METATARSAL WEDGE OSTEOTOMY AFTER 60 YEARS FOR HALLUX VALGUS: DOES IT WORK?

Abstract

Purpose of the study: When it became popular in the 1980s, the wedge osteotomy proposed by Kenneth John-son of the Mayo Clinic was not advocated for patients over 50 years of age. We wanted to known whether it could work in patients over 60.

Material and methods: Between January 1987 and December 1988, 62 patients underwent surgery for moderate hallux valgus. Wedge osteotomy was performed in all cases associated with phalangeal osteotomy and lateral release of the metatarsophalangeal joint (MTJ). Mean patient age was 60.2 years. Patients were followed ten years on average.

Results: Thirty-nine patients (48 feet) were reviewed. Radiological recurrence was noted in nine feet. The average hallux valgus M1P1 angle was 35° preoperatively and 9.8° postoperatively. The average M1M2 angle was 11.4° preoperatively and 4.6° postoperatively. Joint motion was good for the first MPJ, with average 51° dorsiflexion, and 14° plantar flexion. These results were obtained despite the opinion that wedge osteotomy stiffens the MTJ after 50 years. Patient satisfaction was very good, especially for shoe wearing, the esthetic result, and pain relief. Most recurrences involved non-correction of the distal articular angle, an observation which would be rather surprising in older patients. There were no cases of necrosis of the metatarsal head and the degenerative changes observed radiographically had little clinical impact.

Conclusion: This series has enabled us to conclude that the risk of wedge osteotomy of the metatarsal is not greater after the age of 60 years and that it provides very satisfactory long-term results.