Percutaneous Distal Metatarsal Osteotomy for Correction of Hallux Valgus

• Published in: Journal of bone and joint surgery. American volume 2005-06, Vol.87 (6), p.1191-1199
• Main Authors: Magnan, Bruno, Pezzè, Lorenzo, Rossi, Nicola, Bartolozzi, Pietro
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Bandages; Biological and medical sciences; Diseases of the osteoarticular system; Hallux Valgus - diagnostic imaging; Hallux Valgus - surgery; Humans; Malformations and congenital and or hereditary diseases involving bones. Joint deformations; Medical sciences; Metatarsal Bones - diagnostic imaging; Metatarsal Bones - surgery; Middle Aged; Orthopedic surgery; Osteotomy - methods; Radiography; Retrospective Studies; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
• ISSN: 0021-9355; 1535-1386
• DOI: 10.2106/JBJS.D.02280

BackgroundDistal osteotomy of the first metatarsal is indicated for the surgical treatment of mild-to-moderate hallux valgus deformity. The aim of this study was to evaluate the results of a subcapital distal osteotomy of the first metatarsal with use of a percutaneous technique.MethodsFrom 1996 to 2001, 118 consecutive percutaneous distal osteotomies of the first metatarsal were performed for the treatment of painful mild-to-moderate hallux valgus in eighty-two patients. The patients were assessed with a clinical and radiographic protocol at a mean of 35.9 months postoperatively. The American Orthopaedic Foot and Ankle Society (AOFAS) hallux-metatarsophalangeal-interphalangeal scale was used for the clinical assessment.ResultsThe patients were satisfied following 107 (91%) of the 118 procedures. The mean score on the AOFAS scale was 88.2 ± 12.9 points. The postoperative radiographic assessments showed a significant change (p < 0.05), compared with the preoperative values, in the mean hallux valgus angle, first intermetatarsal angle, distal metatarsal articular angle, and sesamoid position. The valgus deformity recurred after three procedures (2.5%), the first metatarsophalangeal joint was stiff but not painful after eight (6.8%), and a deep infection developed after one (0.8%). The infection resolved with antibiotic therapy.ConclusionsThe percutaneous technique proved to be reliable for the correct execution of a distal linear osteotomy of the first metatarsal for the correction of a painful mild-to-moderate hallux valgus deformity. The clinical results appear to be comparable with those obtainable with traditional open techniques, with the additional advantages of a minimally invasive procedure, a substantially shorter operating time, and a reduced risk of complications related to surgical exposure.Level of EvidenceTherapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.