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Distal chevron metatarsal osteotomy is a viable treatment option for hallux valgus with metatarsus adductus—multicentre retrospective study

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Abstract

Purpose

The purpose of this study was to evaluate the radiographic and clinical outcomes of patients with hallux valgus (HV) with concomitant metatarsus adductus (MA) treated with distal chevron metatarsal osteotomy (DCMO), without any procedure for the second or third metatarsal.

Methods

A multicentre retrospective study involving four hospitals was conducted. A total of 45 feet from 38 patients who had received DCMO for HV with MA with at least one year post-operative follow-up were analysed. HV angle (HVâ), inter-metatarsal angle (IMâ), MA angle (MAâ), and the lateral sesamoid grade were measured. Foot function index (FFI) and visual analogue scale (VAS) were recorded. Patients were divided into mild (18° ≤ MAâ < 20°) and moderate (20° ≤ MAâ) MA groups, and results were compared.

Results

The mean HVâ and IMâ improved significantly from 35.1° and 14.4° pre-operatively to 10.6° and 7.1° one year post-operatively (p < 0.001). There were no differences in pre-operative HVâ, IMâ, or the sesamoid grade, and also no difference in post-operative HVâ or the sesamoid grade between mild and moderate MA groups. Only the mean post-operative IMâ showed a difference between the two groups (8.3° vs. 6.3°; p = 0.019). All clauses of FFI and VAS improved significantly (p < 0.001). When the extent of improvement was compared between the two groups, there were no significant differences in any category (p > 0.05). The total rate of recurrence (HVâ ≥ 20°) was 11.1% (5/45), and although the moderate group (4/29, 13.8%) had a higher proportion than the mild group (1/16, 6.3%), this was not statistically significant (p = 0.641).

Conclusion

DCMO for patients with HV with MA had satisfactory radiographic and clinical outcomes with minimal recurrence. Except in cases of severe combined deformity, we recommend performing DCMO alone without any additional procedure or manipulation of the other metatarsals as a viable treatment option.

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Availability of data and material (data transparency)

The data that support the findings of this study are available from the corresponding author, upon reasonable request.

Code availability (software application or custom code)

Not applicable.

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Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang-si, Gyeonggi-do, Republic of Korea

    Jaehyung Lee

  2. Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea

    Ho Seong Lee, Taehong Kee, Sangpil So & Young Rak Choi

  3. Department of Orthopaedic Surgery, Daejeon St. Mary’s Hospital, The Catholic University of Korea, Daejeon, Republic of Korea

    Jae-Jung Jeong

  4. Department of Orthopaedic Surgery, GangNeung Asan Hospital, University of Ulsan College of Medicine, Gangneung-si, Gangwon, Republic of Korea

    Dong-Kyo Seo

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  1. Jaehyung Lee
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  2. Ho Seong Lee
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Jae-Jung Jeong, Dong-Kyo Seo, Taehong Kee, and Sangpil So. The first draft of the manuscript was written by Jaehyung Lee and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Young Rak Choi.

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This retrospective study was approved by the institutional review board of Asan Medical Center.

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Informed consent was obtained from patients included in the study.

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Patients signed informed consent regarding publishing their data.

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The authors declare no competing interests.

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Lee, J., Lee, H.S., Jeong, JJ. et al. Distal chevron metatarsal osteotomy is a viable treatment option for hallux valgus with metatarsus adductus—multicentre retrospective study. International Orthopaedics (SICOT) 45, 2261–2270 (2021). https://doi.org/10.1007/s00264-021-05117-y

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  • DOI: https://doi.org/10.1007/s00264-021-05117-y

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