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

Background and aims. Hallux rigidus in the metatarsophalangeal joint (MTPJ) can be treated with arthroplasty to reduce pain and enhance motion. Few studies have investigated the functionality and the survival of HemiCap arthroplasty. Primarily we aimed to examine the medium to long-term functionality and the degree of pain after surgery. Secondarily the failure and revision rate of HemiCap implants. Methods. A total of 106 patients were operated with HemiCap arthroplasty (n=114) from 2006 to 2014, median age 53 (16 to 80) years, 78 females, 37 dorsal flange (DF) implants. Patient charts were reviewed retrospectively to collect revision data. Pre operative Coughlin/Shurnas arthrosis degree, hallux valgus (HV), intermetatarsalintermetatarsal (IM) and Distal Metaphyseal Articular Angle (DMAA) angles was were measured. Pre- and post operative 3 weeks, 6 months, 1 and 2 year2-year pain levels of the first MTPJ by Visuel Analog Skala (VAS 1–10), American Orthopaedic Foot and Ankle Score (AOFAS 0 to 100 points) and, Range of Motion (ROM), were available for 51 patients. FortysevenForty-seven of the 70 available for reexamination partook in a cross sectional follow up where the Self-Reported Foot and Ankle Score (SEFAS 0–48 points) was added to the Patients Related Outcome Measures (PROMs). Statistics. Kaplan-Meier for survival analysis, adjusted for sex, radiological angles, degree of arthrosis and dorsal flange. Prospective PROMs and ROM compared by paired t-test. Results. At 3, 5 and 7 years we had an mean implant survival of 85%, 83% and 78%. Almost all were revised due to pain, one due to malalignment and one due to loosening of the Hemicap. Dorsal flange, gender, preoperative arthrosis degree, HV, IM or DMAA angles did not statistically influence the result. For those (n=23) that were re-examined, preoperative dorsal ROM changed from mean(sd) 21 (6) to 42 (18) degrees, VAS from 7 (2) to 2 (2) and AOFAS from 61 (11) to 87 (11) (p < 0.001). At mean 5 year follow up (n=47), mean (sd) dorsal ROM was 46 (17) degrees,. AOFAS was 84 (9), VAS 2 (1) and SEFAS 42 (6) points. The dorsal flange made no statistical significant difference for ROM or PROMs, but DF displayed 51 degrees of extension vs. 44 without (p=0.1). Periprostethic lucency (<2 mm) was observed in 27/47. Conclusions. In general, we saw an acceptable implant survival rate. We did not find any predictors that influenced implant failure and the design alterations with the dorsal flange are not evident clinically. Patients who were not revised had significantly less pain, greater ROM, and better overall foot and ankle conditions than preoperatively, but the data are biased by missing numbers and revisions