Is Double Metatarsal Osteotomy Superior to Proximal Chevron Osteotomy in Treatment of Hallux Valgus With Increased Distal Metatarsal Articular Angle?

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Abstract

We compared the results of proximal chevron osteotomy and double metatarsal osteotomy for hallux valgus with an increased distal metatarsal articular angle (DMAA). From October 2008 to December 2012, first metatarsal osteotomies were performed in 64 patients (69 feet) with symptomatic hallux valgus associated with an increased DMAA. Proximal chevron with Akin osteotomy and lateral soft tissue release was performed in 46 feet (PCO group); double metatarsal osteotomy and Akin osteotomy without lateral soft tissue release was performed in 23 feet (DMO group). Clinical assessments were performed using the American Orthopaedic Foot and Ankle Society (AOFAS) scale and visual analog scale (VAS). The hallux valgus angles, intermetatarsal angles, sesamoid positions, metatarsus adductus angles, and DMAAs were compared at different postoperative times. Postoperative shortening of first the metatarsal and complications were compared. The mean AOFAS scale and VAS scores showed significant improvement in both groups after surgery; however, no significant difference was observed between the 2 groups. The immediate postoperative hallux valgus angle and sesamoid position were significantly larger in DMO group; however, no intergroup difference was observed at the last follow-up visit, with the hallux valgus angle gradually increasing in the PCO group. The postoperative DMAA was significantly smaller in the DMO group. The mean shortening of the first metatarsal after surgery was significantly larger in the DMO group than in the PCO group. Transfer metatarsalgia developed in 1 foot (2.2%) in the PCO group and 2 feet (8.7%) in the DMO group. Partial avascular necrosis of the metatarsal head with advanced arthritis of the first metatarsophalangeal joint developed in 1 foot (4.3%) in the DMO group. In conclusion, no differences in the clinical and radiographic results were observed between the 2 groups for hallux valgus deformity with an increased DMAA.

Section snippets

Patient Selection

The institutional review board of our hospital approved the present study. We performed a retrospective analysis of the outcomes after proximal chevron and double metatarsal osteotomy to treat hallux valgus deformity with an increased DMAA. A first metatarsal osteotomy was performed in 70 patients (76 feet) with symptomatic hallux valgus associated with an increased DMAA (≥15°) by a single surgeon (W.-C.L.) from October 2008 to December 2012. The inclusion and exclusion criteria are listed in

Results

The AOFAS and VAS scale scores showed significant improvement in both groups at the last follow-up visit, with no significant intergroup differences. No difference in the mean range of motion of the first MTP joint at the last follow-up visit was observed between the PCO and DMO groups (Table 3).

Also, no differences were observed in the mean preoperative hallux valgus angles, intermetatarsal angles, and sesamoid positions. The changes in the hallux valgus angles, intermetatarsal angles, and

Discussion

The present study was conducted to compare the results of double metatarsal osteotomy and proximal chevron osteotomy for hallux valgus deformity with an increased DMAA. No significant differences in the clinical and radiographic results were observed for the 2 techniques at the last follow-up visit.

Double metatarsal osteotomy was developed to alleviate the high recurrence rate after correction of adolescent hallux valgus deformities with a congruent joint (1). In hallux valgus deformity with a

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