Comparison of Distal Soft-Tissue Procedures Combined with a Distal Chevron Osteotomy for Moderate to Severe Hallux Valgus: First Web-Space Versus Transarticular Approach

• Published in: Journal of bone and joint surgery. American volume 2013-11, Vol.95 (21), p.e158-e158
• Main Authors: Park, Yu-Bok, Lee, Keun-Bae, Kim, Sung-Kyu, Seon, Jong-Keun, Lee, Jun-Young
• Format: Article
• Language: English
• Subjects: Adult; Aged; Female; Hallux - diagnostic imaging; Hallux - surgery; Hallux Valgus - diagnostic imaging; Hallux Valgus - surgery; Humans; Male; Metatarsal Bones - diagnostic imaging; Metatarsal Bones - surgery; Metatarsophalangeal Joint - diagnostic imaging; Metatarsophalangeal Joint - surgery; Middle Aged; Osteotomy - methods; Radiography; Range of Motion, Articular; Treatment Outcome
• ISSN: 0021-9355; 1535-1386
• DOI: 10.2106/JBJS.L.01017

BACKGROUND:There are two surgical approaches for distal soft-tissue procedures for the correction of hallux valgus—the dorsal first web-space approach, and the medial transarticular approach. The purpose of this study was to compare the outcomes achieved after use of either of these approaches combined with a distal chevron osteotomy in patients with moderate to severe hallux valgus. METHODS:One hundred and twenty-two female patients (122 feet) who underwent a distal chevron osteotomy as part of a distal soft-tissue procedure for the treatment of symptomatic unilateral moderate to severe hallux valgus constituted the study cohort. The 122 feet were randomly divided into two groupsnamely, a dorsal first web-space approach (group D; sixty feet) and a medial transarticular approach (group M; sixty-two feet). The clinical and radiographic results of the two groups were compared at a mean follow-up time of thirty-eight months. RESULTS:The American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot scale hallux metatarsophalangeal-interphalangeal scores improved from a mean and standard deviation of 55.5 ± 12.8 points preoperatively to 93.5 ± 6.3 points at the final follow-up in group D and from 54.9 ± 12.6 points preoperatively to 93.6 ± 6.2 points at the final follow-up in group M. The mean hallux valgus angle in groups D and M was reduced from 32.2° ± 6.3° and 33.1° ± 8.4° preoperatively to 10.5° ± 5.5° and 9.9° ± 5.5°, respectively, at the time of final follow-up. The mean first intermetatarsal angle in groups D and M was reduced from 15.0° ± 2.8° and 15.3° ± 2.7° preoperatively to 6.5° ± 2.2° and 6.3° ± 2.4°, respectively, at the final follow-up. The clinical and radiographic outcomes were not significantly different between the two groups. CONCLUSIONS:The final clinical and radiographic outcomes between the two approaches for distal soft-tissue procedures were comparable and equally successful. Accordingly, the results of this study suggest that the medial transarticular approach is an effective and reliable means of lateral soft-tissue release compared with the dorsal first web-space approach. LEVEL OF EVIDENCE:Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.