Distal Metatarsal and Proximal Phalangeal Osteotomies without Soft Tissue Procedure for Hallux Valgus with 80° Hallux Valgus Angle: A Case Report.

ABSTRACT

Introduction: The commonly performed procedure for treating severe hallux valgus is proximal metatarsal osteotomy or first tarsometatarsal arthrodesis combined with a soft tissue procedure in which the severe intermetatarsal angle (IMA) is corrected using proximal metatarsal osteotomy or first tarsometatarsal arthrodesis; although a severe hallux valgus angle (HVA) can be corrected using the soft tissue procedure alone, the correction ability is low. Therefore, the more severe the hallux valgus is, the more difficult it is to correct. Case Report A 52-year-old woman (height, 142 cm; weight, 47 kg) with severe hallux valgus with an HVA of 80° and an IMA of 22° was treated with a combination of the distal metatarsal and proximal phalangeal osteotomies fixated using K-wires, which was a modification of Kramer's and Akin's procedures, without a soft tissue procedure. The concept behind this technique is that distal metatarsal osteotomy primarily corrects the hallux valgus, and when the correction is insufficient, the proximal phalanx osteotomy complements it, which ensures that the first ray is approximately straight. After 4.1 years of follow-up, the HVA and IMA were 16° and 13°, respectively. Conclusion: Distal metatarsal and proximal phalangeal osteotomies without a soft tissue procedure were effective in treating a patient with severe hallux valgus with an HVA of 80°.