Aims. The mainstay of surgical correction of hallux valgus is first
metatarsal
Moderate to severe hallux valgus is conventionally
treated by
As it remains unproven that hypermobility of
the first tarsometatarsal joint (TMTJ-1) is a significant factor
in hallux valgus deformity, the necessity for including arthrodesis
of TMTJ-1 as part of a surgical correction of a hallux valgus is
questionable. In order to evaluate the role of this arthrodesis
on the long-term outcome of hallux valgus surgery, a prospective,
blinded, randomised study with long-term follow-up was performed,
comparing the Lapidus procedure (which includes such an arthrodesis)
with a simple Hohmann distal closing wedge metatarsal osteotomy. The
study cohort comprised 101 feet in 87 patients: 50 feet were treated
with a Hohmann procedure and 51 with a Lapidus procedure. Hypermobility
of TMTJ-1 was assessed pre-operatively by clinical examination.
After a mean of 9.25 years (7.25 to 11.42), 91 feet in 77 patients
were available for follow-up. There was no difference in clinical
or radiological outcome between the two procedures. Also, there
was no difference in outcome between the two procedures in the subgroup
clinically assessed as hypermobile. This study does not support
the theory that a hallux valgus deformity in a patient with a clinically
assessed hypermobile TMTJ-1 joint requires fusion of the first tarso-metatarsal
joint. Cite this article:
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:
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
Severe hallux valgus deformity is conventionally
treated with
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.
A consecutive series of 23 patients (25 ankles) with osteoarthritis of the ankle and severe varus or valgus deformity were treated by open arthrodesis using compression screws. Primary union was achieved in 24 ankles one required further surgery to obtain a solid fusion. The high level of satisfaction in this group of patients reinforces the view that open arthrodesis, as opposed to ankle replacement or arthroscopic arthrodesis, continues to be the treatment of choice when there is severe varus or valgus deformity associated with the arthritis.