Aims

The mainstay of surgical correction of hallux valgus is first metatarsal osteotomy, either proximally or distally. We present a technique of combining a distal chevron osteotomy with a proximal opening wedge osteotomy, for the correction of moderate to severe hallux valgus.

When performing scarf osteotomies some surgeons use intraoperative radiography and others do not. Our experience is that when using intraoperative radiography we often change the osteotomy position to improve the correction of the hallux valgus angle and sesamoid position. We report the results of a single surgeon series of 62 consecutive patients who underwent a scarf osteotomy for hallux valgus. The first 31 patients underwent surgery without the use of intraoperative radiographs and the subsequent 31 patients underwent surgery with the use of intraoperative radiographs, this reflects a change in the surgeons practice. Hallux valgus angle, intermetatarsal angle, distal metatarsal articular angle and sesamoid position using the Hardy Clapham grading system were recorded. All patients had measurements recorded from weight baring radiographs taken pre operatively as well as at 6 and 12 weeks post operatively. Intraoperative measurements were also recorded for all patients in the intraoperative radiography group. The mean hallux valgus angle preoperatively was 28.5° in the control group and 30.5° in the intraoperative radiography group. The mean hallux valgus angle in the control group at 6 weeks was 12.4° and at 12 weeks was 12.6°. The mean hallux valgus angle in the intraoperative radiography group at 6 weeks was 10.5° and at 12 weeks was 9.8°. The median sesamoid position pre operatively was 4 for both groups. At 6 and 12 weeks the sesamoid position improved by a median of 1 position in the control group and 2 positions in the intraoperative radiography group (p<0.05). We recommend that surgeons who do not routinely use intraoperative radiography undertake a trial of this. We have found that the use of intraoperative radiography improves the correction of hallux valgus angle and sesamoid position. These have been shown to increase patient satisfaction and reduce recurrence

We reviewed 91 patients (103 feet) who underwent a Ludloff osteotomy combined with additional procedures. According to the combined procedures performed, patients were divided into Group I (31 feet; first web space release), Group II (35 feet; Akin osteotomy and trans-articular release), or Group III (37 feet; Akin osteotomy, supplementary axial Kirschner (K-) wire fixation, and trans-articular release). Each group was then further subdivided into severe and moderate deformities. The mean hallux valgus angle correction of Group II was significantly greater than that of Group I (p = 0.001). The mean intermetatarsal angle correction of Group III was significantly greater than that of Group II (p < 0.001). In severe deformities, post-operative incongruity of the first metatarsophalangeal joint was least common in Group I (p = 0.026). Akin osteotomy significantly increased correction of the hallux valgus angle, while a supplementary K-wire significantly reduced the later loss of intermetatarsal angle correction. First web space release can be recommended for severe deformity. Additionally, K-wire fixation (odds ratio (OR) 5.05 (95% confidence interval (CI) 1.21 to 24.39); p = 0.032) and the pre-operative hallux valgus angle (OR 2.20 (95% CI 1.11 to 4.73); p = 0.001) were shown to be factors affecting recurrence of hallux valgus after Ludloff osteotomy. Cite this article: Bone Joint J 2013;95-B:803–8

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

To investigate the limitation of proximal spherical metatarsal osteotomies for feet with severe hallux valgus, a follow-up study was performed on the patients whose preoperative hallux valgus angles were 40 degrees or more. Forty-eight feet in 37 patients (11 male, 37 female, 60 years range 20 to 84 years) were investigated. Mean follow-up was 4 years and 1 month ranging from two to eight years. The spherical osteotomy, performed using a curved chisel, was devised for correcting not only varus deviation of the first metatarsal but also pronation and dorsiflexion. A distal soft tissue procedure was done at the same time. Twenty feet received combined operations for their combined deformities. Eighty-one percent of the patients were satisfied with the results. However, six of twelve patients whose preoperative hallux valgus angles were 50 degrees or more were unsatisfactory. Mild metatarsalgia remained in eight feet at the follow-up, but no new metatarsalgia developed in any patients. The mean value of the hallux valgus angle improved from 46.6 degrees to 11.1 degrees. The patients whose preoperative hallux valgus angle were 50 degrees or more showed 16.4 degrees of average hallux valgus angle at follow-up. Their results varied widely and most of them had inadequate correction. The mean correction toward plantar flexion was 0.7 degrees. Average shortening of the first metatarsal was 3.4mm. The shortening of the first metatarsal had not caused worsening of metatarsalgia if adequate correction of hallux valgus was achieved and malunion toward dorsi-flexion was prevented. The proximal spherical osteotomy could consistently achieve satisfactory results for the patients whose hallux valgus angles are under 50 degrees. However, the results were worse in feet with more severe deformities. Other procedures for hallux valgus or proper combined operations were necessary for such patients

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. As hallux valgus (HV) worsens clinical and radiological signs of arthritis develop in metatarsophalangeal joint due to incongruity of joint surfaces. The purpose of this prospective study was to determine if intraoperative mapping of articular erosion of the first metatarsal head, base of the proximal phalanx, and tibial and fibular sesamoids can be correlated to clinical and/or radiographic parameters used during the preoperative assessment of the HV deformity. Materials and methods. We analysed 50 patients prospectively who underwent surgery between Jan 2009-Jan 2010. Patients with a known history of previous first metatarsophalangeal joint surgical intervention, trauma, or systemic arthritis were excluded from analysis. Preoperative demographics and AOFAS score were recorded. Intraoperative evaluation and quantification of the first metatarsal head, base of the proximal phalanx, and sesamoid articular cartilage erosion was performed. Cartilage wear was documented using International Cartilage Research Society grading. Results and Discussion. P. Bock et al have showed that the extent of cartilage lesions were clearly correlated with the degree of hallux valgus angle proving that a malaligned joint is more prone to cartilage degeneration. Kristen et al have described a correlation between a higher pre-operative hallux valgus angle and the post-operative Kitaoka et al score. The higher the preoperative hallux valgus angle, the lower the post-operative score. Our series showed the mean IMA is 15 degrees. The mean AOFAS score was 62. There was a significant positive correlation between hallux valgus angle and AOFAS score. We also found correlation between sesamoid wear and AOFAS score and HV angle. Conclusion. We conclude that preoperative clinical parameters (ie, age) and radiographic measurements (ie, HV, IMA) directly define the incidence and location of articular erosion and are helpful in the preoperative assessment of the HV deformity

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 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

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

Introduction: The Scarf osteotomy for the treatment of hallux valgus is achieving popularity, but no comparative study has proven the efficacy of this procedure over other first metatarsal osteotomies. We present a retrospective comparative review of the radiological outcomes of Chevron and Scarf with Akin osteotomy in the treatment of hallux valgus. Materials and Methods: The radiological outcomes of 40 first metatarsal osteotomies, 20 Chevron and 20 Scarf with Akin are presented. The radiological parameters studied included hallux valgus angle, hallux inter-phallangeus, intermetatarsal angle, sesamoid station and foot width. Results: The mean post-operative hallux valgus angles (HVA’s) were: Chevron mean HVA 17.90, standard deviation 7.360, standard error 1.65. Scarf with Akin osteotomy mean HVA 9.550, standard deviation 6.60, standard error 1.4. The difference in postoperative HVA between the two operations was statistically significant (p< 0.001). The mean post-operative intermetatarsal angles (IMA) were: Chevron mean 8.050, standard deviation 2.560, standard error 0.57. Scarf with Akin mean 7.220, standard deviation 2.56, standard error 0.57. The difference in postoperative IMA between the two groups did not achieve statistical significance. The mean change in IMA for each was: Chevron mean increment 4.90 Standard deviation 2.290, standard error 0.51. Scarf with Akin mean increment 6.680, standard deviation 4.130, and standard error 0.88. The difference in alteration of IMA between the two groups did not achieve statistical significance. Discussion and Conclusion: We conclude that as there was no difference in the distribution of post-op IMA for Scarf and Chevron osteotomies that the added affect of an Akin osteotomy may contribute to the Scarf to produce the better correction in hallux valgus angle

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

The authors report the use of a modified ‘Y-V’ medial capsular repair in association with Scarf osteotomy for Hallux valgus in 55 patients (62 feet) aged 18 to 61 years (mean 43 years) between July 2004 and July 2005. All patients were followed up for minimum 6 months by questionnaire, physical examination (American Orthopaedic Foot and Ankle Society score) and comparison of preoperative and post operative x rays. Using this technique none of the patients required an additional proximal phalangeal osteotomy (Akin Oste-otomy). At six months follow up American Orthopaedic Foot and Ankle Society score improved from 46 to 87. Intermetatarsal (IM) angle and the hallux valgus (HV) angle improved from 16 degree to 9 degree and from 31 degree to 16 degrees respectively (p less than 0.05). Of the sixty two procedures 59 did not develop any complications. Two had superficial infections which required oral antibiotics only. One partial loss of correction of hallux valgus occurred for which the patient refused a second operation. Seven cases had some residual pronation deformity of the big toe identified by the patients who felt the deformity was ‘about 50%’ compared to before the operation. Akins osteotomy achieves an apparent correction of hallux valgus without addressing subluxation of meta-tarso-phalangeal joint. Our technique reduces the meta-tarso-phalangeal joint and corrects the hallux valgus angle anatomically. We recommend the use of this modified ‘Y-V’ medial capsular repair to correct the hallux valgus angle and reduce the need for an additional procedure to augment the correction achieved during Scarf osteotomy for hallux valgus

There are few data available regarding the association between hallux valgus and pain or functional limitation. We determined the prevalence of hallux valgus in a rural Korean population aged between 40 and 69 years, and its association with pain and function. A total of 563 subjects was examined using the foot health status questionnaire, the Short Form-36 questionnaire and weight-bearing anteroposterior radiographs. Hallux valgus was present in 364 subjects (64.7%). It did not significantly correlate with age and was more common in women. Of the 364 subjects, 48 (13.2%) had moderate or greater deformity, defined as a hallux valgus angle > 25°. This was significantly associated with pain, worse function and worse foot health. The putative risk factors associated with painful hallux valgus were female gender, low educational attainment and the presence of pain in the knee

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

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

It is recognised that as the severity of hallux valgus (HV) worsens, so do the clinical and radiological signs of arthritis in the first metatarsophalangeal joint. However, few studies specifically document the degenerate changes. The purpose of this study is to determine if intraoperative mapping of articular erosive lesions of the first MTP joint can be correlated to clinical and/or radiographic parameters used during the preoperative assessment of the HV deformity. Materials & Methods. We prospectively analysed 50 patients who underwent surgery between Jan 2009 & Jan 2010. Patients with a known history of previous first metatarsophalangeal joint surgical intervention, trauma, or systemic arthritis were excluded from analysis. Preoperative demographics and AOFAS scores were recorded. Radiographic measurements were obtained from weight bearing radiographs. Intraoperative evaluation of the first metatarsal head, base of the proximal phalanx, and sesamoid articular cartilage erosion was performed. Cartilage wear was documented using International Cartilage Research Society grading. Results. three patients did not have scoring or cartilage wear documentation carried out and were excluded. The mean age was 56 years. The mean hallux valgus angle was 31 degrees. The mean IMA was 15 degrees. The mean AOFAS score was 62. Patients with no inferomedial (IM) and inferolateral (IL) wear had significantly better AOFAS score than patients who had IM & IL wear (p < 0.05). Patients who had IM & IL wear had a significantly higher HVA (p < 0.05). There was a significant positive correlation between hallux valgus angle and AOFAS score. We also found correlation between sesamoid wear and AOFAS score and HV angle. Conclusion. we conclude that preoperative clinical and radiographic measurements can be used to predict the incidence and location of articular erosions in the 1st MTPJ and are helpful in the preoperative assessment of the HV deformity

Short scarf osteotomy (SSO) retains the versatility of standard scarf in treating moderate and severe hallux valgus deformity with the added benefit of less invasiveness translated into less soft-tissue stripping, reduced exposure, less metalwork, less operative time and reduced cost. We present our medium-term clinical, radiographic and patient satisfaction results. All patients who underwent SSO between January 2015 and December 2017 were eligible (98). Exclusion criteria were: follow up less than a year, additional 1st ray procedures, inflammatory arthropathy, infection, peripheral vascular disease and hallux rigidus. Eighty-four patients (94 feet) were included: 80 females / 4 males with average age of 51-year-old (24–81). Minimum follow up was 12 months (12–28). Weight-bearing x-rays and AOFAS score were compared pre- and postoperatively. Non-parametric Mann-Whitney U test assessed statistical significance of our results. Hallux valgus angle (HVA) improved from preoperative mean of 30.8° (17.4°–46.8°) to 12° (4°–30°) postoperatively (p=0.0001). Intermetatarsal angle (IMA) improved from preoperative mean of 15.1° (10.3°–21.1°) to 7.1° (4°–15.1°) postoperatively (p=0.0001). Average sesamoid coverage according to Reynold's tibial sesamoid position improved from average grade 2.18 (1–3) to 0.57 (0–2) (p=0.0001). Average AOFAS score improved from 51.26 (32–88) to 91.1 (72–100) (p=0.0001). Ninety percent of patients were satisfied and 83% wound recommend the surgery. No troughing phenomenon or fractures. Four overcorrections were found 3 of which did not require surgery. One recurrence at 18 months was treated with standard scarf. We believe that this technique offers a safer, quicker and equally versatile way of dealing with Hallux Valgus

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