A New Alternative Surgical Treatment of Hallux Valgus, in Moderate to Severe Cases of the Disease With a Two-and-a-Half-Year Follow-Up.

Prodromos Natsaridis,Christos Alexandropoulos,Vasileios Akrivos,Stefanos Tsourvakas,Vaios Goulas,Themistoklis Poulios,Aristeidis H Zibis

doi:10.7759/cureus.14334

Abstract

The study aims to evaluate the treatment of moderate to severe forms of hallux valgus with the lowest invasiveness in soft tissues and especially with an alternative modified Chevron osteotomy of the first metatarsal. Additionally, it emphasizes the necessity of the modified McBride procedure (capsuloplasty and release of specific concrete soft tissue structures) and the importance of the soft tissue manipulation in the particular surgery intra-operatively, as well as postoperative medical and personal care and duration of rehabilitation. Patients with an average age 58 years (range 51-65), who underwent a Chevron type osteotomy with combination of soft tissues interventions laterally and medially of the first metatarsophalangeal joint, for symptoms they had of systematic hallux valgus without any other degenerative problems in metatarsophalangeal joint between 2017 to the beginning of 2018, were retrospectively reviewed with an average follow-up of 29 months (range 26-31).

Highlights

A large patient population suffers from hallux valgus more commonly women [1], with the disease appearing, in many cases, from young age
The surgical treatment of the disease with the appropriate surgical technique when surgery is indicated for correction of the deformity is controversial, as there is a high rate of recurrence of the deformity, often a short while after the surgery
Almost all of the varied techniques associated with Chevron osteotomy are performed with two straight oblique osteotomies to the long axis of the first metatarsal, limiting the possibility of correction of larger deformities as they disrupt the stability of the joint and because there is often a lack of the appropriate instrumentation to perform them

Summary

Introduction

A large patient population suffers from hallux valgus more commonly women [1], with the disease appearing, in many cases, from young age. The surgical treatment of the disease with the appropriate surgical technique when surgery is indicated for correction of the deformity (with hallux valgus angle and intermetatarsal angle less than 36° and 17°, respectively) is controversial, as there is a high rate of recurrence of the deformity, often a short while after the surgery. One of these procedures is the classical distal first metatarsal Austin/Chevron osteotomy, a relatively stable V-shaped osteotomy that is commonly used for mild to moderate deformities. Even in simple to moderate deformities, in which the classical Chevron osteotomy can be performed, the fact that there is excessive tissue damage, a poor choice of surgical techniques and materials for restoration, as well as a lack of respect for the anatomy of the region and the soft tissues, all induce complications that repel the patients and the surgeons from the surgical treatment of the deformity

Methods

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Conclusion