Moderate to severe hallux valgus is conventionally treated by proximal metatarsal osteotomy. Several recent studies have shown that the indications for distal metatarsal osteotomy with a distal soft-tissue procedure could be extended to include moderate to severe hallux valgus. The purpose of this prospective randomised controlled trial was to compare the outcome of proximal and distal Chevron osteotomy in patients undergoing simultaneous bilateral correction of moderate to severe hallux valgus. The original study cohort consisted of 50 female patients (100 feet). Of these, four (8 feet) were excluded for lack of adequate follow-up, leaving 46 female patients (92 feet) in the study. The mean age of the patients was 53.8 years (30.1 to 62.1) and the mean duration of follow-up 40.2 months (24.1 to 80.5). After randomisation, patients underwent a proximal Chevron osteotomy on one foot and a distal Chevron osteotomy on the other. At follow-up, the American Orthopedic Foot and Ankle Society (AOFAS) hallux metatarsophalangeal interphalangeal (MTP-IP) score, patient satisfaction, post-operative complications, hallux valgus angle, first-second intermetatarsal angle, and tibial sesamoid position were similar in each group. Both procedures gave similar good clinical and radiological outcomes. This study suggests that distal Chevron osteotomy with a distal soft-tissue procedure is as effective and reliable a means of correcting moderate to severe hallux valgus as proximal Chevron osteotomy with a distal soft-tissue procedure. Cite this article: Bone Joint J 2015;97-B:202–7

The purpose of this study was to compare the results of proximal and distal chevron osteotomy in patients with moderate hallux valgus. We retrospectively reviewed 34 proximal chevron osteotomies without lateral release (PCO group) and 33 distal chevron osteotomies (DCO group) performed sequentially by a single surgeon. There were no differences between the groups with regard to age, length of follow-up, demographic or radiological parameters. The clinical results were assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) scoring system and the radiological results were compared between the groups. At a mean follow-up of 14.6 months (14 to 32) there were no significant differences in the mean AOFAS scores between the DCO and PCO groups (93.9 (82 to 100) and 91.8 (77 to 100), respectively; p = 0.176). The mean hallux valgus angle, intermetatarsal angle and sesamoid position were the same in both groups. The metatarsal declination angle decreased significantly in the PCO group (p = 0.005) and the mean shortening of the first metatarsal was significantly greater in the DCO group (p < 0.001). We conclude that the clinical and radiological outcome after a DCO is comparable with that after a PCO; longer follow-up would be needed to assess the risk of avascular necrosis. Cite this article: Bone Joint J 2013;95-B:649–56

Severe hallux valgus deformity is conventionally treated with proximal metatarsal osteotomy. Distal metatarsal osteotomy with an associated soft-tissue procedure can also be used in moderate to severe deformity. We compared the clinical and radiological outcomes of proximal and distal chevron osteotomy in severe hallux valgus deformity with a soft-tissue release in both. A total of 110 consecutive female patients (110 feet) were included in a prospective randomised controlled study. A total of 56 patients underwent a proximal procedure and 54 a distal operation. The mean follow-up was 39 months (24 to 54) in the proximal group and 38 months (24 to 52) in the distal group. At follow-up the hallux valgus angle, intermetatarsal angle, distal metatarsal articular angle, tibial sesamoid position, American Orthopaedic Foot and Ankle Society (AOFAS) hallux metatarsophalangeal-interphalangeal score, patient satisfaction level, and complications were similar in each group. Both methods showed significant post-operative improvement and high levels of patient satisfaction. Our results suggest that the distal chevron osteotomy with an associated distal soft-tissue procedure provides a satisfactory method for correcting severe hallux valgus deformity.

Cite this article: Bone Joint J 2013;95-B:510–16.

We reviewed the outcome of distal chevron metatarsal osteotomy without tendon transfer in 19 consecutive patients (19 feet) with a hallux varus deformity following surgery for hallux valgus. All patients underwent distal chevron metatarsal osteotomy with medial displacement and a medial closing wedge osteotomy along with a medial capsular release.

The mean hallux valgus angle improved from −11.6° pre-operatively to 4.7° postoperatively, the mean first-second intermetatarsal angle improved from −0.3° to 3.3° and the distal metatarsal articular angle from 9.5° to 2.3° and the first metatarsophalangeal joints became congruent post-operatively in all 19 feet. The mean relative length ratio of the metatarsus decreased from 1.01 to 0.99 and the mean American Orthopaedic Foot and Ankle Society score improved from 77 to 95 points.

In two patients the hallux varus recurred. One was symptom-free but the other remained symptomatic after a repeat distal chevron osteotomy. There were no other complications.

We consider that distal chevron metatarsal osteotomy with a medial wedge osteotomy and medial capsular release is a useful procedure for the correction of hallux varus after surgery for hallux valgus.

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