Percutaneous, intra-articular, chevron osteotomy (PeICO) for the treatment of mild-to-moderate hallux valgus: a case series

Background: Recurrence is relatively common after surgical correction of hallux valgus. Multiple factors are discussed that could have an influence in the loss of correction. The aim of this study was to determine preoperative radiological factors with an influence on loss of correction after distal chevron osteotomy for hallux valgus. Methods: Five hundred twenty-four patients who underwent the correction of a hallux valgus by means of distal chevron osteotomy at our institution between 2002 and 2012 were included. We assessed weightbearing x-rays at 4 time points: preoperatively, postoperatively, and after 6 weeks and 3 months. We investigated the intermetatarsal angle (IMA), the hallux valgus angle (HVA), the distal metatarsal articular angle (DMAA), joint congruity, and the position of the sesamoids. Results: At all points of the survey, significant correction of the IMA and HVA was detected. The IMA improved from 12.9 (± 2.8) to 4.5 (± 2.4) degrees and the HVA from 27.5 (± 6.9) to 9.1 (± 5.3) degrees. Loss of correction was found in both HVA and IMA during follow-up with a mean of 4.5 and 1.9 degrees, respectively. Loss of correction showed a linear correlation with preoperative IMA and HVA, and a correlation between preoperative DMAA and sesamoid position. Conclusion: The chevron osteotomy showed significant correction for HVA, IMA, and DMAA. Preoperative deformity, in terms of IMA, HVA, DMAA, and sesamoid position, correlated with the loss of correction and could be assessed preoperatively for HVA and IMA. Loss of correction at 3 months persisted during the follow-up period. Level of Evidence: Level IV, retrospective case series.

Download Full-text

Proximal Opening Wedge Osteotomy With Distal Chevron Osteotomy of the First Metatarsal for the Treatment of Moderate to Severe Hallux Valgus

Foot & Ankle International ◽

10.1177/1071100718799079 ◽

2018 ◽

Vol 40 (1) ◽

pp. 89-97 ◽

Cited By ~ 4

Author(s):

Matthias Braito ◽

Dietmar Dammerer ◽

Philipp Hofer-Picout ◽

Gerhard Kaufmann

Keyword(s):

Wound Infection ◽

Hallux Valgus ◽

Case Series ◽

Wedge Osteotomy ◽

Metatarsal Osteotomy ◽

Level Of Evidence ◽

Opening Wedge ◽

First Metatarsal ◽

Chevron Osteotomy ◽

Severe Hallux Valgus

Background: The aim of this study was to assess radiographic and clinical outcomes after double osteotomy with proximal opening wedge first metatarsal osteotomy and first metatarsal distal chevron osteotomy in the treatment of moderate to severe hallux valgus. Methods: 33 patients (4 male, 29 female; 36 feet; average age 60.7 years) were included in the study. Radiographic and clinical outcome in terms of intermetatarsal angle (IMA), hallux valgus angle (HVA), distal metatarsal articular angle (DMAA), and the American Orthopaedic Foot & Ankle Society metatarsophalangeal-interphalangeal hallux score (AOFAS MTP-IP hallux score) were investigated at 6 weeks, 6 months, and after an average of 28 (range, 7-123) months postoperatively. Results: Preoperative IMA, HVA, and DMMA showed statistically significant improvement ( P ≤ .05) from 19.1 ± 3.8 (8.9-27.3) degrees, 45.4 ± 8.7 (25.9-60.9) degrees, and 20.8 ± 8.9 (4.5-38.0) degrees to 6.0 ± 3.3 (0.4-12.2) degrees, 9.1 ± 8.9 (–6.7 to 39.0) degrees, and 6.4 ± 5.6 (–6.8 to 21.0) degrees at last follow-up, respectively. Postoperative AOFAS MTP-IP hallux score averaged 88.1 points. Overall, 10 complications were observed: hallux varus (3 feet), hallux valgus recurrence (3 feet), nonunion (1 foot), loss of fixation (1 foot), and wound infection (2 feet). Conclusion: Proximal opening wedge first metatarsal osteotomy with distal chevron osteotomy provided powerful correction of each component of moderate to severe hallux valgus but had a substantial rate of complications in terms of over- and undercorrection, nonunion, loss of fixation, and wound infection. Level of Evidence: Level IV, case series.

Download Full-text

Distal Chevron Osteotomy Increases Anatomic Intermetatarsal Angle in Hallux Valgus

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00161 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0016

Author(s):

Jeremy Y. Chan ◽

Naudereh B. Noori ◽

Stephanie Chen ◽

Glenn B. Pfeffer ◽

Timothy P. Charlton ◽

...

Keyword(s):

Hallux Valgus ◽

Case Series ◽

Metatarsal Head ◽

Rank Test ◽

Metatarsal Osteotomy ◽

Recurrence Rates ◽

Intermetatarsal Angle ◽

First Metatarsal ◽

Chevron Osteotomy

Category: Bunion; Midfoot/Forefoot Introduction/Purpose: Loss of correction in hallux valgus (HV) deformity following distal chevron metatarsal osteotomy (DCO) has been demonstrated in short-term follow-up with HV recurrence rates of up to 75% reported in the long-term. The purpose of this study was to evaluate the radiographic effect of the DCO on the anatomic and mechanical axes of the first metatarsal. Our hypothesis was that patients undergoing DCO would have improvement in the mechanical metatarsal axis but worsening of the anatomic axis. Methods: This was a retrospective single surgeon case series of all patients who underwent DCO for HV between 2017 and 2019. Patients were included if they had both preoperative and postoperative weightbearing foot radiographs. The primary outcomes were the change in anatomic first-second intermetatarsal angle (a1-2IMA, defined by the metatarsal diaphyseal axis) and the change in mechanical first-second intermetatarsal angle (m1-2IMA, defined by the axis from the center of the metatarsal head to the metatarsal base). Secondary outcomes included the change in hallux valgus angle (HVA) and medial sesamoid position (medial sesamoid in relation to the mechanical axis of the metatarsal). Change in second-third intermetatarsal angle (2-3IMA, defined by the metatarsal diaphyseal axis) was measured to control for any inconsistencies in radiographic technique. Given the relatively small patient cohort, the non-parametric Wilcoxon signed rank test and Mann Whitney U test were used for statistical analysis. Results: 41 feet were included for analysis with a mean follow-up of 20.4 weeks. The a1-2IMA increased significantly (mean, 4.0 degrees, p<0.001) while the m1-2IMA decreased significantly (mean, 4.6 degrees, p<0.001) following DCO. There was a significant improvement in HVA (mean, 13.2 degrees, p<0.001). No changes were noted in 2-3IMA (mean, 0.0 degrees, p=0.834). (Table 1) Medial sesamoid position was improved in 22 feet (53.7%). Patients with improved sesamoid position were noted to have a significantly larger decrease in m1-2IMA (mean, 5.3 versus 3.8 degrees, p=0.01) and a smaller increase in a1-2IMA (mean, 3.4 versus 4.7 degrees, p=0.02) compared to patients with no improvement in sesamoid position. Conclusion: Distal chevron osteotomy for HV is associated with an increase in the anatomic intermetatarsal angle despite improvements in the m1-2IMA, HVA and medial sesamoid position. Patients with improved sesamoid position were associated with greater correction of the mechanical first metatarsal axis. Our findings may suggest the presence of intermetatarsal instability, which could limit the power of DCO in HV correction for more severe deformities and provide a mechanism for HV recurrence. [Table: see text]

Download Full-text

Does Hallux Valgus Correction Reduce the Width of the Forefoot?

Foot & Ankle Specialist ◽

10.1177/1938640019835301 ◽

2019 ◽

Vol 13 (2) ◽

pp. 112-115 ◽

Cited By ~ 1

Author(s):

Vinod Panchbhavi ◽

Justin Cordova ◽

Jie Chen ◽

Cory Janney

Keyword(s):

Clinical Outcomes ◽

Hallux Valgus ◽

Surgical Procedures ◽

Case Series ◽

Hallux Valgus Angle ◽

Linear Measurements ◽

Levels Of Evidence ◽

Chevron Osteotomy ◽

Valgus Angle ◽

Akin Osteotomy

Background: Hallux valgus has been associated with a widened forefoot. Most surgical procedures for the correction of hallux valgus have the potential to reduce forefoot width. Success after hallux valgus surgery is correlated with relief of toe pain in conventional shoes and improvement in the appearance of the foot. Therefore, reduction in forefoot width, referred to as metatarsal span (MS), likely correlates with both criteria and may be a reliable radiographic indicator of success after hallux valgus surgery. Methods: Preoperative and postoperative radiographs of 52 patients who underwent correction of hallux valgus with a distal Chevron osteotomy and Akin osteotomy were evaluated by 4 observers. The observers measured the hallux valgus angle (HVA), the intermetatarsal first and second angle (IMA), and the MS. Results: Preoperative HVA ranged from 14° to 48°, IMA ranged from 6° to 25°, and MS ranged from 74.2 to 110.6 mm. The average HVA improvement was 19.4°, IMA improvement was 6.7°, and MS reduction was 8.7 mm. No correlation was identified with regard to correction of the HVA or IMA to MS. Conclusion: Digital radiographic linear measurements were easily and reliably made. Therefore, linear measurements as described in this article can be used as a tool to evaluate if clinical outcomes correlate with reduction of MS. A distal Chevron with an Akin osteotomy has the potential to reduce forefoot width. Levels of Evidence: Level IV: Case series

Download Full-text

Distal Chevron Osteotomy Increases Anatomic Intermetatarsal Angle in Hallux Valgus

Foot & Ankle Orthopaedics ◽

10.1177/2473011420960710 ◽

2020 ◽

Vol 5 (4) ◽

pp. 247301142096071

Author(s):

Jeremy Y. Chan ◽

Naudereh Noori ◽

Stephanie Chen ◽

Glenn B. Pfeffer ◽

Timothy P. Charlton ◽

...

Keyword(s):

Hallux Valgus ◽

Case Series ◽

Metatarsal Osteotomy ◽

Retrospective Case ◽

Level Of Evidence ◽

Intermetatarsal Angle ◽

First Metatarsal ◽

Retrospective Case Series ◽

Chevron Osteotomy ◽

Anatomic Axis

Background: Distal chevron metatarsal osteotomy (DCO) is a common technique to address hallux valgus (HV), which involves coronal translation of the capital fragment resulting in a nonanatomic first metatarsal. The purpose of this study was to evaluate the radiographic effect of the DCO on the anatomic vs the mechanical axis of the first metatarsal. Our hypothesis was that patients undergoing DCO would have improvement in the mechanical metatarsal axis but worsening of the anatomic axis. Methods: This was a retrospective case series of consecutive patients who underwent DCO for HV. The primary outcomes were the change in anatomic first–second intermetatarsal angle (a1-2IMA) vs mechanical first–second intermetatarsal angle (m1-2IMA). Secondary outcomes included the change in hallux valgus angle (HVA) and medial sesamoid position. Results: 40 feet were analyzed with a mean follow-up of 21.2 weeks. The a1-2IMA increased significantly (mean, 4.1 degrees) whereas the m1-2IMA decreased significantly (mean, 4.6 degrees) following DCO. There was a significant improvement in HVA (mean, 12.5 degrees). Medial sesamoid position was improved in 21 feet (52.5%). Patients with no improvement in sesamoid position were found to have a larger increase in a1-2IMA (mean, 4.7 vs 3.5 degrees, P = .03) and less improvement in m1-2IMA (mean, 3.8 vs 5.2 degrees, P = .02) compared to patients with improvement in sesamoid position. Conclusion: Distal chevron osteotomy for HV was associated with worsening of the anatomic axis of the first metatarsal despite improvements in the mechanical metatarsal axis, HVA, and medial sesamoid position. Greater worsening of the anatomic axis was associated with less improvement of sesamoid position. Our findings may suggest the presence of intermetatarsal instability, which could limit the power of DCO in HV correction for more severe deformities and provide a mechanism for HV recurrence. Level of Evidence: Level IV, retrospective case series.

Download Full-text

Short-Term Radiographic Outcome After Distal Chevron Osteotomy for Hallux Valgus Using Intramedullary Plates With an Amended Algorithm for the Surgical Management of Hallux Valgus

Foot & Ankle Specialist ◽

10.1177/1938640018762474 ◽

2018 ◽

Vol 12 (1) ◽

pp. 25-33 ◽

Cited By ~ 1

Author(s):

Takumi Matsumoto ◽

Christopher E. Gross ◽

Selene G. Parekh

Keyword(s):

Hallux Valgus ◽

Case Series ◽

Metatarsal Head ◽

Valgus Deformity ◽

Osteotomy Site ◽

Radiographic Outcome ◽

Short Term ◽

Chevron Osteotomy ◽

Hallux Valgus Deformity ◽

Valgus Angle

Distal Chevron osteotomy is a well-established surgical procedure for mild to moderate hallux valgus deformity. Many methods have been described for fixation of osteotomy site; secure fixation, enabling large displacement of the metatarsal head, is one of the essentials of this procedure. The purpose of the present study was to evaluate the short-term radiographic outcome of a distal Chevron osteotomy using an intramedullary plate for the correction of hallux valgus deformity. The present study evaluated 37 patients (40 feet) who underwent distal Chevron osteotomy using an intramedullary plate by periodic radiographs obtained preoperatively and at 4 weeks, 8 weeks, 3 months, and 6 months postoperatively. Correction of the hallux valgus angle averaged 17.8°, intermetatarsal angle 7.4°, distal metatarsal articular angle 2.7°, and sesamoid position 1.4 stages at 3 months postoperatively. The average lateral shift of the capital fragment was 6.5 mm. All patients achieved bone union, and there were no cases of dislocation, displacement, or avascular necrosis of the metatarsal head fragment. In conclusion, a distal Chevron osteotomy using an intramedullary plate was a favorable method for the correction of mild to moderate hallux valgus deformity. Levels of Evidence: Level IV: Case series

Download Full-text

Outcome of Second-Ray Pathologies Following Weil Osteotomy in Patients Treated for Hallux Valgus

Foot & Ankle Specialist ◽

10.1177/1938640018819778 ◽

2018 ◽

Vol 12 (5) ◽

pp. 452-457 ◽

Cited By ~ 2

Author(s):

Ki Won Young ◽

Hong Seop Lee ◽

Ki Chol Park

Keyword(s):

Patient Satisfaction ◽

Hallux Valgus ◽

Case Series ◽

Relative Length ◽

Claw Toe ◽

Satisfaction Rate ◽

Surgery Outcome ◽

Chevron Osteotomy ◽

Second Metatarsal ◽

Toe Deformity

Background: We hypothesized that the cause of second-ray pathology with hallux valgus is excessive relative length of the second metatarsal and performed Weil osteotomy to shorten it, with correction of hallux valgus. The purpose of this study is to evaluate the outcome of second-ray pathology after distal chevron osteotomy (DCO) with Weil osteotomy to correct metatarsal parabola. Methods: We performed concomitant Weil osteotomy of the second metatarsal with DCO of the first metatarsal as part of hallux valgus with second-ray pathology correction surgery in 45 feet (40 patients). Second-ray pathologies were claw toe deformity, painful plantar callosity, second metatarsophalangeal joint (MTPJ) dislocation, and osteoarthritis (OA) of the second MTPJ. We measured projection of the second metatarsal (PSM), metatarsal protrusion index (MPI), and metatarsal protrusion distance (MPD). The second-ray surgery outcome was assessed by patient satisfaction. Results: Patient satisfaction was good in claw toe deformity and OA (satisfaction rate: 60% [23 patients] and 71% [7 patients], respectively) and fair in painful plantar callosity and second MTP joint dislocation (satisfaction rate: 44% [9 patients] and 33% [6 patients], respectively). Total patient satisfaction rate was higher when the PSM, MPI, and MPD ranged between 7 and 12 mm, −5 and 0 mm, and 0 and 4 mm, respectively. Conclusions: We concluded that simultaneous performance of hallux valgus correction and Weil osteotomy in patients with second-ray pathologies associated with hallux valgus was safe as well as effective. Correcting the metatarsal parabola within the appropriate range after surgery is associated with second-ray pathology outcome. Levels of Evidence: Therapeutic studies, Level VI: Case series

Download Full-text

Correlation analysis of the x-ray and functional parameters from the results of chevron (Austin) osteotomy for hallux valgus

Vrač skoroj pomoŝi (Emergency Doctor) ◽

10.33920/med-02-2005-07 ◽

2020 ◽

pp. 54-63

Author(s):

Ruslan Khairutdinov ◽

Timur Minasov ◽

Ekaterina Yakupova ◽

Elvina Mukhametzyanova

Keyword(s):

Hallux Valgus ◽

Rating Scale ◽

Metatarsophalangeal Joint ◽

Valgus Deformity ◽

First Metatarsophalangeal Joint ◽

Chevron Osteotomy ◽

Hallux Valgus Deformity ◽

Valgus Angle ◽

The Right ◽

Bone Structures

Hallux valgus is characterized by the appearance and growth of a painful “lump” in the region of the first metatarsophalangeal joint, the development of forefoot corns, and inability to choose the right shoes, which leads to a significant decrease in the quality of life of these patients. Corrective osteotomies that preserve the metatarsophalangeal joint, for example Austin (Chevron) osteotomy, are usually used for hallux valgus deformity of the I, II degrees. Radiography with the study of the hallux valgus angle (HVA), the intermetatarsal angle (IMA), the distal metatarsal articular angle (DMAA) is a research method that shows the true correlation between bone structures. The correlation between the radiological and functional indicators of osteotomy allows us to determine possible recommendations for indications for surgical treatment of Hallux valgus. Correlation shows that the largest correction of hallux valgus in older patients occurs due to a small adjustment of the angle of DMMA and HVA. IMA had the best correction after Austin osteotomy among patients of a younger age, then the HVA, and the DMMA had minimum correction according to the AOFAS rating scale (Kitaoka). The revealed correlations allow us to determine the correct tactics for the treatment of hallux valgus by identifying the benefits of Austin osteotomy.

Download Full-text

First-Ray Radiographic Changes After Flexible Adult Acquired Flatfoot Deformity Correction

Foot & Ankle International ◽

10.1177/10711007211034516 ◽

2021 ◽

pp. 107110072110345

Author(s):

Chien-Shun Wang ◽

Yun-Hsuan Tzeng ◽

Tzu-Cheng Yang ◽

Chun-Cheng Lin ◽

Ming-Chau Chang ◽

...

Keyword(s):

Risk Factors ◽

Hallux Valgus ◽

Reconstructive Surgery ◽

Case Series ◽

Deformity Correction ◽

Level Of Evidence ◽

Factors Affecting ◽

Radiographic Parameters ◽

Case Series Study ◽

Adult Acquired Flatfoot Deformity

Background: Adult acquired flatfoot deformity (AAFD) and hallux valgus (HV) are common foot and ankle deformities. Few studies have reported the changes in radiographic parameters of HV after reconstructive surgery for AAFD. This study aimed to evaluate the changes in radiographic parameters of HV and analyze the risk factors for increased HV after correction of AAFD. Methods: Adult patients with flexible AAFD who underwent similar bony procedures including medializing calcaneal osteotomy and Cotton osteotomy were included. Radiographic parameters were measured on weightbearing radiographs preoperatively, postoperatively, and at the final follow-up. Patients were divided into hallux valgus angle (HVA) increased and HVA nonincreased groups; logistic regression analysis was performed to identify risk factors affecting increased HV. Results: Forty-six feet of 43 patients were included. After AAFD reconstructive surgery, the tibial sesamoid position improved by 1 grade, but the HVA increased 4 degrees in average. Further, 21 of 46 feet (46%) showed an HVA increase ≥5 degrees immediately after AAFD correction surgery. Preoperative talonavicular coverage angle <21.6 degrees was a risk factor associated with HV increase immediately after the surgery. Conclusion: In this case series, using plain radiographs to measure standard parameters of foot alignment, we found the association between AAFD correction and HV deformity measures somewhat paradoxical. Correction of overpronation of the hindfoot and midfoot appears to improve the first metatarsal rotational deformity but may also increase HVA. A lower preoperative talonavicular coverage angle was associated with an increase of the HVA after surgery. Level of Evidence: Level IV, case series study.

Download Full-text

Radiographic Outcomes, Union Rates, and Complications Associated With Plantar Implant Positioning for Midfoot Arthrodesis

Foot & Ankle Orthopaedics ◽

10.1177/24730114211027115 ◽

2021 ◽

Vol 6 (3) ◽

pp. 247301142110271

Author(s):

Tyler W. Fraser ◽

Daniel T. Miles ◽

Neal Huang ◽

Franklin B. Davis ◽

Burton D. Dunlap ◽

...

Keyword(s):

Hallux Valgus ◽

Skin Irritation ◽

Case Series ◽

Deformity Correction ◽

Valgus Deformity ◽

Union Rate ◽

Radiographic Outcomes ◽

Hallux Valgus Deformity ◽

Metatarsal Angle ◽

Radiographic Union

Background: Midfoot arthrodesis has long been successfully included in the treatment paradigm for a variety of pathologic foot conditions. A concern with midfoot arthrodesis is the rate of nonunion, which historically has been reported between 5% and 10%. Plantar plating has also been noted to be more biomechanically stable when compared to traditional dorsal plating in previous studies. Practical advantages of plantar plating include less dorsal skin irritation and the ability to correct flatfoot deformity from the same medial incision. The purpose of this study is to report the arthrodesis rate, the success of deformity correction, and the complications associated with plantar-based implant placement for arthrodesis of the medial column. Methods: A retrospective review was undertaken of all consecutive patients between 2012 and 2019 that underwent midfoot arthrodesis with plantar-positioned implants. Radiographic outcomes and complications are reported on 62 patients who underwent midfoot arthrodesis as part of a correction for hallux valgus deformity, flatfoot deformity, degenerative arthritis, Lisfranc injury, or Charcot neuroarthropathy correction. Results: Statistically significant improvement was seen in the lateral talus–first metatarsal angle (Meary angle) and medial arch sag angle for patients treated for flatfoot deformity correction. In patients treated for hallux valgus deformity, there was a reduction in the intermetatarsal angle from 15.4 to 6.8 degrees. The overall nonunion rate was 6.45% in all patients. The rate of nonunion was higher at the NC joint compared to the TMT joint and with compression claw plates. One symptomatic nonunion required revision surgery (1.7%). There were no nonunions when excluding neuroarthropathy patients and smokers. The odds ratio (OR) for nonunion in patients with neuroarthropathy was 6.05 ( P < .05), and in active smokers the OR was 2.33 ( P < .05). Conclusion: Plates placed on the plantar bone surface for midfoot arthrodesis achieved and maintained deformity correction with rare instances of symptomatic hardware for a variety of orthopedic conditions. An overall clinical and radiographic union rate of 94% was achieved. The radiographic union rate improved to 100% when excluding both neuroarthropathy patients and smokers. The incidence of nonunion was higher in smokers, neuroarthropathy patients, naviculocuneiform joint fusions, use of compression claw plates, and when attempting to fuse multiple joints. Incisional healing complications were rarely seen other than in active smokers. Level of Evidence: Level IV, case series.

Download Full-text