Background: The correction of sesamoid subluxation is an important component of hallux valgus reconstruction with some surgeons feeling that the sesamoids can be pulled back under the first metatarsal head when imbricating the medial capsule during surgery. The purpose of this study was to radiographically assess the effect of an osteotomy on sesamoid location relative to the second metatarsal. Methods: This is a retrospective radiographic study review of 165 patients with hallux valgus treated with reconstructive osteotomies. Patients were included if they underwent a scarf or basilar osteotomy for hallux valgus but were excluded if they had inflammatory arthropathy or lesser metatarsal osteotomy. A modified McBride soft tissue procedure was performed in conjunction with the basilar and scarf osteotomies. Each patient's preoperative and postoperative radiographs were evaluated for hallux valgus angle, intermetatarsal 1-2 angle, tibial sesamoid classification, and lateral sesamoid location relative to the second metatarsal. Result: The greatest correction of both hallux valgus and intermetatrsal 1-2 angle was achieved in basilar osteotomies (20.6 degrees and 9.7 degrees, respectively), then scarf osteotomies (14.4 degrees and 8.7 degrees, respectively). Basilar and scarf osteotomies both corrected medial sesamoid subluxation relative to the first metatarsal head an average of 2-3 classification stages. All osteotomies had minimal lateral sesamoid location change relative to the second metatarsal. Conclusion: The majority of sesamoid correction correlated with the intermetatarsal 1-2 correction. The concept that medial capsular plication pulls the sesamoids beneath the first metatarsal (ie, changes the location of the sesamoids relative to the second metatarsal) was not supported by our results. Level of Evidence: Level III, retrospective case series.
[Show abstract][Hide abstract] ABSTRACT: 1. A distal chevron osteotomy appears to be a predictable treatment for mild and some moderate hallux valgus deformities. 2. The addition of a limited lateral capsular release or adductor hallucis tenotomy or both to a distal chevron osteotomy does not seem to increase the risk of first metatarsal osteonecrosis. 3. Multiple proximal first metatarsal procedures, when combined with a distal soft-tissue procedure, appear to provide satisfactory treatment for moderate-to-severe hallux valgus deformity (hallux valgus associated with metatarsus primus varus). These include proximal crescentic, proximal chevron, proximal oblique (Ludloff), proximal closing wedge, and scarf osteotomies and the Lapidus procedure. 4. First metatarsophalangeal joint arthrodesis appears to offer satisfactory outcome in patients with severe hallux valgus. Copyright
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