Transfer metatarsalgia after hallux valgus correction alleviated by ‘auto-Helal’ osteotomy of the second metatarsal

Abstract

There have been many procedures described for the treatment of hallux valgus deformity of the forefoot. Distal first metatarsal osteotomies remain a popular option. Transfer metatarsalgia following correction of the first ray can be an occasional complication of this type of surgery [Laughlin TJ. Complications of distal first metatarsal osteotomies. J Foot Ankle Surg 1995;34:524–31; Kinnard P, Gordon D. A comparison between chevron and Mitchell osteotomies for hallux valgus. Foot Ankle 1984;4:241–3] and the subsequent treatment of these patients can be difficult [Feibel JB, Tisdel CL, Donley BG. Lesser metatarsal osteotomies. A biomechanical approach to metatarsalgia. Foot Ankle Clin 2001;6:473–89]. Helal described an oblique osteotomy of the distal metatarsal shaft [Helal B. Metatarsal osteotomy for metatarsalgia. J Bone Joint Surg [Br] 1975;57:187–92] and this has been used with varying degrees of success in the past [Helal B. Metatarsal osteotomy for metatarsalgia. J Bone Joint Surg [Br] 1975;57:187–92; Trinka HJ, Kabon B, Zettl R, Salzer M, Ritschl P, Helal B. Metatarsal osteotomy for the treatment of metatarsalgia: a critical analysis of results. Orthopaedics 1996;19:457–61]. We describe the unusual course of a patient who developed metatarsalgia after a chevron osteotomy for hallux valgus.