Double wedge osteotomy of the first metatarsal for correction of severe hallux valgus

Abstract

Objective To explore the curative effect of the operation of double wedge osteotomy of the first metatarsal for correction of severe hallux valgus. Methods The data of 62 patients （87 feet） with severe hallux valgus caused by enlarged distal metatarsal articular angle （DMAA） who were followed up after receiving the treatment of double wedge osteotomy of the first metatarsal from January 2008 to December 2011 were analyzed retrospectively. There are 9 males （14 feet）, and 53 females （73 feet）, with an average age of 56 years （range, 28-70 years）. Preoperative radiographs showed hallux valgus angle （HVA） was 48.6° in average, intermetatarsal angle （IMA） was 19.8° in average, and DMAA was 22.1° in average. The operation plan was made based on the preoperative deformity, and the osteotomy site, the angle, the capacity of osteotomy was all based on preoperative measurement. Compare the changes of HVA, IMA, DMAA before and after operation. The changes were also compared before and after the internal fixation extraction. The curative effect was observation based on American Orthopaedic Foot and Ankle Society （AOFAS） propodium score standard. Results Sixty-two patients （87 feet） were followed up for 10 to 57 months, with an average of 21 months. HVA （14.6°±1.2°IMA （7.9°±0.7°）, DMAA （7.7°±0.9°） were all satisfied 6 months after the opera- tion. Stiff occurred in 2 patients after the operation. Cutaneous nerve injury occurred in 2 patients, and metastatic metatarsalgia occurred in l patient. No sever recurrence of deformity, bone nonunion and bone necrosis was found in all the patients. AOFAS score reached 91.8±1.8 one year after the operation, which was 28.4±9.1 preoperatively. Among them, 49 feet were rated as excellent, 31 as good, and 7 as fair. The ex- cellent and good rate was 92% （80/87）. Conclusion The first metatarsal double osteotomy can effectively correct the severe hallux valgus deformity with enlarged DMAA with few complications. It achieves good ef- fect. Patients can bear part of the loading in the early stage of recovery after operation. [Key words] Osteotomy; Hallux valgus; Treatment outcome