Proximal Chevron Metatarsal Osteotomy Research Articles

Improvement of Valgus Deviation of the Lesser Toes of Moderate to Severe Hallux Valgus After Proximal Chevron Metatarsal Osteotomy and Akin Osteotomy.

This study examines the correction of lesser toe valgus deviation following proximal chevron metatarsal osteotomy (PCMO) and Akin osteotomy in moderate to severe hallux valgus patients, while identifying influencing factors. Among 89 patients (116 feet), those with moderate to severe hallux valgus underwent PCMO and Akin osteotomy. Radiologic assessments included preoperative metatarsus adductus angle (MAA), hallux valgus angle (HVA), intermetatarsal angle (IMA), valgus angles of the second to fourth metatarsophalangeal joints, and hallux valgus recurrence. Assessments included visual analog scale (VAS) pain scores, American Orthopaedic Foot & Ankle Society (AOFAS) scores, and patient satisfaction over an average follow-up of 30.6 ± 21.2 (range, 12-99) months. The mean preoperative HVA of 34.4 degrees decreased to 8.7 degrees at final follow-up. The valgus angles of the second, third, and fourth toes improved by 37.1%, 27%, and 44.5%, respectively. In metatarsus adductus patients, lesser toe valgus angles were significantly higher both preoperatively and at final follow-up. Hallux valgus recurrence patients had higher preoperative and final follow-up IMA and valgus angles in the second and third toes. Nonrecurrence patients showed greater decreases in these angles. A larger HVA correction corresponded to a greater decrease in lesser toe valgus deviation. VAS and AOFAS scores improved significantly at the last follow-up. The study found a significant reduction in the valgus angle of the second, third, and fourth toes after PCMO and Akin osteotomy in moderate to severe hallux valgus cases, without additional surgeries on lesser toes. The lesser toe angular reductions were less pronounced in patients with metatarsus adductus or with hallux valgus recurrence. Level IV, case series.

Comparison of Clinical and Radiographic Outcomes Between Modified Lapidus and Proximal Reverse Chevron Metatarsal Osteotomy in Hallux Valgus Concomitant with Metatarsus Adductus

Category: Midfoot/Forefoot; Bunion Introduction/Purpose: Operative treatment of hallux valgus (HV) in the setting of metatarsus adductus (MA) is reported to be difficult and poorer radiographic outcomes. Reduced space between the first and second metatarsals makes it difficult to translate the first metatarsal head laterally. This study aimed to compare the clinical and radiographic outcomes between HV with MA patients treated with modified Lapidus procedures and those with reverse proximal chevron metatarsal osteotomy (PCMO). Methods: The study included the patients of HV with MA (58 feet). 16 feet (Group 1) had been treated with modified Lapidus procedures by the senior author from December 2012 to November 2019. 42 feet (Group 2) had been treated with PCMO from February 2012 to March 2017. For the clinical assessment, visual analog scale (VAS) pain scores, AOFAS scores, and patients' postoperative satisfaction were evaluated. Radiographic assessment was performed with HV angle (HVA), intermetatarsal angle (IMA), and the first- to fifth-metatarsal width (1-5 MTW). Results: The mean follow-up duration was 16.8 (range, 12-54) months in Group 1, and 31.8 (range, 24-62) months in Group 2. The mean pain VAS score and AOFAS score improved from preoperative to the final follow-up in both group, however, Group 1 showed more significant improvement in clinical outcomes (ΔVAS: 6.0+-1.9 (Group 1) vs 5.1+-2.1(Group 2) (p=0.024), ΔAOFAS: 40.8+-11.5 (Group 1) vs 30.0+-11.3 (Group 2) (p=0.031)). As to radiographic assessment, Group 1 also showed more significant improvement in HVA and IMA (ΔHVA: 39.1+-9.1 (Group 1) vs 27.5+-9.8 (Group 2) (p<0.001), ΔIMA: 13.1+-3.0 (Group 1) vs 9.4+-4.5 (Group 2) (p=0.004). Conclusion: This study demonstrated that the HV patients with concomitant MA that treated with modified Lapidus procedures showed more significant clinical and radiographic improvement than those with PCMO. For the management of the HV patients accompanying MA in the setting of large preoperative HVA, modified Lapidus procedures would be good surgical option.

Outcomes of Minimally Invasive Proximal Chevron Metatarsal Osteotomy for Moderate to Severe Hallux Valgus Deformity

Category:Midfoot/ForefootIntroduction/Purpose:The effectiveness of minimally invasive surgery (MIS)-distal chevron metatarsal osteotomy (DCMO) for the correction of moderate to severe hallux valgus deformity is unclear. Traditionally, proximal chevron metatarsal osteotomy (PCMO) has been considered a reliable procedure for correcting severe hallux valgus deformity. This study aimed to clarify the clinicoradiographic outcomes of our novel MIS-PCMO technique and compared its outcomes to those of MIS-DCMO performed during the same timeframe. We addressed the following research questions: (1) can the MIS-PCMO technique be an effective option for correcting moderate to severe hallux valgus deformity?; (2) are there differences in the extent of deformity correction possible with MIS-PCMO and MIS-DCMO?; and (3) what points should be considered before performing the MIS-PCMO technique?Methods:We prospectively compared the outcomes of patients who underwent MIS-PCMO (n=20 patients; 22 surgeries) and those of patients who underwent MIS-DCMO (n=23 patients; 26 surgeries) for moderate to severe hallux valgus deformity (hallux valgus angle [HVA] >=30o) between January 2017 and December 2018. The minimum follow-up duration for inclusion in this study was 18 months. The HVA, first-to-second intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA), relative length of the second metatarsal, medial sesamoid position, and Meary angle were measured preoperatively and at the final follow- up.Results:Compared to MIS-DCMO, MIS-PCMO resulted in significantly greater correction of the HVA (P<0.001) and IMA (P=0.01), along with Meary angle improvement (P<0.001); however, the DMAA worsened (P=0.01). Furthermore, there was a significantly greater change in the relative second metatarsal length in the MIS-DCMO group (P=0.01). There were no significant between-group differences in the correction of the medial sesamoid position (P=0.445).Conclusion:MIS-PCMO can be a better option for correcting moderate to severe hallux valgus deformities than MIS-DCMO. However, this technique should be applied carefully when the preoperative DMAA is already large because the DMAA can become worse postoperatively.

Effect of Metatarsus Adductus on Hallux Valgus Treated With Proximal Reverse Chevron Metatarsal Osteotomy.

This study aimed to compare clinical and radiographic outcomes and recurrence rates after reverse proximal chevron metatarsal osteotomy (PCMO) for patients with hallux valgus (HV) with or without metatarsus adductus (MA). We hypothesized that patients with MA would have poorer outcomes and a higher radiographic recurrence rate than those without MA. This retrospective single-surgeon series comprised 144 patients (173 feet) with moderate to severe HV, treated with PCMO and Akin osteotomy without lesser metatarsal procedures, who were grouped according to the presence (MA group) or absence of MA (non-MA group). Clinical assessment included the American Orthopaedic Foot & Ankle Society (AOFAS) score, pain visual analog scale (VAS), and patient satisfaction rating. Radiographic assessments included metatarsus adductus angle (MAA), HV angle (HVA), and intermetatarsal angle (IMA). The prevalence of the MA was 24.2%. The mean MAA was 23.1 ± 3.3 degrees in the MA group. There were no differences in the mean AOFAS score and pain VAS score at the final follow-up between the 2 groups (all P > .05). The patient satisfaction rate was 73.8% in the MA group vs 90.1% in the non-MA group (P = .017). The mean postoperative HVA and IMA significantly improved at the final follow-up in both groups, respectively (all P < .001). Preoperative and postoperative HVA were larger in the MA group vs non-MA group. However, no significant difference was found in the improvement of HVA and IMA after surgery between the 2 groups (all P > .05). The recurrence rate was 28.6% in the MA group and 6.1% in the non-MA group (P < .001). HV patients associated with the MA had a higher degree of preoperative HV, lower correction of the HVA, higher radiographic recurrence rate, and poorer patient satisfaction than those without MA post-PCMO without lesser metatarsal procedures. Therefore, a more extensive HV correction procedure or the addition of a lesser metatarsal realignment procedure may need to be considered. Level III, retrospective comparative series.

Efficacy of Bilateral Simultaneous Hallux Valgus Correction in the Elderly Aged 70 to 79 Compared to Middle Age

Category:Bunion; Midfoot/ForefootIntroduction/Purpose:Due to the increase in life expectancy, the frequency of elderly patients with moderate to severe hallux valgus deformity is expected to increase. The aim of this study was to evaluate the clinical and radiological efficacy of bilateral simultaneous correction of hallux valgus in elderly patients aged 70s and to compare the results with those of middle age.Methods:From August 2014 to July 2017, 92 women (184 feet) patients, who underwent bilateral simultaneous correction surgery (proximal chevron metatarsal osteotomy, Akin osteotomy, and distal soft tissue procedure) due to moderate to severe hallux valgus deformity, were retrospectively analyzed. Based on the age at the time of surgery, elderly patients in their 70’s (70˜79 years) were defined as the ‘elderly’ group and middle aged patients in the 45˜50 years as the ‘middle age’ group. The VAS score, AOFAS-Hallux Metatarsophalangeal-Interphalangeal score, hallux valgus angle, 1-2 intermetatarsal angle, and post-operative complications were compared and analyzed between the two groups. The mean follow-up period was 30.6(24˜57) months. There was no significant difference in improvement of VAS scores after surgery between the middle age and elderly group (p=0.710).Results:Although the final AOFAS scores were significantly different between two groups, there was no significant difference in AOFAS score improvement after surgery between two groups (p=0.129) (Table 1). At the last follow up after surgery, the HV angles and 1-2 IM angles were all significantly improved compared to the preoperation (Table2). Complications occurred in 16 cases, 5 in middle age (11.1%) and 9 in the elderly (19.1%). In the middle age group, 1 case (2.2%) of HV recurrence (> 15 degrees), 1 case of medial incision site paresthesia, 2 plantar pain, and 1 MTP joint stiffness occurred. In the elderly group, 3 case (6.4%) HV recurrence, 2 cased of displacement after metatarsal bone fixation, 2 cases of medial incision site paresthesia, and 2 plantar pain.Conclusion:In patients aged 70s, bilateral simultaneous correction of moderate to severe hallux valgus showed good improvement of clinical and radiologic outcome without any significant difference compared to the middle age group. However, the attention should be paid to the fixation failure after correction in the simultaneous treatment of hallux valgus in elderly patients aged 70s.

Improvement of Valgus Deviation of the Lesser Toes of Moderate to Severe Hallux Valgus After Proximal Chevron Metatarsal Osteotomy and Akin Osteotomy

Category: Lesser Toes Introduction/Purpose: The valgus deviation of lesser toes is often found in the hallux valgus patients. It has been known that valgus deviation of lesser toes remain unchanged even after correction of hallux valgus. The purpose of this study was to determine whether valgus deviation of lesser toes can be corrected after proximal chevron metatarsal osteotomy (PCMO) and Akin osteotomy for the hallux valgus patients, and to evaluate the factors affecting the degree of correction. Methods: The study is based on 116 feet (89 patients) of moderate to severe hallux valgus that underwent proximal chevron metatarsal osteotomy with Akin ostetomy. Hallux valgus angle (HVA), inter-metatarsal angle (IMA), valgus angle of 2nd, 3 rd, 4th metatarso-phalangeal joint were assessed preoperatively and postoperative 6 month, 1 year and yearly. VAS pain cores, American Orthopedic Foot and Ankle Society metatarsophalangeal-interphalangeal (AOFAS MTP-IP) scale and patient satisfaction were evaluated preoperatively and at subsequent follow-up. Results: The average follow-up was 30.6 months (range,12-99). The mean HVA and IMA reduced from 34.4° to 8.7° and 15.9° to 5.3° respectively at the final follow-up. Patients with more severe HVA showed higher degree of valgus deviation of lesser toes than those with lesser HVA. The valgus angle of 2nd,3 rd,4th MTP joints reduced from 8.9°, 6.7°, 2.4° preoperatively to 5.6°, 4.9°, 1.3° respectively at the final follow-up (p&lt;0.05). The more HVA corrected, the more valgus deviation of lesser toe was found corrected. There was no significant difference in the degree of lesser toe correction angle according to follow up period after postoperative 1 year. The mean VAS and AOFAS scores significantly improved from 6.0, 60.9 to 1.2, 92.0 at the final follow-up, respectively (P&lt;0.05). Conclusion: Unlike the previous reports, the current study showed significant reduction of the valgus angle of 2nd, 3 rd, 4th MTP joints after PCMO and Akin osteotomy for the moderate to severe HV without additional corrective lesser toe surgery.

Treatment of Severe Hallux Valgus Deformity in Rheumatoid Arthritis With 1st MTP Joint Fusion Combined With Proximal Chevron Metatarsal Osteotomy

Category: Bunion Introduction/Purpose: A severe hallux valgus deformity in rheumatoid patient is usually treated with the 1st MTP fusion, since the high success rate with low percentage of recurrence leads to higher patient satisfaction. However the large 1st inter- metatarsal angle, sometimes, is not decreased after the fusion, and the patient may suffer the persistent bunion pain. We tried to solve this problem by performing the 1st MTP fusion and the 1st proximal metatarsal osteotomy in one stage. We report our surgical technique with the outcome analysis of the patients. Methods: Six patients with the severe rheumatoid hallux valgus deformity were followed for more than 12 months after the combined 1st MTP fusion and 1st proximal metatarsal osteotomy. All were women. The mean age of patients was 51.3 years, and the mean follow up period was 2 years and 1 month. Inclusion criterion was a rheumatoid hallux valgus deformity of more than 18 degrees of the 1st intermetatarsal angle. The MTP fusion was fixed with threaded Steinmann pins and the proximal metatarsal osteotomy was fixed with Kirschner wires through the single curvilinear skin incision. Clinically American Orthopaedic Foot and Ankle Society (AOFAS) hallux MP-IP scale, and patient’s satisfaction after the surgery were analyzed. Radiographically the union of the fusion and the osteotomy was investigated. Results: Clinically the AOFAS scale improved from the preoperative 51.2 points to the postoperative 84.3 points. All patients were satisfied with the results. There were no wound problem or nonunion of fusion/osteotomy. Conclusion: The combined 1st MTP fusion and 1st proximal metatarsal osteotomy was an effective and safe procedure for the severe rheumatoid hallux valgus deformity with the large 1st inter-metatarsal angle.

Change in First Metatarsal Length After Proximal and Distal Chevron Osteotomies for Hallux Valgus Deformity

The present study assessed the changes in the length of the first metatarsal bone after performing proximal chevron metatarsal osteotomy (PCMO) or distal Chevron metatarsal osteotomy (DCMO) for patients with hallux valgus deformity. A total of 60 patients with moderate-to-severe hallux valgus deformity from July 2009 to July 2011 were randomly divided into the PCMO and DCMO groups, with 30 patients in each group. The distal soft tissue procedure was performed in the same method for both groups. Measurements were performed preoperatively, postoperatively, and at the last follow-up visit at 6.1 ± 0.8 months. The postoperative length change with respect to the preoperative length was 0.7 ± 2.5 mm and −0.7 ± 5.1 mm for the PCMO and DCMO groups, respectively, with a slight lengthening of the first metatarsal bone in the PCMO group and a shortening in the DCMO group (p < .01). The follow-up length change with respect to the preoperative length was −2.1 ± 3.0 mm and −4.4 ± 2.2 mm for the PCMO and DCMO groups, respectively, demonstrating a clear shortening of the first metatarsal length at the last follow-up point in the DCMO group (p < .01).When DCMO and the distal soft tissue procedure were performed, significant shortening was found at 6 months of follow-up.

Intraoperative Incidence of Hallux Valgus Interphalangeus following Basilar First Metatarsal Osteotomy and Distal Soft Tissue Realignment

The premise of this study was that after the correction of hallux-metatarsophalangeal pronation, the intraoperative interphalangeal angle (HIA) increases significantly, and that an additional Akin osteotomy (AO) is often needed. Therefore, the purpose of this study was to evaluate whether HIAs in hallux valgus (HV) feet were underestimated, and to assess the need for AO during HV correction. This study was conducted on 54 feet with moderate to severe HV treated from June 2007 to December 2008. HIAs and medial sesamoid subluxations (MSS) were measured initially and intraoperatively after a distal soft tissue procedure (DSTP) and proximal chevron metatarsal osteotomy (PCMO). An intraoperative technique was used to evaluate the incongruency of the metatarsophalangeal joint (MTPJ) to determine the need for additional Akin osteotomy. After performing DSTP and PCMO, HIAs significantly increased from an average of 9 to 13.3 degrees and MSS reduced from average grade 2.5 to 0.5 (p < 0.05). Akin ostetomy was added in 44 (81%) feet. After an average followup of 13.2 months in Akin group, average VAS pain score decreased from 5.7 to 1.2 and average AOFAS score increased from 57.8 to 90.2 (p < 0.05). Final hallux MTPJ dorsiflexion in the Akin group was significantly larger than in the without-Akin group (p < 0.05). Average HIA significantly increased after DSTP and PCMO for moderate to severe HV necessitating additional Akin osteotomy, to achieve ideal HV correction and, to preserve MTPJ motion.

Intraoperative Incidence of Hallux Valgus Interphalangeus Following Basilar First Metatarsal Osteotomy and Distal Soft Tissue Realignment

The premise of this study was that after the correction of hallux-metatarsophalangeal pronation, the intraoperative interphalangeal angle (HIA) increases significantly, and that an additional Akin osteotomy (AO) is often needed. Therefore, the purpose of this study was to evaluate whether HIAs in hallux valgus (HV) feet were underestimated, and to assess the need for AO during HV correction. This study was conducted on 54 feet with moderate to severe HV treated from June 2007 to December 2008. HIAs and medial sesamoid subluxations (MSS) were measured initially and intraoperatively after a distal soft tissue procedure (DSTP) and proximal chevron metatarsal osteotomy (PCMO). An intraoperative technique was used to evaluate the incongruency of the metatarsophalangeal joint (MTPJ) to determine the need for additional AO. After performing DSTP and PCMO, HIAs significantly increased from an average of 9 to 13.3 degrees and MSS reduced from average grade 2.5 to 0.5 (p < 0.05). AO was added in 44 (81%) feet. After an average followup of 13.2 months in Akin group, average VAS pain score decreased from 5.7 to 1.2 and average AOFAS score increased from 57.8 to 90.2 (p < 0.05). Final hallux MTPJ dorsiflexion in the Akin group was significantly larger than in the without-Akin group (p < 0.05). Average HIA significantly increased after DSTP and PCMO for moderate to severe HV necessitating additional AO, to achieve ideal HV correction and, to preserve MTPJ motion.

Bunion correction using proximal Chevron osteotomy.

Fifty-one cases of moderate to severe bunion deformity with hallux valgus and metatarsus primus varus in 43 patients were treated by bunionectomy, proximal Chevron metatarsal osteotomy, lateral capsulotomy, adductor tenotomy, and lashing of first and second metatarsals together. The hallux valgus angle improved an average of 19 degrees from 33 degrees (mean) preoperatively to 14 degrees (mean) postoperatively. The intermetatarsal angle improved an average of 7.3 degrees from an average of 14 degrees preoperatively to an average of 6 degrees postoperatively. The position of the sesamoids was realigned to beneath the first metatarsal head and the metatarsal length remained essentially unchanged. Union occurred in 9 weeks (mean). No malunions occurred. Foot score profiles revealed a significant improvement in subjective evaluation from 69/100 preoperatively to 83/100 postoperatively with respect to pain, deformity, motion, disability, and cosmesis. Seventy-eight percent of patients had a good to excellent result. Improved subjective evaluations indicated that proximal Chevron osteotomy combined with bunionectomy, capsulotomy, tenotomy, and metatarsal lashing provides a reliable method with respect to stability, technical ease, low complication, and satisfactory surgical outcome for correction of moderate and severe bunion deformity, both as a primary and revision procedure.