Background: There are at least 5 very popular methods described for the correction of mild to moderate hallux valgus deformities. Despite of reported and self experienced good results in favorable fitting preoperative anatomical conditions of some of these methods; it seems that no one is really satisfying under “difficult” or non favorable preoperative anatomic conditions. How could an optimum operation method for a satisfying correction of a mild to moderate hallux valgus look like? The well known criteria for an optimally satisfying method to achieve full normalization of important forefoot parameters under all conditions should be a lateralization, plantarization and derotation of the Ist metatarsal head and also a normalization of the distal metatarsal articular angle (DMAA) in combination with a soft tissue correction. Methods: In order to achieve this outcome without the disadvantages of shortening or the need for unloading, we developed a new operation technique and new fixation devices. We performed a simple transverse lazy-L subcapital osteotomy and after an additional soft tissue release the Ist metatarsal head was restored to its preplaned optimum position in terms of narrowing the IM angle, plantarization, correction of the hallux valgus angle, derotation of a pronation l malrotation and improvement of the DMAA. Fixation was achieved with an intramedullary angel-stable transfixed 30 mm titanium plate. The rigidity of the implant rendered interfragmental compression or solid bone contact unnecessary. The goal was only an optimal correction. All patients were allowed to ambulate with full weightbearing immediately after the operation. Results: We retrospectively reviewed 346 patients (433 feet) who underwent subcapital osteotomy between May 2007 and December 2011; 308 were women and 38 men; their mean age was 65 years. The follow-up investigation was performed on average after 6.5 years (78 months); range 5.5 to 10 years (66 to 120 months). The AOFAS Score improved from 61.18 to 96.82 (t = 55.13, p < 0.001), the IM angle was reduced from 12.77° to 4.21° (t = 89.70, p < 0.001), the HV angle from 32.47° to 7.75° (t = 51.68, p < 0.001) The DMAA was improved from 20.84° to 6.61° (t = 29.34, p < 0.001). Minimal shortening of the first metatarsal (0.33 mm) and no recurrence of the
References
[1]
Richter, M. (2010) Revised Guidelines for Foot and Ankle Surgery. Aktualisierte Leitlinien Fuß und Sprunggelenk. Fuss Sprung, 8, 268-287. https://doi.org/10.1016/j.fuspru.2010.08.003
[2]
Wulker, N. (1997) Hallux Valgus—Hallux Rigidus. Enke-Verlag, Stuttgart.
[3]
Boebel, A. and Wolff, K. (1960) Relation between Lenght of Metatarsal I and Hallux Valgus. Uber die Beziehung zwischen Großzehenlange und Hallux Valgus. Zeitschrift für Orthopädie und Unfallchirurgie, 93, 254-259.
[4]
Donick, I.I., Berlin, S.J., Block, L.D., Costa, A.J., Fox, J.S. and Martorana, V.J. (1980) An approach for Hallux Valgus. Journal of Foot Surgery, 19, 113.
[5]
Kilmartin, T.E., Barrington, R.L. and Wallace, W.A. (1991) Metatarsus Primus Varus, a Statistical Study. The Journal of Bone and Joint Surgery, 373-B, 937-940.
[6]
Coughlin, M.J. and Jones, C.P. (2007) Hallux Valgus: Demographics, Etiology, and Radiographic Assessment. Foot & Ankle International, 28, 759-777. https://doi.org/10.3113/FAI.2007.0759
[7]
Coughlin, M.J., Saltzman, C.L. and Nunley, J.A. (2002) Angular Measurements in the Evaluation of Hallux Valgus Deformities: A Report of the Ad Hoc Committee of the American Orthopaedic Foot & Ankle Society on Angular Measurements. Foot & Ankle International, 23, 68-74. https://doi.org/10.1177/107110070202300114
[8]
Wülker, N. and Mittag, F. (2012) The Treatment of Hallux Valgus, Deutsches Ärzteblatt International, 109, 857-868.
[9]
Austin, D.W. and Leventen, E.O. (1981) A New Osteotomy for Hallux Valgus: A Horizontally Directed “V” Displacement Osteotomy of the Metatarsal Head for Hallux Valgus and Primus Varus. Clinical Orthopaedics and Related Research, No. 157, 25-30. https://doi.org/10.1097/00003086-198106000-00007
[10]
Havlícek, V., Kovanda, M. and Kunovsky, R. (2007) Surgical Management of Hallux Valgus by Techniques Preserving the First Metatarsophalangeal Joint: Long-Term Results. Acta chi-rurgiae orthopaedicae et traumatologiae Cechoslovaca, 74, 105-110.
[11]
Steinböck, G. (1996) Austin's Horizontal V-Shaped Sliding Osteotomy of the Metatarsal Head Chevron-Osteotomy) in the Treatment of Hallux Valgus. Orthopade, 25, 308-316.
[12]
Trnka, H.J., Zembsch, A., Wiesauer, H., Hungerford, M., Salzer, M. and Ritschl, P. (1997) Modified Austin Procedure for Correction of Hallux Valgus. Foot & Ankle International, 18, 119-127. https://doi.org/10.1177/107110079701800302
[13]
Othman, A. and Hegazy, I. (2016) Treatment of Mild to Moderate Hallux Valgus, Percutaneous Osteotomy versus Distal Chevron Osteotomy. Open Journal of Orthopedics, 6, 150-157. https://doi.org/10.4236/ojo.2016.66023
[14]
Youngswick, F.D. (1982) Modifications of the Austin Bunionectomy for Treatment of Metatarsus Primus Elevatus Associated with Hallux Limitus. Journal of Foot and Ankle Surgery, 21, 114-116.
[15]
Ahn, J., Lee, H.S., Seo, J.H. and Kim, J.Y. (2016) Second Metatarsal Transfer Lesions Due to First Metatarsal Shortening After Distal Chevron Metatarsal Osteotomy for Hallux Valgus. Journal of Foot and Ankle Surgery, 37, 589-595. https://doi.org/10.1177/1071100715627350
[16]
Richard, V.D., Jeffrey, H., Michael, W., Heaslet, M.S. and Walston, S. (2003) Complications of Screw-Fixated Chevron Osteotomies for the Correction of Hallux Abducto Valgus. Journal of the American Podiatric Medical Association, 93, 499-502. https://doi.org/10.7547/87507315-93-6-499
[17]
Lagaay, P.M., Hamilton, G.A., Ford, L.A., Williams, M.E., Rush, S.M. and Schuberth, J.M. (2008) Rates of Revision Surgery Using Chevron-Austin Osteotomy, Lapidus Arthrodesis, and Closing Base Wedge Osteotomy for Correction of Hallux Valgus Deformity. Journal of Foot and Ankle Surgery, 47, 267-272. https://doi.org/10.1053/j.jfas.2008.03.002
[18]
Duan, X.J. and Kadakia, A.R. (2012) Salvage of Recurrence after Failed Surgical Treatment of Hallux Valgus. Article in Archives of Orthopaedic and Trauma Surgery, 132, 477-485. https://doi.org/10.1007/s00402-011-1447-6
[19]
Reverdin, J. (1881) The Deviation of Hallux Valgus and Its Treatment. De la deviation en dehors du gros orl (hallux valgus) et son traitement chirurgical. Trans International Medical Congress, 2, 408-412.
[20]
Hohmann, G. (1924) About the Hallux Valgus Operation. Zur Hallux Valgus-Operation. Zentralblatt Chirurgie, 51, 230.
[21]
Hohmann, G. (1925) Hallux Valgus and Deformities of the Lesser Toes. Der Hallux valgus und die übrigen Zehenverkrümmungen. Ergebnisse der Chirurgie und Orthop ädie, 18, 308.
[22]
Christensen, P.H. and Hansen, T.B. (1995) Hallux Valgus Correction Using a Modified Hohmann Technique. Foot & Ankle International, 16, 177-180. https://doi.org/10.1177/107110079501600401
[23]
Vanore, J.V. (1994) Hohmann Osteotomy, Chapter 13 in Hallux Valgus and Forefoot Surgery. In: Vincent, J., Ed., Hetherington, Churchill Livingstone, New York, 183-196.
[24]
Trnka, H.J., Krenn, S. and Schuh, R. (2013) Minimally Invasive Hallux Valgus Surgery: A Critical Review of the Evidence. International Orthopaedics, 37, 1731-1735. https://doi.org/10.1007/s00264-013-2077-0
[25]
Roukis, T.S. (2009) Percutaneous and Minimum Incision Metatarsal Osteotomies: A Systematic Review. The Journal of Foot and Ankle Surgery, 48, 380-387. https://doi.org/10.1053/j.jfas.2009.01.007
[26]
Díaz Fernández, R. (2017) Percutaneous Triple and Double Osteotomies for the Treatment of Hallux Valgus. Foot & Ankle International, 38, 159-166. https://doi.org/10.1177/1071100716670403
[27]
Magin, M.N. (2011) Stoffella Metatarsal I Osteotomy for Hallux Valgus Correction: An Update. Operative Orthopadie und Traumatologie, 23, 158-166. https://doi.org/10.1007/s00064-010-0013-7
[28]
Wolter, L. (2004) Hueter Mayo Resectionarthroplasty in Hallux Valgus versus Stoffella Subcapital I-Osteteotomy. Resektionsinterpositionsarthropastik nach Hueter Mayo bei Hallux valgus versus subcapitale Metatarsale-I-Osteotomie nach Stoffella bei Hallux valgus. Dissertation Ruhr Universität Bochum 2004.
[29]
Kramer, J. (1990) The Kramer Osteotomy in the Correction of Hallux Valgus and Digitus Quintus Varus. Die Kramer-Osteotomie zur Behandlung des Hallux valgus und des Digitus quintus varus. Operative Orthopädie und Traumatologie, 2, 29-38. https://doi.org/10.1007/BF02512334
[30]
Lamprecht, E. (1993) Kramers Retrocapital Metatarsal I Osteotomy. Retrokapitale Metatarsale-I-Osteotomie nach Kramer. In: Wirth, C.J., Ferdini, R. and Wulker, N., Eds., Vorfußdeformitaten, Springer, Berlin, 241-250.
[31]
Bösch, P., Markowski, H. and Rannicher, V. (1990) Technique and First Results of t he Subcutaneous Distal Ostetomy of Metatarsal I. Technik und erste Ergebnisse der subcutanen distalen Metatarsale-I-Osteotomie. Orthop ädische Praxis, 26, 51-56.
[32]
Bösch, P., Wanke, S. and Legenstein, R. (2000) Hallux Valgus Correction by the Method of Bösch: A New Technique with a Seven to Ten Year Follow-Up. Foot and Ankle Clinics, 5, 485-498.
[33]
Iannò, B., Familiari, F., De Gori, M., Galasso, O., Ranuccio, F. and Gasparini, G. (2013) Midterm Results and Complications after Minimally Invasive Distal Metatarsal Osteotomy for Treatment of Hallux Valgus. Foot & Ankle International, 34, 969-977. https://doi.org/10.1177/1071100713481453
[34]
Burutaran, J.M. (1976) Hallux valgus y cortedad anatomica del primer metatarsano (correction quingica). Actual Medicina e Chirurgia del Piede, 13, 261-266.
[35]
Fakoor, M., Sarafan, N., Mohammadhoseini, P., Khorami, M., Arti, H., Mosavi, S., and Aghaeeaghdam, A. (2014) Comparison of Clinical Outcomes of Scarf and Chevron Osteotomies and the McBride Procedure in the Treatment of Hallux Valgus Deformity. The Archives of Bone and Joint Surgery, 2, 31-36.
[36]
Crevoisier, X., Mouhsine, E., Ortolano, V., Udin, B. and Dutoit, M. (2001) The Scarf Osteotomy for the Treatment of Hallux Valgus Deformity: A Review of 84 Cases. Foot & Ankle International, 22, 970-976. https://doi.org/10.1177/107110070102201208
[37]
Coetzee, J.C. (2003) Scarf Osteotomy for Hallux Valgus Repair: The Dark Side. Foot & Ankle International, 24, 29-33. https://doi.org/10.1177/107110070302400104
[38]
Chandler, L.M. (2014) First Metatarsal Head Osteotomies for the Correction of Hallux Abducto Valgus. Clinics in Podiatric Medicine and Surgery, 31, 221-231. https://doi.org/10.1016/j.cpm.2013.12.004
[39]
Lehman, D.E. (2003) Salvage of Complications of Halluxvalgus Surgery. Foot and Ankle Clinics, 8, 15-35. https://doi.org/10.1016/S1083-7515(02)00130-4
[40]
Duan, X.J. and Kadakia, A.R. (2011) Salvage of Recurrence after Failed Surgical Treatment of Hallux Valgus. Article in Archives of Orthopaedic and Trauma Surgery, 132, 477-485. https://doi.org/10.1007/s00402-011-1447-6
[41]
Vitek, M. (2009) New Techniques in Forfoot Surgery. The V-Tek System. K-Wire Free Forefoot Corrections. Neue Techniken in der Fußchirurgie-das V-tek-System: Bohrdrahtfreie Vorfußkorrekturen. ABW Wissenschaftsverlag.
[42]
Akin, O. (1925) The Treatment of Hallux Valgus: A New Operative Procedure and Its Results. Medical Sentinel, 33, 678-679.
