Rigid Internal Fixation of Proximal Crescentic Metatarsal Osteotomy in Hallux Valgus Correction

• Published in: Foot & ankle international 2019-07, Vol.40 (7), p.778-789
• Main Authors: Stith, Andrew, Dang, Debbie, Griffin, Matthew, Flint, Wesley, Hirose, Christopher, Coughlin, Michael
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Bone Plates; Bone Screws; Disability Evaluation; Female; Hallux Valgus - diagnostic imaging; Hallux Valgus - surgery; Humans; Male; Metatarsal Bones - diagnostic imaging; Metatarsal Bones - surgery; Middle Aged; Osteotomy - methods; Pain Measurement; Radiography; Range of Motion, Articular; Retrospective Studies
• ISSN: 1071-1007; 1944-7876
• DOI: 10.1177/1071100719842800

Background: The purpose of this study was to evaluate outcomes utilizing a low-profile titanium plate and screw construct for rigid fixation of first ray proximal crescentic osteotomies in the treatment of hallux valgus. Methods: Forty-eight patients (53 feet) with mild to severe hallux valgus were prospectively enrolled and completed 12-month follow-up. All were treated with a proximal crescentic osteotomy, fixed with a low-profile titanium plate, distal soft tissue correction, with or without an Akin osteotomy. Recorded outcomes included change in first ray dorsiflexion angles, need for hardware removal, radiographic and clinical evaluation, pain, and American Orthopaedic Foot & Ankle Society (AOFAS) scores. Results: All patients achieved radiographic union of their osteotomy. An Akin osteotomy was performed in 83% of patients. Seventeen feet (32%) had hardware removed. First ray dorsiflexion angles increased from a mean of 1.6 degrees preoperatively to 5.0 degrees postoperatively (P < .001). Dorsal malunion, defined as change in dorsiflexion angle greater than 1 standard deviation above the mean, occurred in 7 feet. The mean hallux valgus angle improved from 29 to 9 degrees (P < .001). The mean 1-2 intermetatarsal angle decreased from 14 to 6 degrees (P < .001). The first metatarsophalangeal joint range of motion decreased from 77 to 59 degrees (P < .001). The mean visual analog scale score improved from 4 to 0.7 (P < .0001). The mean AOFAS score improved from 55 to 89 points (P < .001). Conclusion: Proximal crescentic metatarsal osteotomy, fixed with a low-profile titanium plate and screw construct, with distal soft tissue repair, and Akin osteotomy as indicated, was a safe and reliable method for operative treatment of hallux valgus. Level of Evidence: Level IV, retrospective case series.