Purpose: For patients with moderate to severe hallux valgus with increased intermetatarsal angle, correction with a proximal first metatarsal osteotomy is indicated. The purpose of this study is to compare the opening-wedge osteotomy of the proximal first metatarsal the proximal chevron osteotomy in the treatment of moderate to severe hallux valgus with increased intermetatarsal angle. Method: This prospective, randomized, multi-centered study is being conducted at three centers in Canada. Approximately 75 adult patients with hallux valgus are being randomized to either the proximal metatarsal opening-wedge osteotomy with plate fixation or the proximal chevron osteotomy. Patient functional scores using the SF-36, American Orthopaedic Foot and Ankle Society (AOFAS) forefoot metatarsophalangeal inter-phalangeal score and Visual Analogue Scale (VAS) for pain, activity & patient satisfaction, are assessed prior to surgery and 3, 6, 12 and 24 months. Surgeon preference is being evaluated based on a questionnaire and actual surgical times. Radiologic measurements (inter-metatarsal angle correction, hallux valgus angle correction, sagital talus-first metatarsal (Meary’s) angle, metatarsal length and union) will also be assessed. Results: Preliminary results demonstrate that patients who undergo the opening-wedge osteotomy have less pain at 3 months (ave. VAS pain reduction 2.9, SE±1.0) than those with the chevron (ave. VAS pain reduction 2.4, SE±1.2). VAS for activity demonstrates greater improvements with the chevron osteotomy at 3 months (0.8, SE±0.8) versus the opening-wedge (0.1, SE±1.0). AOFAS scores improve on average 18.3 (SE±8.6) with the opening wedge compared to 20.8 (SE±7.4) with the chevron at 3 months. Average hallux valgus angle correction for opening-wedge and chevron osteotomies are 11.0 degrees (SE±2.5) and 19.0 degrees (SE±3.1) respectfully. Average intermetatarsal angle correction for opening-wedge and chevron osteotomies are 6.5 (SE±1.3) and 4.3 (SE±1.7) respectfully. Both procedures are effective at maintaining metatarsal length. The opening-wedge osteotomy takes on average 60.9 minutes (SE±3.9) to complete compared to 69.1 minutes (SE±5.1) for the chevron ostetotomy. Surgeon response to the new opening-wedge osteotomy is favorable. Conclusion: Opening-wedge and proximal chevron osteotomies have comparable pain, function and radiographic outcomes. Opening wedge osteotomy is technically less demanding and requires less surgical time

Introduction: Standard arthrodesis of the first metatarsophalageal joint (MTPJ) is often carried out for degenerative disease in the presence of a hallux valgus without a first metatarsal corrective osteotomy. Despite this there is an improvement in the intermetatarsal angle (IMA) as well as the position of the tibial sesamoid. We attempt to quantify the amount of correction in this study. Method: A cohort of 30 (35 feet) consecutive patients (10 males, 20 females) treated from May 2006 to May 2007 were reviewed. The mean age was 61.6 years (39 to 78 years). All patients underwent a standard primary fusion of the first MTPJ with a low profile plate and compression screw. There was no attempt to free the sesamoids, perform a lateral release or medial reefing of the medial capsule. We measured the hallux valgus angle (HVA), IMA as well as the position of the tibial sesamoid pre and postoperatively using a digital radiology imaging system. Result: The mean improvement in IMA was 3.38° (p< 0.001) with a mean correction of 2.5° (p=0.02), 6.5° (p=0.02) and 5.8° (p=0.06) in the mild, moderate and severe groups respectively. A greater correction is expected with a more severe initial IMA (r=0.688). A similar trend is seen with the severity of the initial HVA (r=0.640). The tibial sesamoid position also tends to improve by one station (spearman correlation 0.861) post operatively. Conclusion: There is an improvement in the IMA when the first MTPJ is fused. This improvement is proportional to the severity of the initial HVA and IMA. There is also an improvement in the resting position of the tibial sesamoid. We conclude that with a mobile first metatarsal medial cuneiform joint, the IMA corrects spontaneously when the first MTPJ is arthrodesed negating the need for a separate corrective osteotomy of the first metatarsal

Aim When first metatarsophalangeal (MTP) joint fusion is performed in the presence of a high first intermeta-tarsal angle (IMA), an important question to arise is whether the first metatarsal varus will correct with MTP fusion alone or whether an additional basal osteotomy is necessary. We compared the pre-operative IMAs to the post-operative angles to answer this question.

Method Twenty patients had a first MTP fusion for severe hallux valgus deformity performed by the senior author over a 2-year period. All were female. Mean age was 54.2 years (range 42–78). Seven patients had rheumatoid arthritis. Their IMAs were retrospectively measured on weight bearing X-rays taken pre-operatively and 6 weeks post-operatively. They were recalled for an additional measurement at a mean of 13.72 months (range 6–30).

Results Pre-operatively the mean hallux valgus angle was 46.55 degrees and the mean IMA was 16.65 degrees (range 12–26). The mean 6 week post-operative IMA was 10.35 degrees (range 6–15) with a mean improvement of 6.3 degrees (range 0–12). The mean IMA at final follow-up was 8.67 degrees (range 5–12). The mean final improvement was 8.22 degrees (range 4–14). In eight patients with a pre-operative IMA of 15 degrees or less the mean improvement was 6.13 degrees. In 10 patients with an pre-operative IMA of 16 degrees or more, the mean improvement was 9.9 degrees.

Significance First MTP joint fusion in hallux valgus deformity permanently reduces the IMA. As the pre-operative IMA increases from moderate to severe, there is a significant increase in post-operative correction. An additional basal osteotomy is not indicated.

Aims. The first metatarsal pronation deformity of hallux valgus feet is widely recognized. However, its assessment relies mostly on 3D standing CT scans. Two radiological signs, the first metatarsal round head (RH) and inferior tuberosity position (ITP), have been described, but are seldom used to aid in diagnosis. This study was undertaken to determine the reliability and validity of these two signs for a more convenient and affordable preoperative assessment and postoperative comparison. Methods. A total of 200 feet were randomly selected from the radiograph archives of a foot and ankle clinic. An anteroposterior view of both feet was taken while standing on the same x-ray platform. The intermetatarsal angle (IMA), metatarsophalangeal angle (MPA), medial sesamoid position, RH, and ITP signs were assessed for statistical analysis. Results. There were 127 feet with an IMA > 9°. Both RH and ITP severities correlated significantly with IMA severity. RH and ITP were also significantly associated with each other, and the pronation deformities of these feet are probably related to extrinsic factors. There were also feet with discrepancies between their RH and ITP severities, possibly due to intrinsic torsion of the first metatarsal. Conclusion. Both RH and ITP are reliable first metatarsal pronation signs correlating to the metatarsus primus varus deformity of hallux valgus feet. They should be used more for preoperative and postoperative assessment. Cite this article: Bone Jt Open 2024;5(11):1037–1040

Aims. The purpose of this study is to examine the adductus impact on the second metatarsal by the nonosteotomy nonarthrodesis syndesmosis procedure for the hallux valgus deformity correction, and how it would affect the mechanical function of the forefoot in walking. For correcting the metatarsus primus varus deformity of hallux valgus feet, the syndesmosis procedure binds first metatarsal to the second metatarsal with intermetatarsal cerclage sutures. Methods. We reviewed clinical records of a single surgical practice from its entire 2014 calendar year. In total, 71 patients (121 surgical feet) qualified for the study with a mean follow-up of 20.3 months (SD 6.2). We measured their metatarsus adductus angle with the Sgarlato’s method (SMAA), and the intermetatarsal angle (IMA) and metatarsophalangeal angle (MPA) with Hardy’s mid axial method. We also assessed their American Orthopaedic Foot & Ankle Society (AOFAS) clinical scale score, and photographic and pedobarographic images for clinical function results. Results. SMAA increased from preoperative 15.9° (SD 4.9°) to 17.2° (5.0°) (p < 0.001). IMA and MPA corrected from 14.6° (SD 3.3°) and 31.9° (SD 8.0°) to 7.2° (SD 2.2°) and 18.8° (SD 6.4°) (p < 0.001), respectively. AOFAS score improved from 66.8 (SD 12.0) to 96.1 (SD 8.0) points (p < 0.001). Overall, 98% (119/121) of feet with preoperative plantar calluses had them disappeared or noticeably subsided, and 93% (113/121) of feet demonstrated pedobarographic medialization of forefoot force in walking. We reported all complications. Conclusion. This study, for the first time, reported the previously unknown metatarsus adductus side-effect of the syndesmosis procedure. However, it did not compromise function restoration of the forefoot by evidence of our patients' plantar callus and pedobarographic findings. Level of Clinical Evidence: III. Cite this article: Bone Jt Open 2021;2(3):174–180

Background. There are many different procedures described for the correction of hallux valgus deformity. Minimally invasive surgery has become increasingly popular, with clinical and radiological outcomes comparable to traditional open osteotomy approaches. There is increasing interest in hallux valgus deformity correction using third-generation minimally invasive chevron akin osteotomy (MICA) technique. Objective. To assess the radiographic correction and 2 year clinical outcomes of third-generation MICA using validated outcome measures. Methods. This is a prospective single-surgeon case series of 420 consecutive feet undergoing MICA surgery between July 2014 and November 2018. Primary clinical outcome measures included the Manchester-Oxford Foot Questionnaire (MOXFQ), EQ-5D, and the Visual Analogue Pain Scale. Secondary outcome measures included radiographic parameters, and complication rates. Results. Pre-operative and 2 year post-operative patient reported outcomes were collected for 334 feet (79.5%). At minimum 2 year follow-up, the MOXFQ scores (mean ± standard deviation (SD)) had improved for each domain: pain; pre-operative 43.9±21.0 reduced to 9.1±15.6 post-operatively (p<0.001), walking and standing; pre-operative 38.2±23.6 reduced to 6.5±14.5 post-operatively (p<0.001) and social interaction; pre-operative 47.6±22.1, reduced to 6.5±13.5 post-operatively (p<0.001). At 2 year follow-up, the VAS Pain score (mean ± SD) improved from a pre-operative of 31.3±22.4 to 8.3±16.2 post-operatively (p<0.001). 1–2 intermetatarsal angle (mean ± SD) reduced from 15.4°±3.5° to 5.8°±3.1° (p<0.001) and hallux valgus angle reduced from 33.1°±10.2° to 9.0°±5.0° post-operatively (p<0.001). Conclusion. Third-generation MICA showed significant improvement in clinical outcomes at 2 year follow-up and can be successfully used for correction of a wide range of hallux valgus deformities

Background. Recent large studies of third-generation minimally invasive hallux valgus surgery (MIS) have demonstrated significant improvement in clinical and radiological outcomes. It remains unknown whether these clinical and radiological outcomes are maintained in the medium to long-term. The aim of this study was to investigate the five-year clinical and radiological outcomes following third-generation MIS hallux valgus surgery. Methods. A retrospective observational single surgeon case series of consecutive patients undergoing primary isolated third-generation percutaneous Chevron and Akin osteotomies (PECA) for hallux valgus with a minimum 60 month clinical and radiographic follow up. Primary outcome was radiographic assessment of the hallux valgus angle (HVA) and intermetatarsal angle (IMA) pre-operatively, 6 months and ≥60 months following PECA. Secondary outcomes included the Manchester-Oxford Foot Questionnaire, patient satisfaction, Euroqol-5D Visual Analogue Scale and Visual Analogue Scale for Pain. Results. Between 2012 and 2014, 126 consecutive feet underwent isolated third-generation PECA. The mean follow up was 68.8±7.3 (range 60–88) months. There was a significant improvement in radiographic deformity correction; IMA improved from 13.0±3.0 to 6.0±2.6, (p < 0.001) and HVA improved from 27.5±7.6 to 7.8±5.1. There was a statistically significant but not clinically relevant increase of 1.2±2.6° in the HVA between 6 month and ≥60 month radiographs. There was an increase in IMA of 0.1±1.6º between 6 month and ≥60 month radiographs which was not statistically or clinically significant. MOXFQ Index score at ≥follow up was 10.1±17.0. The radiographic recurrence rate was 2.6% at final follow up. The screw removal rate was 4.0%. Conclusion. Radiological deformity correction following third-generation PECA is maintained at a mean follow up of 68.8 months with a radiographic recurrence rate of 2.6%. Clinical PROMs and patient satisfaction levels are high and comparable to other third-generation studies with shorter duration of follow up

Introduction. Recurrence after surgical correction of hallux valgus may be related to coronal rotation of the first metatarsal. The scarf osteotomy is a commonly used procedure for correcting hallux valgus but has limited ability to correct rotation. Using weightbearing computed tomography (WBCT), we aimed to measure the coronal rotation of the first metatarsal before and after a scarf osteotomy, and correlate these to clinical outcome scores. Methods. We retrospectively analyzed 16 feet (15 patients) who had a WBCT before and after scarf osteotomy for hallux valgus correction. On both scans, hallux valgus angle (HVA), intermetatarsal angle, and anteroposterior/lateral talus-first metatarsal angle were measured using digitally reconstructed radiographs. Metatarsal pronation (MPA), alpha angle, sesamoid rotation angle and sesamoid position was measured on standardized coronal CT slices. Preoperative and postoperative(12 months) clinical outcome scores(MOxFQ and VAS) were captured. Results. Mean HVA was 28.6±10.1 degrees preoperatively and 12.1±7.7 degrees postoperatively. Mean IMA was 13.7±3.8 degrees preoperatively and 7.5±3.0 degrees postoperatively. Before and after surgery, there were no significant differences in MPA (11.4±7.7 and 11.4±9.9 degrees, respectively; p = 0.75) or alpha angle (10.9±8.0 and 10.7±13.1 degrees, respectively; p = 0.83). There were significant improvements in SRA (26.4±10.2 and 15.7±10.2 degrees, respectively; p = 0.03) and sesamoid position (1.4±1.0 and 0.6±0.6, respectively; p = 0.04) after a scarf osteotomy. There were significant improvements in all outcome scores after surgery. Poorer outcome scores correlated with greater postoperative MPA and alpha angles (r= 0.76 (p = 0.02) and 0.67 (p = 0.03), respectively). Conclusion. A scarf osteotomy does not correct first metatarsal coronal rotation, and worse outcomes are linked to greater metatarsal rotation. Rotation of the metatarsal needs to be measured and considered when planning hallux valgus surgery. Further work is needed to compare postoperative outcomes with rotational osteotomies and modified Lapidus procedures when addressing rotation

Background: The purpose of this study was to evaluate the results after hallux valgus surgery by transar-ticular adductor tenotomy, distal Chevron metatarsal osteotomy and Akin phalangeal osteotomy using medial one incision. Materials and Methods: From June 2004 to June 2007, eighty feet of 54 patients were included in this study. During the same period, other cases of hallux valgus correction were excluded. Thirty seven patients underwent both feet operation at the same time and 17 patients underwent single foot operation. Among the 37 patients who underwent both feet operation, proximal metatarsal osteotomy was performed for contralateral 11 feet at same time, and these cases with proximal metatarsal osteotomy were excluded from this study. Postoperatively, all patients were allowed immediate full weight bearing walking. Patients were evaluated according to the American Orthopedic Foot and Ankle Society(AOFAS) hallux metatarsophalangeal-interpha-langeal scale, VAS(visual analogue scale), post-operative complications and radiologic parameters such as hallux valgus angle, intermetatarsal angle, T-test was used to evaluate the degree of hallux valgus and intermetatarsal angles. The mean follow up period was 25.9 months. Results: At the last follow up, the mean AOFAS hallux metatarsophalangeal-interphalangeal scale increased from 48.7 to 91.9. The Mean VAS score decreased from 7.1 to 0.8 post-operatively. The mean hallux valgus angle of 31.4° (range, 22° to 46°) improved to 5.3 ° (range, 0° to 20°) after the operation. The mean intermetatarsal angle also showed improvement from 12.3° (range, 7° to 16°) to 5.5 ° (range, 2° to 11°). Comparison between preoperative and postoperative hallux valgus and intermetatarsal angles was done by T test in dependent groups, which showed statistical significance (p< 0.05). There were three cases of mild hallux varus and three cases of recurred valgus deormity. No avascular necrosis or union problem was observed on the radiographs in any of the patients. Conclusion: Hallux valgus deformity correction by transarticular adductor tenotomy, distal Chevron metatarsal osteotomy and Akin phalangeal osteotomy using medial one incision has the advantages of lower morbidity and less scar without avascular necrosis of the metatarsal head

For hallux valgus correction, distal first metatarsal osteotomy is generally used for minor to moderate deformities, diaphyseal osteotomy for moderate deformities and basal osteotomy or fusion for severe deformities. With the advent of locking plates, there has been renewed interest in opening wedge basal osteotomy. As little has been written about its geometry, we undertook this study in order to understand its power and limitations. Proximal opening wedge osteotomies were performed on saw bone models in four orientations, with three different wedge sizes: 1. Perpendicular to the ground (PG); 2. Perpendicular to the shaft (PS); 3. Perpendicular to shaft with 30° declination (DEC); 4. 30° oblique (OB). Pre- and post-osteotomy measurements were made of axial and plantar translation and intermetatarsal angle. Plantar translation and intermetatarsal angle correction increased with increasing wedge size. The DEC osteotomy produced the greatest increase in length of metatarsal shaft, while the PS osteotomy gave the least. The most plantar translation was achieved with the DEC osteotomy. Overall, the PS osteotomy gave the largest correction of the intermetatarsal angle. Although there are several published clinical case series of the proximal opening wedge osteotomy, this is the first study to fully evaluate its geometry

Though there are many techniques utilised in the correction of hallux valgus (HV), no single approach has been reported to be ideal for all patients to date. A great deal of controversy remains concerning the type of osteotomy, method of fixation, and inclusion of soft tissue procedures. Herein, we compared the outcomes of two different operative techniques, the minimally-invasive modified percutaneous technique and the distal chevron osteotomy, used to treat mild to moderate hallux valgus. This study was conducted in line with the CONSORT 2010 guidelines. 41 patients (58 feet) with mild to moderate hallux valgus were randomly assigned by computer to two different groups. The first group containing 24 patients (33 feet) was treated by the modified percutaneous technique, whereas the second group included 17 patients (25 feet) treated by distal chevron osteotomy. In the modified percutaneous group, after a mean follow up of 43 months, the mean correction of hallux valgus angle (HVA) was 26.69° (P=0.00001), the mean correction of intermetatarsal angle (IMA) was 9.45° (P=0.00001), and the mean improvement of AOFAS score was 47.94 points (P=0.00001). In the chevron osteotomy group, after a mean follow up of 44 months, the mean correction of hallux valgus angle was 26.72° (P=0.00001), the mean correction of intermetatarsal angle was 9° (P=0.00001), and the mean improvement of AOFAS score was 44.76 points (P=0.00001). In our study, the modified percutaneous technique proved to be equally effective as the distal chevron osteotomy, but with fewer complications and a higher rate of patient satisfaction

The intermetatarsal angle is widely used to determine whether a basal or distal metatarsal osteotomy should be used to correct a hallux valgus deformity. We have noticed that the point of intersection of the long axes of the first and second metatarsals on standard pre-operative weight-bearing AP radiographs consistently predicts the type of osteotomy required. A basal osteotomy is generally recommended if the inter-metatarsal angle is ≥14°, whereas a distal osteotomy is usually sufficient if the angle is less than 14°. Sixty standardised pre-operative AP weight bearing in-patients undergoing hallux valgus correction were included in our study. The intermetatarsal angle was measured in a standard fashion. The point of intersection in the foot was recorded in terms of the distance from the talonavicular joint. Using a Pearson’s Correlation coefficient, our study revealed that an intermetatarsal angle of 14° or more consistently intersected either within the talar head or distal to thetalonavicular joint. We propose that this as an accurate and simple method of pre-operatively determining the choice of metatarsal osteotomy

Scarf osteotomy improves hallux valgus and can be used for deformities with large intermetatarsal angles. It is designed to minimise shortening of the first ray. The aim of this radiographic analysis was to assess the outcome of patients undergoing Scarf osteotomy at the Royal Cornwall Hospital. The initial 18 consecutive cases performed by the senior author were analysed using the guidelines recommended by the American Foot and Ankle Society. Standardised anterior-posterior radiographs of the foot were compared pre-operatively and at 6 weeks postoperatively. Measurements of the intermetatarsal angle (IMA), hallux valgus angle (HVA), joint congruency angle (JCA), distal metatarsal articular angle (DMAA), sesamoid position and metatarsal length were used to assess any improvement. The results showed a significant median reduction of the IMA of 70, HVA of 180, JCA of 50, and the DMAA of 30 (all p values < 0.001). The medial sesamoid position in relation to the first metatarsal also improved from a mean value of 2.28 to 1 using the American Foot and Ankle Society grading system. There was no shortening of metatarsal length as measured using the Hardy and Clapham method. This study shows that the radiographic outcome of Scarf osteotomy at the Royal Cornwall Hospital compares favourably with that found in the literature. It provides effective correction of moderate to large intermetatarsal angles

Aims: The aim of the study is to present later results in the treatment of hallux valgus with Mitchell corrective metatarsal osteotomy. Materials and methods: In the period from 1982 to 1991, 238 patients (230 females and 8 males) and 380 foots were operated. The patients were followed from 11 to 20 years. The age of the patients varied from 13 up to 55 years (the median value of around 36 years). Indications for the Mitchell corrective metatarsal osteotomy were, in the þrst place, the angel of hallux valgus bigger then 20 degrease, intermetatarsal angle bigger then 10 degrease, pain due to shoe pressure over the medial side of metatarsophalangeal joint, cosmetics appearance. In this study 130 patients with 230 foots were evaluated (radiological, clinical and subjective evaluation). Results: The angel of hallux valgus was 20 to 52 degrease (mean- 34,5 degres) before operation and was 8 to 36 (mean Ð 16,1 degrease) after operation. Intermetatarsal angle was 10 to 25 (median Ð 15 degrease) before operation and was 7 to 22 degrease (mean Ð 8 degrease) after operation. Shortening of þrst metatarsal bone was 2 to 6 mm (mean Ð 3 mm)Conclusion: The study shows that Mitchell corrective metatarsal osteotomy in treatment of hallux valgus is method of selection in younger patients and with distinctive intermetatarsal angle

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

Approximately 40 to 50% of the civilized population may expect feet disorders, and in 90% localized in the forefoot. Hallux valgus (H.V.) deformity is not a single malformation, but a complex problem affecting the first ray of foot, frequently accompanied by deformities and symptoms of the lesser toes. Proximal osteotomy and soft tissue release of I metatarso-phalangeal joint (MTP) provides adequate correction of intermetatarsal angle and joint alignment. Material and methods. 65 patients (59 women and 6 men) with 83 hallux valgus deformities treated by surgical corrections with cuneiform proximal osteotomy of the first metatarsal bone and soft tissue plasty of I MTP joint were evaluated. The average age of the patients was 52,8 years (±12,4) and the mean follow-up was 4,2 years (±1,0). Mann criteria were used to assess the radiological stage of the disease. Treatment results were assessed by means of two numerical scales: Mielke scale and AOFAS scale. On the basis of the sum of points obtained for each criteria, the treatment result was qualified as: excellent, good, fair or poor. In the radiological assessment the alteration of the valgus angle (HVA) and the intermetatarsal angle (IMA) of the hallux were evaluated. Results. Exacerbation of hallux valgus deformity in radiological examination was moderate or severe in accordance to the Mann criteria. 21 feet accompanied by deformities of lesser toes had additionally surgical procedure for the treatment of them. According to Mielkie scale the mean score was 6,5pts. (±1,9), and the treatment result of 95% of patients was evaluated as excellent or good. The mean score in AOFAS scale was 91,2pts (±11,2) with percentage of 80,6% excellent and good results. Higher percentage of fair and poor results in AOFAS scale was due to restricted motion of first MTP joint in 8 patients, out of whom due to persistent pain ailments in 6. In case of 4 feet, cosmetic improvement was unsatisfactory, and 4 patients had problems with wearing commercial shoes. Average correction value of the hallux valgus angle was 21° (33,5° to 12,5°). Foot intermetatarsal angle correction was 9° (16,2° to 7,2°). Conclusions. Proximal osteotomy of the first metatarsal bone with soft tissue release of I metatarso-phalangeal joint allows for good correction of the hallux valgus deformity with good functional results

Background: First Metatarsophalangeal joint (MTP) arthrodesis is commonly performed for hallux valgus with an arthritic joint, however previous studies have recommended that this should be combined with another procedure to correct the hallux valgus when the intermetatarsal angle is enlarged. We propose that an arthrodesis of the first MTP joint with a soft tissue release produces a significant correction of the intermetatarsal angle in such a group of patients avoiding the need for a concomitant procedure to change the intermetatatarsal angle. Patients and Methods: The charts and radiographs of 20 patients who had an arthrodesis of the first MTP joint were retrospectively reviewed. All 20 patients were female with a mean age of 54.2 years (range 42–78 years). The intermetatarsal (IMT) angles were measured by two individuals independently. These were measured on a weight-bearing pre-operative film and a weight-bearing 6-week post-operative film. Fusions were performed using either the Hallu-S® plate or two crossed screws. A Student “t” test was performed on the change of the IMT angle and also on the inter-observer variations for the same. Results: The mean pre-operative IMT angle was 16.85° (range 12–30°). The mean post-operative IMT angle was 10.6° (range 6–20°). The mean change in the IMT angle was 6.25° (range 2–12°). This change of the IMT angle was statistically significant – p< 0.0001 – Student “t” test. There was no significance in the inter-observer difference (p> 0.5) note in 6 radiographs with a mean of 1.3° (range 1–2°). Conclusion: This is the first study to show that performing an arthrodesis of the first MTP joint with soft tissue release in patients with hallux valgus and degenerate first MTP joint will significantly correct the IM angle. Therefore, this alleviates the need for performing another procedure on these patients

Background & aim. There have been many operations described for the treatment of hallux valgus deformities and b ette done separately with variable success rates. Our aim is to radiologically assess the outcome following simultaneous osteotomies to the 1st and 5th metatarsals in symptomatic patients with splay foot. To our knowledge, this procedure has not been described in the literature yet. Materials & method. 9 symptomatic patients (12 feet) were included in the study. The pre-operative and post-operative X-rays were assessed and the hallux valgus angles, 1st and 2nd intermetatarsal angles, distal metatarsal articular angles (DMAA), 4th and 5th intermetatarsal angles, maximum widths of the 1st and 5th metatarsal heads and the maximum distance between 1st and 5th metatarsals were calculated. The improvement in the angles and distances post-operatively were then assessed for statistical significance using Non-parametric paired T tests. Results. Hallux valgus angles (pre op mean of 28.17o (range, 20o-40o), post-op. mean of 16.33o (range, 4o-30o)), inter-metatarsal angles (mean of 14o (range, 9o-20o) and a post-op. mean of 9.29o (range, 4o-14o)), 1st and 5th metatarsal head widths (pre-op mean of 2.27cm and 1.27cm respectively and a post-op. width of 1.87cm and 1.09cm respectively), and maximum distance between 1st and 5th metatarsals head (pre-op mean of 8.05cm (range, 7.4cm-9.1cm) and post-op mean of 7.15cm (range, 6.8cm-7.7cm) all have significantly decreased post-operatively (p< 0.05). Conclusion. The results suggest a very good outcome in symptomatic patients following simultaneous 1st and 5th metatarsal osteotomies. All the angles measured except for the DMAA showed a statistically significant reduction post-operatively

Scarf osteotomy is a commonly performed method of hallux valgus correction. Release of deforming lateral soft tissue structures is an integral part of this correction. The aim of this study was to determine if there was any difference in the correction achieved by dorsal and transarticular releases as part of a scarf osteotomy. This radiological study was performed at a single institution. One surgeon utilised the dorsal first web approach for the distal soft tissue release and one the transarticular approach. There were 23 patients in each group. The same post-operative regime was used on both sets of patients. Data was collected on hallux valgus angle (HVA), intermetatarsal angle (IMA) and AFS sesamoid scoring. The pre-operative deformity as measured by hallux valgus angle and intermetatarsal angle where similar for both groups (p= 0.25, 0.79 respectively) with a significant difference in severity of AFS scoring in the dorsal group (p < 0.001). Patients who underwent a dorsal approach release had a mean improvement in IMA of 5.46 degrees compared to 3.86 in the transarticular group. The HVA improved by 17.92 degrees in the dorsal group compared to 8.08 in the transarticular group. Both these results were statistically significant (p= < 0.01,< 0.002 respectively). There was a statistically significant difference in number of patients returning to within normal limits of the HVA (p= < 0.05); 18 patients returned to a normal hallux valgus angle after undergoing the dorsal approach compared to 9 patients in the transarticular group. Our study shows that when performing a distal soft tissue release in conjunction with a scarf osteotomy for correction of hallux valgus, a dorsal first web approach is significantly better at correcting the HVA as compared to a transarticular approach. We would, therefore, recommend the use of a dorsal approach when performing this surgery

Aims: The aim of the study is to present later results in the treatment of hallux valgus with Austin corrective metatarsal osteotomy. Materials and methods: In the period from 1982 to 1991, 238 patients (230 females and 8 males) and 380 feet were operated. The patients were followed up from 11 to 20 years. The age of the patients varied from 40 up to 60 years (the median value of around 46 years of age). Indications for the Austin corrective metatarsal osteotomy were the angle of hallux valgus more than 20 degrees, intermetatarsal angle more than 10 degrees as well as pain due to shoe pressure over the medial side of metatarsophalangeal joint and aesthetic reasons. In this study, 130 patients and 230 feet were evaluated (radiological, clinical and subjective evaluation). Results: The angle of hallux valgus was 20 to 52 degrees (mean value – 34.5 degrees) before operation, and 8 to 36 degrees after operation (mean value – 16.1 degrees). Intermetatarsal angle was 10 to 25 (mean value – 15 degrees) before operation and 7 to 22 degrees (mean value – 8 degrees) after operation. Shortening of first metatarsal bone was 2 to 6 mm (mean value – 3 mm). Conclusion: The study shows that Austin corrective metatarsal osteotomy in treatment of hallux valgus is a good method if strict and precise criteria are closely followed in the indication of operative procedure in treating hallux valgus, especially with middle-aged patients