THE MANAGEMENT OF SEVERE HALLUX VALGUS WITH THE CHEVRON OSTEOTOMY: CLINICAL AND RADIOLOGICAL OUTCOMES

Background:

The Chevron osteotomy is straightforward, requires less dissection and allows earlier rehabilitation than some other osteotomies. However it is generally perceived as unsuitable for severe deformities even though a 2012 meta-analysis and an earlier RCT failed to show any advantage of the scarf over the chevron. We aim to assess the correctability of severe HV comparing the correction, the clinical outcomes and complications of the Chevron osteotomy with other techniques employed in a consecutive series.

Methodology:

We reviewed a series of 92 cases of severe hallux valgus (IMA >17° regardless of the HVA). The follow-up period varied from 1 to 4 years. Pre-operative x-rays and final post-operative weight-bearing x-rays were performed. Outcome scores (MOXFQ and AOFAS), IMA, HVA and foot width were collected. Complications were monitored.

Results:

There were 97 cases of severe hallux valgus performed during the study period, 55 were treated with a large-shift modified Chevron osteotomy, 42 with a number of other techniques that included Ludloff, Basal or Scarf osteotomy and also fusion in the form of a Lapidus or 1^st MTP. The average pre-operative measurements were IMA of 19.1°, HVA of 40°, osseous forefoot width of 93.2 mm and the forefoot: hindfoot ratio was 3.11. Post-operatively the measurements were IMA of 9.2 and HVA of 9.76, the osseous forefoot width was 82.8 mm and the forefoot: hindfoot ratio was 2.57.

Radiological outcomes for the Chevrons were similar to the alternative techniques though the rate of recovery was better. There is an increase in the rate of screw removal after a large shift Chevron osteotomy, reasons for this are discussed.

Conclusion:

The Chevron osteotomy is successful in the management of severe hallux valgus. It has the advantage of being a stable osteotomy that permits immediate weight-bearing and movement of the MTP joint.