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Osteodesis for Hallux Valgus Correction: Is it Effective?

Abstract

Background

Although the etiology of hallux valgus is contested, in some patients it may be failure of the stabilizing soft tissue structures around the first ray of the foot. Because there is lack of effective soft tissue techniques, osteotomies have become the mainstream surgical approach to compensate for the underlying soft tissue deficiency; osteodesis, a soft tissue nonosteotomy technique, may be a third alternative, but its efficacy is unknown.

Questions/purposes

We asked: (1) Can an osteodesis, a distal soft tissue technique, correct hallux valgus satisfactorily in terms of deformity correction and improvement in American Orthopaedic Foot and Ankle Society (AOFAS) score? (2) Is the effectiveness of an osteodesis affected by the patient’s age or deformity severity? (3) What complications are associated with this procedure?

Methods

Between February and October 2010, we performed 126 operations to correct hallux valgus, of which 126 (100%) were osteodeses. Sixty-one patients (110 procedures) (87% of the total number of hallux valgus procedures) were available for followup at a minimum of 12 months (mean, 23 months; range, 12–38 months). This group formed our study cohort. During the study period, the general indications for this approach included failed conservative measures for pain relief and metatarsophalangeal angle greater than 20° or intermetatarsal angle greater than 9°. Intermetatarsal cerclage sutures were used to realign the first metatarsal and postoperative fibrosis was induced surgically between the first and second metatarsals to maintain its alignment. The radiologic first intermetatarsal angle, metatarsophalangeal angle, and medial sesamoid position were measured by Hardy and Clapham’s methods for deformity and correction evaluation. Clinical results were assessed by the AOFAS score.

Results

The intermetatarsal angle was improved from a preoperative mean of 14° to 7° (p < 0.001; Cohen’s d = 1.8) at followup, the metatarsophalangeal angle from 31° to 18° (p < 0.001; Cohen’s d = 3.1), the medial sesamoid position from position 6 to 3 (p < 0.001; Cohen’s d = 2.4), and AOFAS hallux score from 68 to 96 points (p < 0.001). Neither patient age nor deformity severity affected the effectiveness of the osteodesis in correcting all three radiologic parameters; however, the deformities treated in this series generally were mild to moderate (mean intermetatarsal angle, 14°; range, 9°–22°). There were six stress fractures of the second metatarsal (5%), five temporary metatarsophalangeal joint medial subluxations all resolved in one month by the taping-reduction method without surgery, and six metatarsophalangeal joints with reduced dorsiflexion less than 60°.

Conclusions

The osteodesis is a soft tissue nonosteotomy technique, and provided adequate deformity correction and improvement in AOFAS scores for patients with mild to moderate hallux valgus deformities, although a small number of the patients had postoperative stress fractures of the second ray develop. Future prospective studies should compare this technique with osteotomy techniques in terms of effectiveness of the correction, restoration of hallux function, complications, and long-term recurrence.

Level of Evidence

Level IV, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.

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Acknowledgments

We thank Rachel Tam RN for providing assistance with measuring radiologic parameters and data processing and Grace Lam for word processing.

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Corresponding author

Correspondence to Daniel Y. Wu MD.

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Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research ® editors and board members are on file with the publication and can be viewed on request.

Clinical Orthopaedics and Related Research ® neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA-approval status, of any drug or device prior to clinical use.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

This study was performed at Hong Kong Adventist Hospital.

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Wu, D.Y., Lam, K.F. Osteodesis for Hallux Valgus Correction: Is it Effective?. Clin Orthop Relat Res 473, 328–336 (2015). https://doi.org/10.1007/s11999-014-3938-6

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Keywords

  • Hallux Valgus
  • Metatarsophalangeal Joint
  • Soft Tissue Procedure
  • Intermetatarsal Angle
  • Hallux Valgus Deformity