Evaluation of a Weightbearing CT Artificial Intelligence-Based Automatic Measurement for the M1-M2 Intermetatarsal Angle in Hallux Valgus

2021 ◽  
pp. 107110072110151
Author(s):  
Jonathan Day ◽  
Cesar de Cesar Netto ◽  
Martinus Richter ◽  
Nacime Salomao Mansur ◽  
Celine Fernando ◽  
...  
Keyword(s):  
Artificial Intelligence ◽  
Hallux Valgus ◽  
Imaging Modality ◽  
Automatic Measurement ◽  
Daily Practice ◽  
Level Of Evidence ◽  
Intermetatarsal Angle ◽  
Retrospective Comparative Study ◽  
3D Scans

Background: Weightbearing cone beam computed tomography (WBCT) has been gaining traction as a useful imaging modality in the diagnosis and follow-up of foot and ankle musculoskeletal pathologies due to the ability to perform quick, low-dose, 3-dimensional (3D) scans. However, the resulting wealth of 3D data renders daily clinical use time-consuming. The aim of this study was to evaluate a new artificial intelligence (AI)–based automatic measurement for the M1-M2 intermetatarsal angle (IMA) in hallux valgus (HV). We hypothesized that automatic and manual measurements would have a strong correlation, and that the AI software would yield better reproducibility and would be faster compared with manual measurements. Methods: This was a multicenter retrospective comparative case-control study in which a total of 128 feet were included from 93 patients who underwent WBCT scans as part of their routine follow-up: 59 feet with symptomatic HV and 69 controls. The IMA was measured automatically using the AI software and manually on digitally reconstructed radiographs (DRRs). The AI software produced both an automatic 2D (auto 2D) and 3D (auto 3D) measurement. Results: There were strong intermethod correlations between the DRR IMA and the auto 2D (HV, r = 0.61; control, r = 0.60; all P < .0001) and auto 3D (HV, r = 0.63; control, r = 0.52; all P < .0001) measurements, respectively. The intrasoftware reproducibility was very close to 100%. Measurements took 23.6 ± 2.31 seconds and 14.5 ± 1.18 seconds, respectively, when taken manually on DRRs and automatically. Controls demonstrated a mean DRR IMA of 8.6 (95% CI, 8.1-9.1), mean auto 2D of 11.2 (95% CI, 10.7-11.7), and mean auto 3D IMA of 11.0 (95% CI, 10.5-11.5). The HV group demonstrated significantly increased IMA compared with controls ( P < .0001), with a mean DRR IMA of 15.4 (95% CI, 14.8-16.1), mean auto 2D of 17.8 (95% CI, 17.2-18.4), and mean auto 3D IMA of 16.8 (95% CI, 16.8-17.4). Conclusion: Measurements generated by the WBCT AI-based automatic measurement system for IMA demonstrated strong correlations with manual measurements, with near-perfect reproducibility. Further developments are warranted in order to make this tool more usable in daily practice, particularly with respect to its use in the presence of hardware in the foot. Level of Evidence: Level III, retrospective comparative study.

Effect of Bipartite Hallucal Sesamoid on Hallux Valgus Surgery

2017 ◽  
Vol 38 (6) ◽  
pp. 634-640 ◽  
Author(s):  
Young Hwan Park ◽  
Chan Dong Jeong ◽  
Gi Won Choi ◽  
Hak Jun Kim
Keyword(s):  
Hallux Valgus ◽  
Study Cohort ◽  
Aofas Score ◽  
Level Of Evidence ◽  
Radiographic Outcomes ◽  
Chevron Osteotomy ◽  
Radiographic Measurements ◽  
Valgus Angle ◽  
Retrospective Comparative Study

Background: Bipartite hallucal sesamoids are often found in patients with hallux valgus. However, it is unknown whether bipartite hallucal sesamoids affect the results of hallux valgus surgery or not. The purpose of the present study was to evaluate the outcomes of chevron osteotomy for hallux valgus with and without bipartite hallucal sesamoid. Methods: A total of 152 patients (168 feet) treated with distal or proximal chevron osteotomy for hallux valgus constituted the study cohort. The 168 feet were divided into 2 groups: bipartite hallucal sesamoid (31 feet) and without bipartite hallucal sesamoid (137 feet). Hallux valgus angle (HVA), intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA), tibial sesamoid position, and first metatarsal length were measured for radiographic outcomes and the American Orthopaedic Foot & Ankle Society (AOFAS) hallux metatarsophalangeal-interphalangeal (MTP-IP) score was measured for clinical outcomes. Results: All radiographic measurements and the AOFAS score showed significant ( P < .05) improvement at the time of final follow-up compared with preoperative measurements in both groups. No significant differences ( P > .05) were found between the 2 groups in terms of HVA, IMA, DMAA, tibial sesamoid position, metatarsal shortening, and AOFAS score on final follow-up. Conclusions: This study suggests that bipartite hallucal sesamoids do not affect the results of hallux valgus surgery. Level of Evidence: Level III, retrospective comparative study.

scholarly journals Minimally invasive Chevron-Akin osteotomy

2020 ◽  
Vol 14 (3) ◽  
pp. 264-268
Author(s):  
Gustavo Nunes ◽  
João Magalhães ◽  
Tiago Baumfeld ◽  
Roberto Pinto
Keyword(s):  
Minimally Invasive ◽  
Hallux Valgus ◽  
Case Series ◽  
Preoperative Assessment ◽  
Foot And Ankle ◽  
Level Of Evidence ◽  
Intermetatarsal Angle ◽  
Akin Osteotomy ◽  
Severe Hallux Valgus

Objective: To present the clinical and radiographic results of surgical treatment of patients with moderate to severe hallux valgus (HV) by minimally invasive Chevron - Akin osteotomy (MICA). Methods: The case series comprises 25 patients (30 feet) with diagnoses of moderate to severe HV treated surgically with the MICA technique. All patients answered the American Orthopedic Foot and Ankle Score (AOFAS) and rated pain on visual analogue scale (VAS) at preoperative assessment and at the last follow-up consultation. Radiological assessment included measurement of the valgus angles of the hallux (HVA) and the 1st and 2nd ray intermetatarsal angle (IMA). Complications and satisfaction ratings were also documented. Results: Mean follow-up was 14.6 months. Mean AOFAS increased from 42.8 to 90 and VAS reduced from 8.6 to 1.7. Mean HVA reduced from 31.7o to 8.4o and IMA from 14o to 5o. All these improvements were statistically significant (p<0.001). The most common complication observed was discomfort caused by hardware, affecting five feet (16.6%). Two patients (6.6%) had transitory neurapraxia and one patient (3.3%) developed reflex sympathetic dystrophy. There were no cases of infection, relapse, pseudarthrosis, or malunion of osteotomies. Subjective satisfaction ratings classified 93.3% of results as good or excellent. Conclusion: Minimally invasive Chevron-Akin osteotomy is a safe and reproducible technique that achieves good clinical and radiographic results for treatment of moderate to severe hallux valgus. Level of Evidence IV; Therapeutic Studies; Case Series.

Results of Scarf Osteotomy Without Implant Fixation in the Treatment of Hallux Valgus

2018 ◽  
Vol 39 (11) ◽  
pp. 1320-1327 ◽  
Author(s):  
Henryk Liszka ◽  
Artur Gądek
Keyword(s):  
Hallux Valgus ◽  
Cost Effective ◽  
Implant Fixation ◽  
Level Of Evidence ◽  
Scarf Osteotomy ◽  
Valgus Angle ◽  
Duration Of Surgery ◽  
American Orthopaedic ◽  
Retrospective Comparative Study

Background: The main goal of the study was to evaluate the costs, clinical and radiologic results, and complications of hallux valgus surgery using scarf osteotomy, depending on the type of fixation (with or without screws). Methods: We evaluated 169 patients who underwent scarf osteotomy between January 2013 and August 2016. The patients were separated into 3 groups depending on the type of stabilization: A, 2 screws (50 patients); B, modified with 1 screw (55 patients); C, modified without implant (64 patients). We assessed duration of surgery, additional procedures, pre- and postoperative hallux valgus angle (HVA) and intermetatarsal angle (IMA) on anteroposterior and lateral foot weightbearing radiographs, the American Orthopaedic Foot & Ankle Society (AOFAS) hallux-metatarsophalangeal-interphalangeal scale for the clinical assessment preoperatively and at the 12-month follow-up. We recorded all the complications and compared the costs between the groups. Results: Both the average HVA (A: from 33.7 to 12.6 degrees, B: 35.0 to 13.2 degrees, C: 34.7 to 12.4 degrees) and IMA (A: from 14.9 to 7.5 degrees, B: 15.2 to 6.9 degrees, C: 15.5 to 7.8 degrees) decreased in all groups without significant intergroup differences. The average AOFAS score improved in all the groups (A: from 40 to 88 points, B: 38 to 89 points, C: 42 to 91 points). A similar complication rate was observed (A: 9%, B: 10%, C: 11%). In group C, we noted a shorter time of surgery, and the procedure was the most cost-effective. Conclusion: Scarf osteotomy without implant stabilization was faster and cost-effective and gave comparable results. It was technically demanding and required patient compliance. Level of Evidence: Level III, retrospective comparative study.

Foot Width Changes Following Hallux Valgus Surgery

2018 ◽  
Vol 39 (11) ◽  
pp. 1272-1277 ◽  
Author(s):  
Shay A. Tenenbaum ◽  
Amir Herman ◽  
Nathan Bruck ◽  
Jason T. Bariteau ◽  
Ran Thein ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Hallux Valgus ◽  
Angular Deformity ◽  
Level Of Evidence ◽  
Intermetatarsal Angle ◽  
Bone Width ◽  
Valgus Angle ◽  
Radiographic Data

Background: Hallux valgus (HV) adversely affects quality of life. Patients frequently express concerns regarding postoperative foot appearance, foot width and footwear anticipations. However, only scarce data are available regarding postoperative foot width. Materials and Methods: Seventy-one cases with moderate to severe HV treated with scarf osteotomy were included. The average age was 55.7 years (range, 20-76), with average follow-up of 20.7 months (range, 6-96). Patients’ medical records were reviewed for demographic, operative, and radiographic data. Foot width was assessed radiographically by measuring both bone (distance between the first and fifth metatarsal heads) and soft tissue width (maximal distance of the soft tissue outline). Results: Preoperative HV deformity (mean hallux valgus angle [HVA] 35.8 degrees, intermetatarsal angle [IMA] 14.1 degrees, and distal metatarsal articular angle [DMAA] 15.2 degrees) was successfully corrected (postoperative mean HVA 13.7 degrees, IMA 6.9 degrees, and DMAA 7.7 degrees). Overall bony foot width was reduced by 5% and soft tissue foot width by 2%. Further analysis showed that 13 feet (18.3%) had increased (>5%) bone width, 26 feet (36.6%) with no change (±5%), and 32 feet (45.1%) for which the width decreased (>5%) postoperatively. Angular deformity (HVA, IMA, and DMAA) showed low correlation with postsurgery foot width. Conclusion: HV surgery effect on foot width was very limited, overall reducing foot width by 2%. Furthermore, in only about half of the patients, the postoperative foot width decreased, regardless of angular deformity magnitude. Patients with the widest feet had a decrease in foot width following surgery, whereas patients with the narrowest feet had an increase in foot width. Level of Evidence: Level III, comparative series.

Modified Austin Procedure for Correction of Hallux Valgus

1997 ◽  
Vol 18 (3) ◽  
pp. 119-127 ◽  
Author(s):  
Hans-Jörg Trnka ◽  
Alexander Zembsch ◽  
Hermann Wiesauer ◽  
Marc Hungerford ◽  
Martin Salzer ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Hallux Valgus ◽  
Metatarsophalangeal Joint ◽  
Metatarsal Head ◽  
Hallux Valgus Angle ◽  
First Metatarsophalangeal Joint ◽  
Intermetatarsal Angle ◽  
Soft Tissue Procedure ◽  
Valgus Angle

The Austin osteotomy is a widely accepted method for correction of mild and moderate hallux valgus. In view of publications by Kitaoka et al. in 1991 and by Mann and colleagues, a more radical lateral soft tissue procedure was added to the originally described procedure. From September 1992 to January 1994, 85 patients underwent an Austin osteotomy combined with a lateral soft tissue procedure to correct their hallux valgus deformities. Seventy-nine patients (94 feet) were available for follow-up. The average patient age at the time of the operation was 47.1 years, and the average follow-up was 16.2 months. The average preoperative intermetatarsal angle was 13.9°, and the average hallux valgus angle was 29.7°. After surgery, the feet were corrected to an average intermetatarsal angle of 5.8° and an average hallux valgus angle of 11.9°. Sesamoid position was corrected from 2.1 before surgery to 0.5 after surgery. The results were also graded according to the Hallux Metatarsophalangeal Interphalangeal Score, and the functional and cosmetic outcomes were graded by the patient. Dissection of the plantar transverse ligament and release of the lateral capsule repositioned the tibial sesamoid and restored the biomechanics around the first metatarsophalangeal joint. There was no increased incidence of avascular necrosis of the first metatarsal head compared with the original technique.

Loss of Correction After Chevron Osteotomy for Hallux Valgus as a Function of Preoperative Deformity

2018 ◽  
Vol 40 (3) ◽  
pp. 287-296 ◽  
Author(s):  
Gerhard Kaufmann ◽  
Stefanie Sinz ◽  
Johannes M. Giesinger ◽  
Matthias Braito ◽  
Rainer Biedermann ◽  
...  
Keyword(s):  
Hallux Valgus ◽  
Case Series ◽  
X Rays ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Loss Of Correction ◽  
Chevron Osteotomy ◽  
Significant Correction ◽  
Preoperative Deformity

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.

scholarly journals Radiographic Recurrence of Hallux Valgus Based on Osteotomy Location

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0021
Author(s):  
Andrew Federer ◽  
Travis Dekker ◽  
David Tainter ◽  
Jordan Liles ◽  
Mark Easley ◽  
...  
Keyword(s):  
Hallux Valgus ◽  
Weight Bearing ◽  
Surgical Correction ◽  
P Value ◽  
Single Individual ◽  
Hallux Valgus Angle ◽  
Intermetatarsal Angle ◽  
Valgus Angle ◽  
Significant Difference

Category: Bunion Introduction/Purpose: Hallux valgus (HV) is one of the most common deformities of the foot resulting in pain and lifestyle modification of the patient. Recurrence rates of 10-47% have been documented in single individual osteotomy series. Unfortunately, surgical correction and recurrence are often defined as changes related to normal radiographs and not actually as the magnitude of correction lost with follow-up. Currently there have not been studies evaluating the percentage of recurrence of intermetatarsal angle (IMA) and hallux valgus angle (HVA). As there is substantial difference in starting IMA and HVA, as well as amount of surgical correction, our goal was to evaluate the percentage loss of correction over time comparing preoperative, initial postoperative and minimum of 2-year follow up radiographs among three different surgical correction techniques. Methods: This is a retrospective chart review study that examines the weight-bearing radiographic measurements of patients undergoing hallux valgus corrective surgery at a single institution over 5 years. Fifty-three patients were divided into first tarsometatarsal arthrodesis (i.e. Lapidus), mid-diaphyseal osteotomies (i.e. scarf), and distal metatarsal osteotomies (i.e. chevron). The preoperative, initial postoperative, and final follow up weight-bearing radiographs were measured for intermetatarsal angle (IMA) and hallux valgus angle (HVA). Primary outcome was percentage of recurrence of IMA and HVA, with the difference in angles between preoperative and initial postoperative weight-bearing films being considered 100% correction. The percentage of recurrence between initial postoperative and most recent follow up was then calculated (Figure 1A). A one-way analysis of variance (ANOVA) test and post-hoc Tukey-Kramer tests were used to compare preoperative IMA and HVA and percentage recurrence of IMA and HVA at most recent follow up. Results: There was no significant difference between Lapidus (14.3deg) and mid-diaphyseal osteotomies (12.7deg) in preoperative IMA (p-value=0.26). There was a significant difference between Lapidus (-0.3deg) and mid-diaphyseal (2.8deg) osteotomies for degree of hallux valgus recurrence as measured by IMA between initial postoperative films and final 2-year follow up (p-value=0.009). Lapidus procedure showed a greater magnitude decrease in IMA degrees from preoperation to final follow up compared to distal osteotomy (p-value=0.037) and trended toward significance compared to mid-diaphyseal (p-value=0.056). Mid-diaphyseal osteotomies (30%) showed a statistically significant higher percentage of IMA recurrence compared to Lapidus (-11%) (p-value=0.0014) (Figure 1B). When comparing percentage recurrence of HVA, distal osteotomies had a significantly smaller rate of recurrence when compared to the diaphyseal osteotomies (p-value=0.030). Conclusion: Though Lapidus and mid-diaphyseal osteotomies were performed for patients with a similar preoperative IMA, mid-diaphyseal osteotomies had a significantly higher percentage of recurrence at 2-year follow up compared to Lapidus procedures. Moreover, Lapidus procedures trended toward greater overall of IMA correction compared to mid-diaphyseal osteotomies. When either a Lapidus or mid-diaphyseal osteotomy is indicated, a Lapidus procedure may result in decreased rate of radiographic recurrence of hallux valgus at 2 years.

scholarly journals Hallux Valgus Recurrence After Simple Bunionectomy: Algorithm Treatment

2022 ◽  
Author(s):  
Josep Torrent ◽  
Raúl Figa ◽  
Iban Clares ◽  
Eduard Rabat
Keyword(s):  
Comparative Study ◽  
Hallux Valgus ◽  
Treatment Algorithm ◽  
Metatarsophalangeal Joint ◽  
Salvage Procedure ◽  
Bone Stock ◽  
Level Of Evidence ◽  
First Metatarsophalangeal Joint ◽  
Retrospective Comparative Study ◽  
End Stage

Abstract Background: Recurrences of hallux valgus can be difficult to manage, especially after a prior simple bunionectomy. This study aimed to present a treatment algorithm for the correction of recurrences after a simple bunionectomy.Methods: This was a single-center, descriptive, and retrospective comparative study. Thirty-four consecutive patients were classified according to the bone stock and the presence or absence of end-stage arthritis of the first metatarsophalangeal joint (MTPJ). According to our algorithm, we only performed an osteotomy as the salvage procedure in cases with sufficient bone stock and absence of or mild arthritis. In the other cases, we performed an MTPJ fusion. Exceptionally, we chose a Keller-Brandes arthroplasty for patients with advanced age and comorbidities. Results: We performed 17 scarf osteotomies (50%), 15 MTPJ arthrodeses (44.1%), and 2 Keller-Brandes arthroplasties (5.9%). Following the algorithm, we achieved an improvement of the AOFAS score of >30 points without severe complications in all groups.Conclusions: The proposed operative algorithm successfully addresses the recurrences considering the lack of bone stock and the presence of MTPJ arthritis.Level of EvidenceLevel 3: retrospective comparative study

Clinical and Radiological Outcomes Comparing Percutaneous Chevron-Akin Osteotomies vs Open Scarf-Akin Osteotomies for Hallux Valgus

2017 ◽  
Vol 39 (3) ◽  
pp. 311-317 ◽  
Author(s):  
Mun Chun Lai ◽  
Inderjeet Singh Rikhraj ◽  
Yew Lok Woo ◽  
William Yeo ◽  
Yung Chuan Sean Ng ◽  
...  
Keyword(s):  
Hallux Valgus ◽  
Short Form ◽  
Perioperative Period ◽  
Tertiary Hospital ◽  
Wound Complications ◽  
Percutaneous Technique ◽  
Level Of Evidence ◽  
Valgus Angle ◽  
American Orthopaedic

Background: Minimally invasive surgeries have gained popularity due to less soft tissue trauma and better wound healing. To date, limited studies have compared the outcomes of percutaneous and open osteotomies. This study aims to investigate the clinical and radiological outcomes of percutaneous chevron-Akin osteotomies vs open scarf–Akin osteotomies at 24-month follow-up. Method: We reviewed a prospectively collected database in a tertiary hospital hallux valgus registry. Twenty-nine feet that underwent a percutaneous technique were matched to 58 feet that underwent open scarf and Akin osteotomies. Clinical outcome measures assessed included visual analog scale (VAS) scores, American Orthopaedic Foot & Ankle Society Hallux Metatarsophalangeal-Interphalangeal score (AOFAS Hallux MTP-IP), and Short Form 36 (SF-36) Health Survey. Radiological outcomes included hallux valgus angle (HVA) and intermetatarsal angle (IMA). All patients were prospectively followed up at 6 and 24 months. Results: Both groups showed comparable clinical and radiological outcomes at the 24-month follow-up. However, the percutaneous group demonstrated less pain in the perioperative period ( P < .001). There were significant differences in the change in HVA between the groups but comparable radiological outcomes in IMA at the 24-month follow-up. The percutaneous group demonstrated shorter length of operation ( P < .001). There were no complications in the percutaneous group but 3 wound complications in the open group. Conclusions: We conclude that clinical and radiological outcomes of third-generation percutaneous chevron-Akin osteotomies were comparable with open scarf and Akin osteotomies at 24 months but with significantly less perioperative pain, shorter length of operation, and less risk of wound complications. Level of Evidence: Level III, retrospective comparative series.

scholarly journals Proximal Rotational Metatarsal Osteotomy for Hallux Valgus (PROMO)

2018 ◽  
Vol 3 (3) ◽  
pp. 247301141879007 ◽  
Author(s):  
Pablo Wagner ◽  
Emilio Wagner
Keyword(s):  
Hallux Valgus ◽  
Case Series ◽  
Valgus Deformity ◽  
Metatarsal Osteotomy ◽  
Level Of Evidence ◽  
Reliable Technique ◽  
Intermetatarsal Angle ◽  
Hallux Valgus Deformity ◽  
The Mean ◽  
Prospective Case Series

Background: Hallux valgus deformity consists of a lateral deviation of the great toe, metatarsus varus, and pronation of the first metatarsal. Most osteotomies only correct varus, but not the pronation of the metatarsal. Persistent postoperative pronation has been shown to increase deformity recurrence and have worse functional outcomes. The proximal rotational metatarsal osteotomy (PROMO) technique reliably corrects pronation and varus through a stable osteotomy, avoiding fusing any healthy joints. The objective of this research is to show a prospective series of the PROMO technique. Methods: Twenty-five patients (30 feet) were operated with the PROMO technique. The sample included 22 women and 3 men, average age 46 years (range 22-59), for a mean prospective follow-up of 1 year (range 9-14 months). Inclusion criteria included symptomatic hallux valgus deformities, absence of severe joint arthritis, or inflammatory arthropathies, with a metatarsal malrotation of 10 degrees or more, with no tarsometatarsal subluxation or arthritis on the anteroposterior or lateral foot radiograph views. The mean preoperative and postoperative Lower Extremity Functional Scale (LEFS) score, metatarsophalangeal angle, intermetatarsal angle, metatarsal malrotation, complications, satisfaction, and recurrence were recorded. Results: The mean preoperative and postoperative LEFS scores were 56 and 73. The median pre-/postoperative metatarsophalangeal angle was 32.5/4 degrees and the intermetatarsal angle 15.5/5 degrees. The metatarsal rotation was satisfactorily corrected in 24 of 25 patients. An Akin osteotomy was needed in 27 of 30 feet. All patients were satisfied with the surgery, and no recurrence or complications were found. Conclusions: PROMO is a reliable technique, with good short-term results in terms of angular correction, satisfaction, and recurrence. Long-term studies are needed to determine if a lower hallux recurrence rate occurs with the correction of metatarsal rotation in comparison with conventional osteotomies. Level of evidence: IV, prospective case series.

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