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7th Congress of the European Federation of National Associations of Orthopaedics and Traumatology, Lisbon - 4-7 June, 2005


Background: Distal metatarsal osteotomy is indicated for correction of mild to low-moderate symptomatic hallux valgus deformity and has shown good to excellent functional and cosmetic results. Original chevron osteotomy and its modifications are the most used distal metatarsal osteotomies. These techniques have limitations for correction of greater deformities.

Objective: To describe a new reversed L-shaped (ReveL) distal metatarsal osteotomy through minimal invasive technique to treat mild to severe hallux valgus deformities and to analyze the functional and cosmetic results of this procedure after at least two years follow-up.

Methods: Between November 2002 and March 2004, a ReveL osteotomy through single medial short approach was performed by 95 patients (120 feet) of an average age of 53 years (range 16 to 79). Overall complications, hallux valgus and I–II intermetatarsal angle corrections were analysed. 28 patients (36 feet) were clinically and radiologically reviewed with a mean follow-up of 33 months (range 25 to 42).

Results: 89% of the patients were satisfied or very satisfied with the cosmetic result. The average AOFAS score increased from 56 points preoperatively to 91 points at mean follow-up. There were no nonunion or avascular necrosis. The mean correction of the hallux valgus angle was 11° and 5 ° for the I–II intermetatarsal angle. There was no significant loss of correction of hallux valgus angle and I–II intermetatarsal angle between first postoperative assessment and follow-up. At least two years after the procedure, the force developped at the forefoot at push-off was still decreased compared to a normal population, particularly on the first metatarsal and on the big toe.

Conclusions: Good and very good functional and cosmetic results were obtained after Revel osteotomy for correction of symptomatic hallux valgus up to 60° of deformity in our series. There was no significant loss of correction after two years follow-up. The reduced forces on the first metatarsal head and on the first toe had no negative influence on the final subjective and objective result.

Theses abstracts were prepared by Professor Roger Lemaire. Correspondence should be addressed to EFORT Central Office, Freihofstrasse 22, CH-8700 Küsnacht, Switzerland.