimally invasive distal metatarsal osteotomy for hallux valgus. Foot Ankle Int 32(5):S503–S507PubMedCrossRefGoogle Scholar
  25. 25.
    De Lavigne C, Rasmont Q, Hoang B (2011) Percutaneous double metatarsal osteotomy for correction of severe hallux valgus deformity. Acta Orthop Belg 77(4):516–521PubMedGoogle Scholar
  26. 26.
    Deenik A, De Visser E, Louwerens J (2008) Hallux valgus angle as main predictor for correction of hallux valgus. BMC Musculoskelet Disord 9:70–75PubMedCrossRefGoogle Scholar
  27. 27.
    Vidal C, Vila J (2009) A geometric analysis of hallux valgus: correlation with clinical assessment of severity. J Foot Ankle Res 2:15–21CrossRefGoogle Scholar
  28. 28.
    D’Arcangelo P, Landorf K, Munteanu S et al (2010) Radiographic correlates of hallux valgus severity in older people. J Foot Ankle Res 3:20–28PubMedCrossRefGoogle Scholar
  29. 29.
    Miller J (1974) Distal first metatarsal displacement osteotomy: its place in the schema of bunion surgery. J Bone Joint Surg Am 56(5):923–931PubMedGoogle Scholar
  30. 30.
    Coughlin M, Freund E, Roger A et al (2001) The reliability of angular measurements in hallux valgus deformities. Foot Ankle Int 22(5):369–379PubMedGoogle Scholar
  31. 31.
    Schneider W, Csepan R, Kasparek M et al (2002) Intra and interobserver repeatability of radiographic measurements in hallux surgery: improvement and validation of a method. Acta Orthop Scand 73(6):670–673PubMedCrossRefGoogle Scholar
  32. 32.
    Schneider W, Csepan R, Knahr K (2003) Reproducibility of the radiographic metatarsophalangeal angle in hallux surgery. J Bone Joint Surg Am 85(3):494–499PubMedGoogle Scholar
  33. 33.
    Shima H, Okuda R, Yasuda T et al (2009) Radiographic measurements in patients with hallux valgus before and after proximal crescentic osteotomy. J Bone Joint Surg Am 91(6):1369–1376PubMedCrossRefGoogle Scholar
  34. 34.
    Thordarson D, Ebramzadeh E, Moorthy M et al (2005) Correlation of hallux valgus surgical outcome with AOFAS forefoot score and radiological parameters. Foot Ankle Int 26:122–127PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  1. 1.Orthopaedic Surgery Department, Faculty of MedicineCairo UniversityCairoEgypt

Personalised recommendations