Effectiveness of double metatarsal osteotomy for severe hallux valgus with increased distal metatarsal articular angle / 中国修复重建外科杂志

Objective: To summarize the technique and effectiveness of double metatarsal osteotomy for treating severe hallux valgus with increased distal metatarsal articular angle (DMAA). Methods: Between June 2014 and December 2017, 64 patients (94 feet) of severe hallux valgus with an increased DMAA were treated with the double metatarsal osteotomy (distal metatarsal Reverdin osteotomy+proximal metatarsal open wedge osteotomy) combined with Akin osteotomy and soft tissue surgery to correct the deformity. There were 10 males (15 feet) and 54 females (79 feet) with an average age of 44.5 years (range, 26-66 years), including 34 of unilateral foot and 30 of bilateral feet. The Maryland metatarsophalangeal joint score of the American Orthopaedic Foot and Ankle Society (AOFAS) was 54.3±7.4 and the visual analogue scale (VAS) score was 6.0±2.0. The pre- and post-operative AOFAS score, VAS score, DMAA, hallux valgus angle (HVA), first-second intermetatarsal angle (1-2IMA), and the first metatarsal length (FML) were recorded and compared. Results: All incisions healed by first intention. All patients were followed up 12-15 months, with an average of 13.2 months. The complications occurred in 4 feet, including 1 foot of hallux stiffness, 1 foot of numbness at the edge of the wound, 1 foot of metastatic metatarsalgia, and 1 foot of metatarsal bone necrosis. At 1 year after operation, the Maryland metatarsal joint score of AOFAS was 89.2±7.4, showing significant difference compared with preoperative score ( t=18.427, P=0.000); and the effectiveness was rated as excellent in 78 feet, good in 12 feet, poor in 3 feet, and bad in 1 foot, with an excellent and good rate of 95.7%. The VAS score was 1.5±2.0, showing significant difference compared with the preoperative score ( t=10.238, P=0.000). The X-ray films showed that the osteotomies achieved bony healing at 3 months after operation. There were significant differences ( P<0.05) in HVA, 1-2IMA, and DMAA between preoperation and 6 months and 1 year after operation; but no significant difference was found in FML between preoperation and 1 year after operation ( t=0.136, P=0.863). Conclusion: For the patients with severe hallux valgus with increased DMAA, the double metatarsal osteotomy can significantly relieve the clinical symptoms and improve the imaging parameters with less postoperative complications.

Lesser Metatarsal Osteotomies for Metatarsalgia / 대한족부족관절학회지

Metatarsalgia means the pain under the lesser metatarsal heads. The many causes of metatarsalgia can be categorized into three groups: local disease in the region, altered forefoot biomechanics, and systemic disease affecting the region. Surgical options need to be considered if nonsurgical treatment fails. The metatarsal osteotomies are designed primarily to reduce the weightbearing forces on the metatarsal head by elevating or shortening the metatarsal. Many lesser metatarsal osteotomies have been described, and their success depends on many factors. Regardless of the method employed, it is important to maintain or restore the metatarsal cascade to maintain an even pressure under the lesser metatarsal heads and prevent transfer lesions. The surgeon must understand the effects of the metatarsal osteotomy on the forefoot patho-biomechanics and decide, using a combination of clinical examinations and imaging, whether the desired effect of the osteotomy is to shorten or elevate the metatarsal head or both.

Biomechanical Comparison Study of Three Fixation Methods for Proximal Chevron Osteotomy of the First Metatarsal in Hallux Valgus

BACKGROUND: Fixation of proximal chevron metatarsal osteotomy has been accomplished using K-wires traditionally and with a locking plate recently. However, both methods have many disadvantages. Hence, we developed an intramedullary fixation technique using headless cannulated screws and conducted a biomechanical study to evaluate the superiority of the technique to K-wire and locking plate fixations. METHODS: Proximal chevron metatarsal osteotomy was performed on 30 synthetic metatarsal models using three fixation techniques. Specimens in group I were fixated with K-wires (1.6 mm × 2) and in group II with headless cannulated screws (3.0 mm × 2) distally through the intramedullary canal. Specimens in group III were fixated with a locking X-shaped plate (1.3-mm thick) and screws (2.5 mm × 4). Eight metatarsal specimens were selected from each group for walking fatigue test. Bending stiffness and dorsal angulation were measured by 1,000 repetitions of a cantilever bending protocol in a plantar to dorsal direction. The remaining two samples from each group were subjected to 5 mm per minute axial loading to assess the maximal loading tolerance. RESULTS: All samples in group I failed walking fatigue test while group II and group III tolerated the walking fatigue test. Group II showed greater resistance to bending force and smaller dorsal angulation than group III (p = 0.001). On the axial loading test, group I and group II demonstrated superior maximum tolerance to group III (54.8 N vs. 47.2 N vs. 28.3 N). CONCLUSIONS: Authors have demonstrated proximal chevron metatarsal osteotomy with intramedullary screw fixation provides superior biomechanical stability to locking plate and K-wire fixations. The new technique using intramedullary screw fixation can offer robust fixation and may lead to better outcomes in surgical treatment of hallux valgus.

Results of Minimal Incision Distal Metatarsal Osteotomy for Moderate to Severe Hallux Valgus / 대한족부족관절학회지

PURPOSE: Minimal incision distal metatarsal osteotomy (MIDMO) is known to be an effective surgical procedure for mild to moderate hallux valgus. However, the result of MIDMO on moderate to severe hallux valgus is controversial; therefore, we investigated the radiological and clinical results of MIDMO on moderate to severe hallux valgus. MATERIALS AND METHODS: We reviewed 51 feet (48 patients) with moderate to severe hallux valgus. The mean age was 67.0 years and the mean follow-up period was 32.2 months. Radiological data of hallux valgus angle, first intermetatarsal angle, and distal metatarsal articular angle on plain radiographs were analyzed. Recurrence, union, lateral translation of distal fragment and angulation were also analyzed. The clinical data were obtained using American Orthopaedic Foot and Ankle Society (AOFAS) score of preoperation and last follow-up. Receiver operating characteristic (ROC) curve was used to determine a cut-off value. RESULTS: The mean hallux valgus angle measured at preoperation was 37.7o and 15.9degrees at last follow-up. The mean first intermetatarsal angle of preoperation and last follow-up were 15.2degrees and 8.3degrees. The mean distal metatarsal articular angle changed from 12.6degrees at preoperation to 7.8degrees at last follow-up. Preoperative hallux valgus angle (p=0.0051) and distal metatarsal articular angle (p=0.0078) were statistically significant factors affecting postoperative AOFAS score. Cut-off value of each was 37degrees and 13degrees, respectively. Lateral translation of distal fragment in 5 recurrent cases was 23.0% compared to 45.3% of 46 non-recurrent cases. The result was statistically significant and the cut-off value was 38%. CONCLUSION: Sufficient lateral translation over 38% in MIDMO on moderate to severe hallux valgus patients with preoperative hallux valgus angle under 37degrees and distal metatarsal articular angle under 13degrees can lead to good clinical results without recurrence.

Operative Treatment of Hallux Valgus / 대한족부족관절학회지

Hallux valgus, or a 'bunion', is a deformity characterized by lateral deviation of the big toe. Surgery is indicated when conservative treatments have failed to result in improvement of symptoms. Operative techniques include simple bunionectomy, distal soft tissue procedure, phalangeal osteotomy, metatarsal osteotomy (distal, shaft, or proximal), arthrodesis (metatarsophalangeal or tarsometatarsal), or resection arthroplasty. Good results are expected when the selection of operative technique is based on the correct treatment principle.

Treatment for Hallux Valgus with Chevron Metatarsal Osteotomy in Patients over 60 Years Old / 대한족부족관절학회지

PURPOSE: To treat hallux valgus in old age patients with chevron metatarsal osteotomy and to see the subsequent clinical and radiological outcomes. MATERIALS AND METHODS: 23 cases of 18 hallux valgus patients of age 60 years or older who received proximal or distal corrective osteotomy from April 2007 to August 2009 and were followed up for at least 1 year were included in the study. The mean age at operation was 65 years (range, 60~81 years), and the mean follow-up period was 2 years and 6 months (range, 1 year~3 years 6 months). Clinical outcome was assessed with the American Orthopaedic Foot and Ankle Society (AOFAS) score, complications, satisfaction rate, as well as measurements and comparison of pre- and postoperative hallux valgus angles, the 1st~2nd intermetatarsal angle, and the position of hallucal medial sesamoid bone. RESULTS: The AOFAS score was improved from preoperative average of 35.1 (range, 13-47) to average 85.1 at last follow-up (range, 75-100). Patients were satisfied about the operation in 21 cases (91.3%). Preoperative hallux valgus angle was 31.7degrees on average (range, 19.1degrees-48.9degrees), and 4.9degrees on average at last follow-up (range, 0.3degrees-21.2degrees). The 1st~2nd intermetatarsal angle was 14.4degrees on average (range, 8.7degrees-25.7degrees) and 3.1degrees on average at last follow-up (range, 0.6degrees-7.5degrees). The hallucal medial sesamoid bone position was improved from preoperative average 3.5 (range, 3-4) to postoperative average 1.0 (range, 0-2). CONCLUSION: Proximal and distal metatarsal osteotomy treatment yielded good clinical and radiological outcomes in old age hallux valgus patients.

Comparison of Proximal and Modified Distal Chevron Osteotomy for the Treatment of Moderate to Severe Hallux Valgus Deformity / 대한족부족관절학회지

PURPOSE: The purpose of our study is the comparison of radiological and clinical outcomes between modified distal chevron osteotomy and proximal metatarsal osteotomy for the patients who had moderate to severe hallux valgus deformity. MATERIALS AND METHODS: In this retrospective study, we included 54 patients (65 feets) who underwent the operation of moderate to severe hallux valgus in our hospital from May 2007 to August 2010. Our study compares two groups. For Group 1, a modified distal chevron osteotmy and a distal soft tissue procedure were done and for Group 2, a proximal metatarsal osteotmy and a distal soft tissue procedure were done. The group 1 were 29 feets; the group 2 were 36 feets, and the average follow up was 9 months. RESULTS: The radiological results show that the hallux valgus angle and the first-second intermetatarsal angle were significantly decreased in two groups. In each parameter, the correction of the hallux valgus angle was 19.1degrees (Group 1) and 24.3degrees (Group 2), the correction of the first-second intermetatarsal angle was 9.6degrees (Group 1) and 10.3degrees (Group 2). Shortening of the first metatarsal length was 0.87 mm (Group 1) and 0.77 mm (Group 2). There are no significant clinical results (American Orthopaedic Foot and Ankle Society score, AOFAS score) in two groups. CONCLUSION: It is thought that a modified distal chevron osteotomy and a distal soft tissue procedure are a considerable operative treatment of moderate to severe hallux valgus deformity because of the similar cilinical results, more simple operative techniques, and less complications than a proximal metatarsal osteotomy.

Surgical Treatment for Plantar Keratosis Using Vertical Chevron Osteotomy / 대한족부족관절학회지

PURPOSE: Painful plantar callosities under the second, third or fourth metatarsal head have been controverted about its treatment mordalities. We performed the vertical chevron osteotomy in patients with painful callosities on the second and third metatarsal head, and evaluated the outcome clinically. MATERIALS AND METHODS: Fourteen cases from 10 patients who had plantar keratosis were operated by vertical chevron osteotomy from March 2005 to October 2008. We used K-wire fixation for all cases. We evaluated the clinical results by the patients' satisfaction and disappearance of plantar lesion. RESULTS: The plantar keratosis was completely disappeared in 8 cases and partially in 5 cases. In 2 cases, patients expresses their pain caused by constant metatarsalgia that was suspected to be dorsal incisional pain and joint capsulitis. Transmetatarsalgia was not appeared. CONCLUSION: We consider vertical chevron osteotomy as a good surgical method for treatment of plantar keratosis.

Surgical Treatment for Plantar Keratosis Using Vertical Chevron Osteotomy / 대한족부족관절학회지

PURPOSE: Painful plantar callosities under the second, third or fourth metatarsal head have been controverted about its treatment mordalities. We performed the vertical chevron osteotomy in patients with painful callosities on the second and third metatarsal head, and evaluated the outcome clinically. MATERIALS AND METHODS: Fourteen cases from 10 patients who had plantar keratosis were operated by vertical chevron osteotomy from March 2005 to October 2008. We used K-wire fixation for all cases. We evaluated the clinical results by the patients' satisfaction and disappearance of plantar lesion. RESULTS: The plantar keratosis was completely disappeared in 8 cases and partially in 5 cases. In 2 cases, patients expresses their pain caused by constant metatarsalgia that was suspected to be dorsal incisional pain and joint capsulitis. Transmetatarsalgia was not appeared. CONCLUSION: We consider vertical chevron osteotomy as a good surgical method for treatment of plantar keratosis.

Treatment of Severe Hallux Valgus Deformity with Proximal Reverse Chevron Metatarsal Osteotomy and Akin Osteotomy / 대한족부족관절학회지

PURPOSE: This study analyzed the clinical and radiographic outcome of the severe hallux valgus corrected with proximal reverse chevron metatarsal osteotomy and Akin osteotomy. MATERIALS AND METHODS: The study was based on 18 feet (15 patients) of severe hallux valgus (hallux valgus angle> or =40degrees or intermetatarsal angle> or =18degrees) treated with proximal reverse chevron metatarsal osteotomy and followed for more than 1 year. Akin osteotmy was added in 72% of the patients. Clinically preoperative and postoperative AOFAS Hallux Metatarsophalangeal - interphalangeal score, VAS pain score and satisfaction after the surgery were analyzed. Radiologically hallux valgus angle, hallux valgus interphalangeal angle, the intermetatarsal angle and sesamoid position before and after the operation were analyzed. RESULTS: AOFAS Hallux Metatarsophalangeal - interphalangeal score improved from 54.5 (25-78) to 87.7 (70-100) and VAS pain score decreased from 6.0 (3-8) to postoperative 1.2 (0-5). Ninety-six percents of the patients were satisfied with results. Radiologically hallux valgus angle was decreased from 43.3degrees(31-58degrees) preoperatively to 6.8degrees (-8-27degrees) postoperatively. The intermetatarsal angle was decreased from 18.4degrees(11-24degrees) preoperatively to 5.3degrees (1-12degrees) postoperatively. The sesamoid subluxation was improved from 2.8+/-0.4 preoperatively to 0.4+/-0.6 postoperatively. CONCLUSION: Proximal reverse chevron metatarsal osteotomy and lateral soft tissue release with additional Akin osteotomy is good treatment option for severe hallux valgus.

Treatment of Severe Hallux Valgus Deformity with Proximal Reverse Chevron Metatarsal Osteotomy and Akin Osteotomy / 대한족부족관절학회지

PURPOSE: This study analyzed the clinical and radiographic outcome of the severe hallux valgus corrected with proximal reverse chevron metatarsal osteotomy and Akin osteotomy. MATERIALS AND METHODS: The study was based on 18 feet (15 patients) of severe hallux valgus (hallux valgus angle> or =40degrees or intermetatarsal angle> or =18degrees) treated with proximal reverse chevron metatarsal osteotomy and followed for more than 1 year. Akin osteotmy was added in 72% of the patients. Clinically preoperative and postoperative AOFAS Hallux Metatarsophalangeal - interphalangeal score, VAS pain score and satisfaction after the surgery were analyzed. Radiologically hallux valgus angle, hallux valgus interphalangeal angle, the intermetatarsal angle and sesamoid position before and after the operation were analyzed. RESULTS: AOFAS Hallux Metatarsophalangeal - interphalangeal score improved from 54.5 (25-78) to 87.7 (70-100) and VAS pain score decreased from 6.0 (3-8) to postoperative 1.2 (0-5). Ninety-six percents of the patients were satisfied with results. Radiologically hallux valgus angle was decreased from 43.3degrees(31-58degrees) preoperatively to 6.8degrees (-8-27degrees) postoperatively. The intermetatarsal angle was decreased from 18.4degrees(11-24degrees) preoperatively to 5.3degrees (1-12degrees) postoperatively. The sesamoid subluxation was improved from 2.8+/-0.4 preoperatively to 0.4+/-0.6 postoperatively. CONCLUSION: Proximal reverse chevron metatarsal osteotomy and lateral soft tissue release with additional Akin osteotomy is good treatment option for severe hallux valgus.

Combined First Metatarsal and Calcaneal Osteotomy for Fixed Cavovarus Deformity of The Foot / 대한족부족관절학회지

PURPOSE: The aim of this study was to evaluate the result of combined first metatarsal and calcaneal osteotomy for static cavovarus deformity of the foot. MATERIALS AND METHODS: We performed a dorsal closing wedge 1st metatarsal osteotomy and a lateral and upward displacement calcaneal osteotomy for 9 patients, 12 feet (6 male and 3 female). The mean age at the time of operation was 37 years and the mean followup period was 27 months. The causes of deformity were 2 poliomyelitis, 1 cerebral palsy, 1 Charcot-Marie-Tooth disease and 5 idiopathic type. Five lateral ligament reconstructions of the ankle and six percutaneous Achilles tendon lengthenings were added. The surgical results in terms of pain, function and alignment of the foot were evaluated by means of AOFAS ankle-hindfoot score and talo-1st metatarsal, calcaneus-1st metatarsal and calcaneal pitch angles were checked with weight bearing radiographs in lateral projection. RESULTS: Talo-1st metatarsal and calcaneal pitch angles were reduced from the mean preoperative values of 21degrees and 25degrees to 12degrees and 19degrees, respectively, at last followup. Also, calcaneus-1st metatarsal angle was increased from the mean 114degrees to 144degrees. The mean AOFAS score was improved from 44.5 points preoperatively to 89.2 points at followup. There were 1 metatarso-cueiform joint nonunion, 1 sural nerve injury and 3 remaining symptomatic claw toes. CONCLUSION: Combined first metatarsal and calcaneal osteotomy appears to be an effective procedure for the treatment of adult static cavovarus foot.

Operative Treatment of Hallux Valgus Deformity in Male Patients / 대한족부족관절학회지

PURPOSE: We evaluated the result of operative treatment of the hallux valgus in male patients. MATERAILS AND METHODS: Total 11 cases (10 patients) of the hallux valgus deformity that treated with operation were evaluated. Following Mann's radiological classification system, there was 1 cases of mild, 8 cases of moderate, and 2 cases of severe. Preoperative, postoperative, postoperative 3 months and postoperative 6 months follow up standing radiographs were used as radiologic evaluation. And we evaluated radiological outcomes by hallux valgus angle (HVA), first-second intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA), proximal phalangeal articular angle (PPAA) and clinical outcomes by hallux-metatarsophalangeal scale of American Orthopaedic Foot and Ankle Society (AOFAS) score. RESULT: Radiologically, the mean preoperative HVA 37degrees and IMA 13.7degrees were improved postoperatively as HVA 11.9degrees and IMA 4.7degrees, and the mean preoperative DMMA 29.4degrees and PPAA 8.6degrees were improved postoperatively DMMA 13.9degrees and PPAA 7degrees. But, postoperative 6 months follow up HVA, IMA, DMMA and PPAA was increased at 14.2degrees, 6.3degrees, 16.1degrees and 8.3degrees. Average AOFAS score were improved from 61.2 points to 75.2 points. CONCULSION: In our study, operative treatment of hallux valgus in male patients with proximal metatarsal osteotomy and distal soft tissue procedure showed good results but it was necessary to pay attention to increase aspect of follow up radiologic measurements.

Treatment of Hallux Valgus with Distal Chevron Metatarsal Osteotomy / 대한족부족관절학회지

PURPOSE: The authors intended to analyze the operative results of mild to moderate hallux valgus treated with distal chevron metatarsal osteotomy. MATERIALS AND METHODS: Twenty six feet of twenty three patients were followed for more than 1 year after the distal chevron metatarsal osteotomy. Biplanar osteotomy with wedge resection was done when the distal metatarsal articular angle (DMAA) was increased. The mean age was 39 years, and the mean follow up period was 27 months. Clinically preoperative and postoperative AOFAS hallux MP-IP scale and satisfaction after the surgery were analyzed. Radiologically hallux valgus angle, the 1st intermetatarsal angle, DMAA and sesamoid position before and after the operation were analyzed. RESULTS: Distal chevron osteotomy was done in 15 cases and biplanar osteotomy was done in 11 cases. Clinically AOFAS scale was increased from 65.3 points preoperatively to 92.2 points postoperatively. Two patients were not satisfied with the results. Radiologically hallux valgus angle was decreased from 21.9degrees preoperatively to 8.5degrees postoperatively. The first intermetatarsal angle was decreased from 11.8degrees preoperatively to 6.7degrees postoperatively. DMAA was decreased from 11.8degrees preoperatively to 5.5degrees postoperatively. There was one case of minor wound infection. CONCLUSION: Distal chevron metatarsal osteotomy appears to be safe and satisfactory procedure for mild to moderate hallux valgus.

Comparison of Proximal Metatarsal Osteotomy andDistal Chevron Osteotomy for Correction of Hallux Valgus / 대한족부족관절학회지

PURPOSE: The purpose of this study is comparison of radiological and clinical outcomes between proximal metatarsal osteotomy and distal chevron osteotomy for the correction of hallux valgus. MATERIALS AND METHODS: In this retrospective study, we included subjects who underwent the correction of hallux valgus in our institution between March 2001 and August 2006, with a minimum follow-up of 12 months. The group of proximal metatarsal osteotomy was 23 patients (34 feet); the group of distal chevron osteotomy was 20 patients (26 feet). The group of proximal metatarsal osteotomy was composed of 26 severe cases (76.5%) and 8 moderate cases (23.5%); the group of distal chevron osteotomy was composed of 13 severe cases (50.0%) and 13 moderate cases (50.0%). RESULTS: Compared to preoperative values, the hallux valgus angle, the first-second intermetatarsal angle and the distance of first-fifth metatarsal head were significantly decreased in two groups (p<0.05). In each parameter, the hallux valgus angle was decreased 66.3% (proximal metatarsal osteotomy) versus 49.6% (distal chevron osteotomy), which were significant (p=0.037). The first-second intermetatarsal angle and the distance of first-fifth metatarsal head were not significant. Mayo clinic forefoot scoring system (FFSS) score was significantly improved in two groups (p<0.05). The ratio of improvement was not significant (p=0.762). In severe group, hallux valgus angle and the first-second intermetatarsal angle was significantly decreased in proximal metatarsal osteotomy group compared to distal chevron osteotomy group (p<0.05), but the difference of the distance of first-fifth metatarsal head and FFSS score was not significant in both groups. In moderate group, the difference of all parameters was not significant in both groups. CONCLUSION: Although both proximal metatarsal osteotomy and distal chevron osteotomy showed satisfactory result in FFSS, proximal metatarsal osteotomy was more proper operative technique than distal chevron osteotomy in severe group, because of superiority of correction in radiological parameters.

Treatment of Moderate Hallux Valgus with Proximal Chevron Metatarsal Osteotomy and Distal Soft Tissue Procedure / 대한족부족관절학회지

PURPOSE: The authors intended to analyze the operative results of moderate hallux valgus with proximal chevron metatarsal osteotomy and distal soft tissue procedure. MATERIALS AND METHODS: Seventy feet of fifty-seven patients were followed for more than 1 year after the proximal chevron metatarsal osteotomy. The mean age was 47.2 years, and the mean follow up period was 2 years and 3 months. Clinically preoperative and postoperative AOFAS MP-IP scale and satisfaction after the surgery were analyzed. Radiologically hallux valgus angle, hallux valgus interphalangeal angle, the intermetatarsal angle and sesamoid position before and after the operation were analyzed. RESULTS: Additional Akin osteotomy was performed 48 out of 70 feet. Clinically AOFAS MP-IP scale was increased from 60.4 points preoperatively to 89.8 points postoperatively. Ninety-four percents of the patients were satisfied with the results. Radiologically hallux valgus angle was decreased from 34.8 degrees preoperatively to 12.8 degrees postoperatively. The intermetatarsal angle was decreased from 15.7 degrees preoperatively to 8.0 degrees postoperatively. Hallux valgus interphalangeal angle was increased from 7.4 degrees preoperatively to 9.8 degrees postoperatively. There were 3 recurrences, 1 hallux varus and 3 minor wound infections. There were no nonunion or malunion of the 1st metatarsal. CONCLUSION: Proximal chevron metatarsal osteotomy with distal soft tissue procedure and additional Akin osteotomy appears to be safe and satisfactory procedure.

The Early Results of Linear Distal Metatarsal Osteotomy with Minimal Incision for Correction of Hallux Valgus / 대한족부족관절학회지

PURPOSE: Good results using minimal invasive hallux valgus surgery has been reported recently. We evaluate the usefulness of linear distal metatarsal osteotomy with minimal skin incision in mild and moderate hallux valgus deformity. MATERIALS AND METHODS: Twenty-eight patients (thirty-one cases) who had mild to moderate hallux valgus deformity and underwent linear distal metatarsal osteotomy using minimal skin incision were evaluated between February 2005 and February 2006. Hallux-metatarsophalangeal-interphalangeal scale of AOFAS (American Orthopaedic Foot and Ankle Society) score was used as clinical evaluation. Preoperative, postoperative, after pin removal, and final follow up plain radiographs were used as radiologic evaluation. RESULTS: Twenty-six cases (83%) among thirty-one cases showed more than average satisfaction, Average AOFAS score were improved from 63.2 points (range 45-74 points) to 86.4 points (range 67-93 points). Preoperative radiologic index of IMA 14.0 degrees (range 10-18 degrees), HVA 30.2 degrees (range 19-39 degrees), DMAA 13.8 degrees (range 5-23 degrees) were improved postoperatively as IMA 8.3 degrees (range 5-10 degrees), HVA 10.5 degrees (range 2-20 degrees), DMAA 7.2 degrees (range 0-14 degrees) correctively. Mean operative time was 15.5 minutes (range 11-18 minutes) and mean operative time was 5.6 days (range 2-8 days). CONCLUSION: Despite small skin incision and short operative time and admission period, linear distal metatarsal osteotomy with minimal skin incision showed similar results with conventional distal metatarsal osteotomy. Thus, it was thought to be useful operation in mild and moderate hallux valgus deformity.

Cirugía ambulatoria del hallux valgus / Ambulatory surgery for the treatment of hallux valgus

Prospective short and medium term study about the outpatient surgery result of the hallux valgus in 43 feet (37 patients), with a 14 months average follow up (5-29), utilizing Chevron osteotomy for those with < 15° IM angle and proximal in crescente dome osteotomy for > 15° IM angle, plus a distal soft tissue procedure. Results were analized according the AOFAS score and K. Johnson subjective satisfaction scale, angles correction, walk staring point time, consolidation time and complications rate. An increment of the mean AOFAS score from 29 to 30 points was obtained, with an 85 percent of satisfaction without repairs, a mean correction of 19° for the HV angle and 6° for the IM angle. The proximal osteotomy delayed one more week aprox. in consolidating and walk starting from the distal one. A global 15 percent of complications were registered, most of them minors, which did not had any influences in the score and final satisfaction. The study shows satisfactory results in short and medium term for both osteotomies and validates the hallux valgus outpatient surgery as an efficient alternative to solve this pathology in the public health system, where orthopaedic surgery is in many occasions delayed because the great traumatological surgeries demand.

Estudio prospectivo a corto y mediano plazo sobre el resultado de la cirugía ambulatoria del hallux valgus en 43 pies (37 pacientes), con un seguimiento medio de 14 meses (5-29), utilizando osteotomía en Chevron para ángulos IM < 15° y en cúpula proximal para IM > 15°, más procedimiento sobre partes blandas. Se analizaron resultados según escala AOFAS y de satisfacción subjetiva de K. Johnson, corrección de ángulos, tiempo de inicio de marcha, tiempo de consolidación y complicaciones. Se obtuvo un incremento del puntaje medio AOFAS de 29 a 93 puntos, con un 85 por ciento de satisfacción sin reparos, una corrección media de 19° para el HV y de 6° para el IM. La osteotomía proximal demoró aprox una semana más en consolidar y en inicio de marcha que la distal. Se registró un 15 por ciento de complicaciones, la mayoría menores, que no influyeron en el puntaje y satisfacción final. El estudio muestra resultados satisfactorios a corto y mediano plazo para ambas osteotomías y valida la cirugía ambulatoria del hallux valgus como una alternativa eficaz para resolver esta patología en el sistema público de salud, donde la cirugía ortopédica muchas veces es postergada por la gran demanda de cirugías traumatológicas.

Proximal Metatarsal Wedge Osteotomy with Single Screw Fixation in Treatment of Hallux Valgus / 대한족부족관절학회지

PURPOSE: We conducted this study to examine the clinical results of the proximal metatarsal wedge osteotomy using a single screw fixation and the distal soft tissue procedure in patients with moderate to severe hallux valgus deformity. MATERIALS AND METHODS: Between February 2002 and February 2004, we performed these procedures on 12 patients (15 cases). The 6 cases of all patients had mild to moderate instability in the first MTC (metatarsocuneiform) joint. We estimated the clinical outcomes, the radiological findings and complications. RESULTS: AOFAS score was improved from preoperative 41.5 points to 87.7 points lastly on average. The mean correction angle of HVA and IMA was 23.8 degrees and 6.6 degrees, respectively. The mean position of tibial sesamoid was 2.67 before surgery and 0.87 after surgery. The mean shortening of the first metatarsal bone was 3.07 mm after surgery. There was no pain and complications on the first MTC joint except the breakage of screw in one case and instability of the first MTC joint was improved postoperatively. CONCLUSION: We obtained good clinical and radiographic outcomes in our series. So, proximal metatarsal wedge osteotomy using a single screw fixation and distal soft tissue procedure seems one of the good surgical treatments for moderate hallux valgus deformity.

Correction of Sesamoid after Proximal Metatarsal Osteotomy and Distal Soft Tissue Procedure in Hallux Valgus / 대한족부족관절학회지

PURPOSE: A retrospective review of the radiographs of the proximal metatarsal osteotomy and distal soft tissue procedure for hallux valgus, evaluating the correction of the tibial sesamoid, was undertaken. We evaluated the correlation between the reduction of the tibial sesamoid and the clinical outcomes. MATERIALS AND METHODS: 17 patients (23 cases) with moderate to severe hallux valgus deformity underwent the proximal metatarsal osteotomy and distal soft tissue procedure. The preoperative and last follow-up radiographs were reviewed according to the tibial sesamoid grade classification recommended by the Research Committee of the American Orthopedic Foot and Ankle Society (AOFAS). We divided them into two groups according to the reduction of the tibial sesamoid. We anaylyzed the clinical outcomes in each group according to Mayo Clinic Forefoot Scoring System (FFSS). RESULTS: In all of the patients, the preoperative tibial sesamoid position were grade 2 or greater. At the last follow-up, 52% (n=12) were grade 1 or less (Group I) and 48% (n=11) were grade 2 or greater (Group II). In group I, the forefoot score was improved from preoperative mean value of 32.0 points to final follow-up value of 66.3 points. In group II, the forefoot score was improved from preoperative mean value of 31.7 points to final follow-up value of 65.9 points. There was no statistical significance between postoperative, average scores in group I and II (p>0.05). CONCLUSION: The position of the tibial sesamoid was corrected insufficiently in almost half of all cases. In view of clinical outcomes, there was no significant difference between the corrected group and the other group.