Outcomes of proximal chevron osteotomy for moderate versus severe hallux valgus deformities.
ABSTRACT Proximal chevron osteotomy with a distal soft tissue procedure has been widely used to treat moderate to severe hallux valgus deformities. However, there have been no studies comparing the results of proximal chevron osteotomy between patients with moderate and severe hallux valgus. We compared the results of this procedure among these groups.
A retrospective review of 95 patients (108 feet) that underwent proximal chevron osteotomy and distal soft tissue procedure for moderate and severe hallux valgus was conducted. The 108 feet were divided into two groups: moderate hallux valgus (Group A) and severe hallux valgus (Group B). Group A was composed of 57 feet (52 patients) and Group B of 51 feet (43 patients). Average followup was 45 months.
Mean American Orthopedic Foot and Ankle Society hallux metatarsophalangeal-interphalangeal scores were 54.1 points in Group A and 53.0 points in Group B preoperatively, and these improved to 90.8 and 92.6, respectively, at the last followup. Mean hallux valgus angles in Groups A and B reduced from 32.3 and 40.8 degrees, preoperatively to 10.7 and 13.2 degrees, postoperatively. Similarly, mean first intermetatarsal angles in Groups A and B reduced from 15.0 and 19.2 degrees, preoperatively to 9.0 and 9.2 degrees, postoperatively.
The clinical and radiographic outcomes of proximal chevron osteotomy with a distal soft tissue procedure were found to be comparable for moderate and severe hallux valgus. Accordingly, our results suggest that this procedure provides an effective and reliable means of correcting hallux valgus regardless of severity of deformity.
- SourceAvailable from: Ichiro Yoshimura[Show abstract] [Hide abstract]
ABSTRACT: PURPOSES: To date, actual results of a minimally invasive distal linear metatarsal osteotomy (DLMO) via more explicit radiographic delineation are poorly understood and radiographic findings and clinical results have not been systematically correlated. Purposes of this study were (1) to evaluate the effectiveness of DLMO using a precise radiographic mapping system; and (2) to determine the relationship between radiographic outcomes and clinical results. MATERIALS AND METHODS: In 2008-2011, DLMO was performed in 30 patients (36 feet) who had reducible symptomatic hallux valgus. Clinical data were assessed using American Orthopaedic Foot and Ankle Society (AOFAS) score. Radiographs were reviewed at preoperative and final follow-up for delineations of first ray construct, hallux valgus angle (HVA), intermetatarsal angle (IMA), distal metatarsal articular angle, and other radiographic profiles. Correlation between postoperative AOFAS score and degree of malalignment was also analyzed. RESULTS: A total of 36 feet had predominantly moderate hallux valgus (26 feet with HVA: 21-39°; 23 feet with IMA: 12-17°). Mean preoperative and postoperative AOFAS scores were 70.2 ± 11.3 and 95 ± 6.4, respectively (p < 0.001). Mapping system revealed improvements of first ray construct deformity (p < 0.05). Significant reductions in all angular measurements were observed at final follow-up period (p < 0.001) and correlated significantly with changes in AOFAS score (p < 0.001). Nine feet (25 %) were observed with recurrence of deformity which showed HVA >15°. Significant sesamoid lateralization was observed (p < 0.05). Twenty-four feet (66.7 %) showing overall sagittal malunions were found with significant plantar angulation (p = 0.026) and non-significant plantar displacement compared with preoperative reference (p = 0.43). These radiographic abnormalities were not related to clinical outcomes including postoperative AOFAS scores (p > 0.05). CONCLUSION: DLMO is an acceptable procedure to correct reducible hallux valgus in most patients with moderate level of severity. Sagittal malunion, recurrence, and sesamoid lateralization are possibly radiographic abnormalities but are not associated with clinical impairments.Archives of Orthopaedic and Trauma Surgery 12/2012; · 1.36 Impact Factor