scholarly journals Temporary screw epiphyseodesis of the first metatarsal for correction of juvenile hallux valgus

2018 ◽  
Vol 12 (4) ◽  
pp. 375-382 ◽  
Author(s):  
C. Schlickewei ◽  
K. Ridderbusch ◽  
S. Breyer ◽  
A. Spiro ◽  
R. Stücker ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Hallux Valgus ◽  
Treatment Option ◽  
Skeletal Maturity ◽  
Weight Bearing ◽  
Deformity Correction ◽  
Epiphyseal Plate ◽  
Hallux Valgus Deformity ◽  
First Ray

Purpose Juvenile hallux valgus deformity (JHVD) is rare but may be associated with symptoms or deformities that require surgical treatment. Literature recommends waiting to perform surgical treatment until maturity. However, if conservative treatment is not sufficient and the children’s psychological or physical suffering is particularly severe, earlier surgical treatment should be considered. The aim of this study was to evaluate the safety and efficiency of temporary screw epiphyseodesis of the lateral epiphyseal plate of the first ray metatarsal as a new treatment option for JHVD during growth age. Methods Between June 2011 and November 2017, 33 patients (24 girls, nine boys; 59 feet) with a JHVD were treated by temporary screw epiphyseodesis of the lateral epiphyseal plate of the first ray metatarsal. At the time of surgery mean age was 11.1 years SD 1.4 (8 to 15). Patients were followed clinically and with standing, weight-bearing radiographs of the feet in two planes. Results In all, 22 patients (39 feet) were included into this study. Mean follow-up was 27.8 months SD 9.9 (12 to 58). The hallux valgus angle changed from 26.5° SD 6.6° preoperatively to 20.2° SD 6.2° (p < 0.001) at time of follow-up. The intermetatarsal angle changed from 14.1° SD 5.4° to 10.5° SD 2.9° during this time (p < 0.01). In two patients (three feet) the screws were removed before the JHVD was fully corrected due to local tenderness over the screw head. In two patients screw migration away from the growth plate was observed, resulting in no further deformity correction in one patient and increasing deformity in the other patient. No other complications were seen. Conclusion Temporary screw epiphyseodesis of the lateral epiphyseal plate of the first ray metatarsal seems to be an effective, safe, technically easy and minimally invasive early treatment option to correct JHVD in children with particularly severe suffering. Due to the individual correction rate, frequent follow-up visits are recommended until skeletal maturity. Level of Evidence IV

scholarly journals Does the Presence of Pes Planus Deformity Increase Recurrence of Hallux Valgus Deformity Following Surgery?

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0021
Author(s):  
Gavin Heyes ◽  
Eric Swanton ◽  
Lyndon Mason ◽  
Andrew P. Molloy
Keyword(s):  
Hallux Valgus ◽  
Weight Bearing ◽  
Valgus Deformity ◽  
P Value ◽  
X Rays ◽  
Recurrence Rates ◽  
Pes Planus ◽  
Hallux Valgus Deformity ◽  
Increased Risk

Category: Bunion Introduction/Purpose: Factors linked with increased risk of developing Hallux Valgus include; shod footwear, genetic factors, metatarsal morphology, ligamentous laxity and Pes Planus. With regards to Pes planus, it has been suggested that the loss of the medial longitudinal arch in Pes Planus increases Hallux plantar medial pressures and drives deformity during heel rise. There is little in the literature regarding whether Pes Planus is associated with increased recurrence rates. Given this is a potentially modifiable risk factor we believe the risk of recurrence should be studied. This paper reports the results of a retrospective study following up 183 consecutive Hallux valgus cases. The primary objective is to evaluate whether pes planus is associated with increased recurrence following treatment. Methods: Retrospective review of consecutively treated patients from 07/03/2008 to 05/12/2017. Patients were typically followed up for six to twelve months depending on any additional factors that require follow up. X-rays were performed routinely at six weeks, three months and many had x-rays at six and/or 12 months for additional pathology. We examined radiological markers including Sesamoid location (using the Hardy and Clapham Classification), Hallux Valgus Angle (HVA), Intermetatarsal Angle, Meary’s angle and Talonavicular uncovering. 183 cases were reviewed, 12 were excluded due to previously amputated second toes, Hallux Varus, revision surgery and only 6 weeks follow up. This left 171 cases of which 75 had Pes Planus (Meary’s angle < -4°). Results: Table 1 describes the preoperative HVAs we encountered and the correction achieved along with frequencies. Postoperative measurements were taken off weight bearing x-rays. The incidence of recurrent HVA > 15° was significantly higher in those with Meary’s angle < - 4° (Chi-Sq 22.6 P-value 0.000002). Those with a Meary’s angle -20° to -10° had a significantly higher rate of recurrence than ones measuring -10° to -4° (Chi-Sq 9.7 P-value 0.0018 There was no difference in progression of recurrent deformity between those initially corrected to HVA < 15° (Chi-Sq 0.26 P- value 0.61) and those not. Multiple regression analysis revealed there was no meaningful association with sesamoid location or pes planus with recurrence of Hallux Valgus deformity. Conclusion: Our results demonstrate a link between Preoperative Pes Planus deformity and increased recurrence rates of Hallux Valgus deformity following surgery. Consideration of correction of pes planus and appropriate consent of recurrence rates should therefore be undertaken in treatment of hallux valgus in the presence of pes planus

scholarly journals Percutaneous Chevron Akin (Peca) Osteotomy for Treatment of Hallux Valgus Deformity: The Long- Term Results

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0007
Author(s):  
Peter W. Robinson ◽  
Robbie Ray ◽  
Thomas A. Goff ◽  
Paul M. Dearden ◽  
Clare Watt ◽  
...  
Keyword(s):  
Hallux Valgus ◽  
Weight Bearing ◽  
Patient Reported Outcome Measures ◽  
Long Term Results ◽  
Consecutive Series ◽  
Satisfaction Scale ◽  
Hallux Valgus Deformity ◽  
Patient Reported

Category: Bunion Introduction/Purpose: Little is known about the long-term results of percutaneous hallux valgus correction, particularly the recurrence rate and factors leading to recurrence. Methods: We retrospectively reviewed a single surgeon consecutive series of percutaneous chevron and akin osteotomies (PECA) performed between 2012-14 on 127 feet in 86 patients. Mean age was 52+-13 years at surgery and mean follow up (FU) was 69+-7 months. Patient reported outcome measures (PROMs) were completed by 65 patients (MOXFQ, VAS pain (0-100)) and Likert satisfaction scale by 86 patients. Pre-operative, 6 month and final follow up weight bearing radiographs were available for 68 feet. Radiological parameters measured were the hallux valgus angle (HVA) and 1-2 intermetatarsal angle (IMA). The data was normally distributed and presented as mean+-SD. Paired t-test was used to compare pre- and post-operative angles. Ordinal logistic regression was used to test for significant dependent variables on PROMs. Results: Mean MOXFQ was 10+-16 and mean VAS pain was 6+-13 out of 100 at a mean FU of 69+-7 months. 99% (85/86) patients were highly satisfied or satisfied. Mean HVA improved from 28.3+-8.1º to 8.4+-5.6º at final FU (p<0.001). No clinically relevant difference in HVA was seen between 6 months and final FU. Mean IMA improved from 12.7+-2.9º to 6.2+-2.7º at final FU (p<0.001). 2.9% (2/68) had an HVA >20º at final FU, these both started with a pre-operative HVA >40°. Pre-operative HVA >40º was significantly more likely to have an HVA >20º at final FU than those with pre-operative HVA <40º (22% vs 0%, p<0.001). There were 5 re-operations for removal of screws. 1 foot had hallux varus, but was still satisfied. Conclusion: The 5 year results for PECA hallux valgus correction show high levels of patient satisfaction, function and pain relief, with low complication and re-operation rates. Radiological correction is maintained at long term FU.

scholarly journals Management of Juvenile Hallux Valgus Deformity: the role of combined Hemiepiphysiodesis

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Ming-Hung Chiang ◽  
Ting-Ming Wang ◽  
Ken N. Kuo ◽  
Shier-Chieg Huang ◽  
Kuan-Wen Wu
Keyword(s):  
Hallux Valgus ◽  
Skeletal Maturity ◽  
Proximal Phalanx ◽  
Case Series ◽  
Large Degree ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Hallux Valgus Deformity ◽  
The Mean

Abstract Background This study aimed to investigate the efficacy of percutaneous hemiepiphysiodesis for gradual correction of symptomatic juvenile hallux valgus (HV) deformity. Methods Between 2012 to 2014, 24 patients with symptomatic juvenile HV were treated by combined percutaneous medial drilling hemiepiphysiodesis of the first proximal phalanx and lateral transphyseal screw hemiepiphysiodesis of the first metatarsal at our institution. Twenty-one of 24 patients fulfilled inclusion criteria had a complete radiological and clinical follow-up of at least 2 years. Preoperative and postoperative radiographs of the feet were reviewed for measurements of hallux valgus angle (HVA), intermetatarsal angle (IMA), proximal metatarsal articular angle (PMAA), proximal phalangeal articular angle (PPAA), and metatarsal length ratio (MTLR). Clinical outcomes were assessed using the AOFAS hallux metatarsophalangeal-interphalangeal score. Results The study included 21 consecutive patients (37 ft) for analysis. The mean age at surgery was 12.0 years (SD = 1.3) and mean follow-up after surgery was 35.1 months (SD = 6.0). With the data available, the HV deformity improved in terms of the reduction of HVA by a mean of 4.7 degrees (P < .001) and the reduction of IMA by 2.2 degrees (P < .001). The PMAA and PPAA also improved significantly in the anteroposterior plane; however, the PMAA difference was insignificant in lateral plane as expected. The mean difference in the MTLR was 0.00 (P = .216) which was indicative of no length discrepancy between first and second metatarsals. The AOFAS score increased from 68.7 to 85.2 (P < .001). In correlation analysis, time to physeal closure was significantly correlated with the final HVA change (r = −.611, P = .003). Conclusion Although combined hemiepiphysiodesis does not create a large degree of correction as osteotomy, yet it did improve HV deformity with adequate growth remaining in our series. It is a procedure that can be of benefit to patients with symptomatic juvenile HV from this minimal operative approach before skeletal maturity. Level of evidence Level IV, retrospective case series.

scholarly journals Os Intermetatarseum May not Interfere with Metatarsus Primus Varus Deformity Correction: A Case Report

2018 ◽  
Vol 25 (1) ◽  
pp. 24-28
Author(s):  
Daniel Y. Wu
Keyword(s):  
Case Report ◽  
Soft Tissue ◽  
Hallux Valgus ◽  
Deformity Correction ◽  
Varus Deformity ◽  
Valgus Deformity ◽  
Hallux Valgus Deformity ◽  
Os Intermetatarseum ◽  
First Time

It has been believed that the correction of metatarsus primus varus (MPV) deformity of hallux valgus foot using nonosteotomy procedures would be compromised by the presence of os intermetatarseum (OI). Therefore, no soft tissue procedure has ever been reported for the correction of MPV deformity of hallux valgus foot. This is a case report of a female patient with bilateral hallux valgus deformity and also a large OI of her left foot that was corrected, satisfactorily and simultaneously, with a soft tissue technique called syndesmosis procedure, without osteotomy or OI resection. Excellent feet function was observed for 2 years until her last follow-up examination without any symptoms or signs of problems relating to the OI in her left foot. This case report demonstrated for the first time that OI may not interfere with proper MPV deformity correction because it can be preexisting and X-ray can be misleading.

Percutaneous Chevron and Akin (PECA) Osteotomies for Severe Hallux Valgus Deformity With Mean 3-Year Follow-up

2021 ◽  
pp. 107110072110084
Author(s):  
Thomas L. Lewis ◽  
Robbie Ray ◽  
Peter Robinson ◽  
Paul M. C. Dearden ◽  
Thomas J. Goff ◽  
...  
Keyword(s):  
Hallux Valgus ◽  
Deformity Correction ◽  
Valgus Deformity ◽  
Percutaneous Surgery ◽  
Residual Deformity ◽  
Hallux Valgus Deformity ◽  
Patient Reported ◽  
The Mean ◽  
Severe Hallux Valgus

Background: Patients with severe hallux valgus deformity present technical and operative challenges with high rates of recurrence and residual deformity. The clinical and radiologic outcomes of percutaneous surgery for severe hallux valgus are not known. Methods: A retrospective review of consecutive patients with a hallux valgus angle (HVA) >40 degrees or intermetatarsal angle (IMA) >20 degrees who underwent third-generation percutaneous chevron and Akin osteotomy (PECA) for hallux valgus deformity correction. Results: Between December 2012 and August 2019, 59 feet in 50 patients underwent PECA. Preoperative and follow-up radiographic data were available for 53 feet (89.8%). Postoperative clinical patient-reported outcome measures and satisfaction results were available for 51 feet (86.4%). The mean clinical and radiographic follow-up was 3.1 years and the mean postoperative Manchester-Oxford Foot Questionnaire Index score was 15.1. There was a statistically significant improvement ( P < .001) in both IMA and HVA following surgery (IMA 17.5-5.1 degrees; HVA 44.1-11.5 degrees). All patients reported they were satisfied with their outcome, with 76.8% reporting they were highly satisfied. The hallux valgus recurrence rate was 7.5%. Conclusion: Percutaneous surgery for severe hallux valgus deformity can achieve a large deformity correction, patient satisfaction, and quality of life, with reasonable rates of residual deformity and low rates of recurrence. Level of Evidence: IV

scholarly journals Radiographic Measurements Associated with the Natural Progression of the Hallux Valgus Deformity during at Least Two Years of Follow-up

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0002 ◽  
Author(s):  
Kyoung Min Lee ◽  
Seung Yeol Lee ◽  
Sonya Ahmed ◽  
Byung Chae Cho ◽  
Moon Seok Park ◽  
...  
Keyword(s):  
Hallux Valgus ◽  
Weight Bearing ◽  
Binary Logistic Regression ◽  
Valgus Deformity ◽  
Binary Logistic Regression Analysis ◽  
First Metatarsal ◽  
Hallux Valgus Deformity ◽  
Metatarsal Angle ◽  
Radiographic Measurements

Category: Bunion Introduction/Purpose: There have been few longitudinal studies regarding hallux valgus deformity. This retrospective study aimed to investigate the radiographic measurements associated with the progression of hallux valgus deformity during at least two years of follow-up. Methods: Seventy adult patients (mean age, 58.0 years; standard deviation [SD], 12.3 years; 13 males and 57 females) with hallux valgus who were followed-up for at least two years and underwent weight-bearing foot radiography were included. Radiographic measurements included the hallux valgus angle (HVA), hallux interphalangeal angle, intermetatarsal angle (IMA), metatarsus adductus angle, distal metatarsal articular angle (DMAA), tibial sesamoid position, anteroposterior (AP) talo-first metatarsal angle, and lateral talo-first metatarsal angle. Progression of hallux valgus deformity was defined as an increase of 5 degrees or more in the HVA during follow-up. Patients were divided into progressive and non-progressive groups. Binary logistic regression analysis was performed to identify factors that significantly affect the progression of hallux valgus deformity. The correlation between change in HVA and changes in other radiographic indices during follow-up was analyzed. Results: Eighteen out of 70 patients showed progression of 5 degrees or more in the HVA during the mean follow-up of 47.0 months (SD, 19.8 months). The DMAA (p=0.027) and AP talo-first metatarsal angle (p=0.034) at initial presentation were found to be significant factors affecting the progression of hallux valgus deformity. Change in the HVA during follow-up was significantly correlated with changes in the IMA (r=0.423; p=0.001) and DMAA (r=0.541; p<0.001). Conclusion: Special attention needs to be given to patients with pes planovalgus and increased DMAA during follow-up. Change in HVA was significantly correlated with changes in IMA and DMAA. Therefore, progression of hallux valgus deformity is considered to be closely related to the progressive instability of the first tarsometatarsal joint.

scholarly journals Early Clinical Outcomes of Triplanar Modified Lapidus Arthrodesis with Immediate Weight Bearing

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0039
Author(s):  
Justin Ray ◽  
Jennifer Koay ◽  
Robert Santrock
Keyword(s):  
Clinical Outcomes ◽  
Hallux Valgus ◽  
Weight Bearing ◽  
Valgus Deformity ◽  
Recurrence Rates ◽  
Full Activity ◽  
Radiographic Outcomes ◽  
Hallux Valgus Deformity ◽  
Athletic Shoes

Category: Bunion Introduction/Purpose: There are numerous corrective procedures for hallux valgus deformity. The majority of procedures prioritize correction in the transverse plane based on anteroposterior (AP) radiographs. Long-term results demonstrate high recurrence rates ranging from 8-78% with various metatarsal osteotomy techniques. Recent evidence suggests that hallux valgus is a multi-planar deformity with significant contributions from the sagittal and frontal planes. Correction of hallux valgus at the first tarsometatarsal joint (modified Lapidus) offers a powerful method to restore anatomic alignment in all three planes and correct hallux valgus at the apex of the deformity. The purpose of this study is to investigate early clinical and radiographic outcomes and complications of triplanar tarsometatarsal (TMT) arthrodesis with immediate weight-bearing. Methods: After receiving IRB approval, charts and radiographs were retrospectively reviewed for 37 patients (30 female, age 54.8 years) undergoing triplanar tarsometatarsal (TMT) arthrodesis for hallux valgus deformity correction at our institution between June 2016 and June 2017. All patients were allowed immediate weight-bearing as tolerated in a boot walker. Radiographic imaging at 4 months and 12 months was compared to pre-operative imaging. Clinical outcomes were evaluated using the American Academy of Orthopaedic Surgeons Foot and Ankle questionnaire (AAOS FAQ), Quality of Life 12 (QOL-12), and the patient-reported outcomes measurement information system 10 (PROMIS 10). Demographics included age, gender, body mass index, and medical comorbidities. The time in days to weight-bearing, wearing athletic shoes, and return to full activity were noted. Any complications were recorded. For statistical analysis, t-tests were performed for continuous variables and chi-square tests were performed for categorical variables using JMP 11.0.0 (SAS Institute Inc., Cary, NC). Results: Although improvements were noted in the AAOS FAQ and PROMIS 10 at 3 and 6 months post-operative, these results were not significantly different compared to baseline scores (Table 1). From the time of procedure, average time to weight-bearing was 2.75 ± 7.2 days. Patients returned to wearing athletic shoes an average of 48.3 ± 12.1 days after the procedure. Return to full activity without restrictions was 130.9 ± 37.0 days from surgery. Radiographic results demonstrated significant improvement in IMA and HVA at final follow-up (p < 0.001). 35 patients (94.6%) demonstrated evidence of radiographic union by final follow-up. Regarding complications, one patient (2.7%) required hardware removal for soft-tissue irritation, and there were three cases (8.1%) of hardware failure that did not require re-operation. Conclusion: In this study, early clinical and radiographic outcomes of triplanar tarsometatarsal corrective arthrodesis (modified Lapidus) with immediate weight-bearing were promising with low complication rates. Patients were able to return to normal shoe wear approximately 7 weeks after the procedure and return to full activity a little more than 4 months after surgery. Radiographic results demonstrated high union rates, low recurrence rates, and significant improvements in HVA and IMA at final follow-up. Longer follow-up is necessary to determine the long-term radiographic and clinical outcomes of triplanar tarsometatarsal arthrodesis to correct hallux valgus deformity.

scholarly journals Non-restricted weight-bearing after modified Lapidus arthrodesis

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0003
Author(s):  
Manuel Pellegrini ◽  
Giovanni Carcuro ◽  
Natalio Cuchacovic ◽  
Gerardo Muñoz ◽  
Marcelo Somarriva
Keyword(s):  
Hallux Valgus ◽  
Weight Bearing ◽  
Clinical Results ◽  
Delayed Union ◽  
Rigid Fixation ◽  
X Rays ◽  
Non Union ◽  
Fixation Methods ◽  
First Ray

Category: Bunion, Midfoot/Forefoot Introduction/Purpose: Modified lapidus arthrodesis is performed in the treatment of different pathologies, including hallux valgus and osteoarthritis of the first cuneo-metatarsal joint. Complications of this procedure include delayed union and non-union, reported to be between 5 to 20%. To prevent them, prolonged foot unloading and rigid fixation methods have been proposed. We sought to investigate our clinical results and complications in patients operated on with a modified Lapidus arthrodesis and inmediate weight bearing in a rigid post-operative shoe. Methods: After IRB approval, we conducted a retrospective patient chart review in a single center. Dedicated foot and ankle orthopaedic surgeons performed all procedures. Patients were included if they were older than 18 years, had a minimum follow up of one year and agreed to participate in the study. Patients with neuropathy, revision arthrodesis or those with concomitant midfoot/hindfoot procedures were excluded. All patients were operated on with an inter-articular lag screw and a locking neutralization plate. Patients were allowed to weight bear without restriction in a rigid post-operative shoe from postoperative day one. An independent musculoskeletal radiologist evaluated bone consolidation of the arthrodesis in x-rays or CT scan, when available. Results: Fifteen patients (18 feet) with an average age of 47 years (15-66) met inclusion criteria. All patients were female. Mean follow up was 19 months (12-24). Surgical indications were: hallux valgus in 14 cases and cuneo-metatarsal osteoarthritis in one case. Consolidation rate was 94% (14/15). Average time for radiological consolidation was 11 weeks (7-27). One patient (6%) developed non-union and required a revision arthrodesis with bone grafting. No loss of radiological correction or malalignment of the first ray was observed at last follow-up. Conclusion: Our results suggest that modified lapidus arthrodesis with rigid fixation methods and non restricted weight bearing is a safe and effective alternative to manage first ray pathology. This approach may not increase non-union rates or affect the reduction obtained.

scholarly journals Long-term clinical outcomes of scarf osteotomy in regional hospital Hong Kong

2019 ◽  
Vol 27 (1) ◽  
pp. 28-32
Author(s):  
Ng Weng-Io ◽  
Chan Kwok-Bill ◽  
Yeung Yuk-Nam
Keyword(s):  
Hong Kong ◽  
Clinical Outcomes ◽  
Hallux Valgus ◽  
Recurrence Rate ◽  
Weight Bearing ◽  
Symptom Control ◽  
Scarf Osteotomy ◽  
Hallux Valgus Deformity

Background: Lack of local data concerning the long-term clinical outcomes of scarf osteotomy in Hong Kong. Methods: This is a retrospective review of 75 patients (88 feet) who underwent scarf osteotomy with a mean follow-up of 94.20 months (60–144 months). Clinical ratings were based on visual analog scale (VAS) and American Orthopaedic Foot & Ankle Society (AOFAS) scale. Weight-bearing radiographs were used to perform angular measurements: (i) hallux valgus angle (HVA), (ii) intermetatarsal angle, (iii) distal metatarsal articular angle, and (iv) tibial sesamoid position before operation and at the time of latest follow-up. Results: The mean overall AOFAS scales improved from 29.66 (5–49) points preoperatively to 86.83 (39–100) points at the time of final follow-up. The VAS improved from 6.61 (5 to 9) to 0.66 (0 to 4). The average HVA correction was 25.42 (8–46). The 8- to10-year recurrence rate (HVA > 20) was 31.80%. A higher degree of preoperative HVA predicts higher recurrence rate. Conclusion: Scarf osteotomy is an effective procedure for symptom control and improvement in radiological parameters for hallux valgus deformity. However, recurrence rate is relatively high.

scholarly journals Proximal Rotational Metatarsal Osteotomy for Hallux Valgus

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0000
Author(s):  
Pablo Wagner ◽  
Emilio Wagner ◽  
Diego Zanolli de Solminihac ◽  
Cristian Ortiz ◽  
Andres Keller Díaz ◽  
...  
Keyword(s):  
Surgical Technique ◽  
Internal Rotation ◽  
Hallux Valgus ◽  
Recurrence Rate ◽  
Case Series ◽  
Deformity Correction ◽  
Varus Deformity ◽  
Metatarsal Osteotomy ◽  
Hallux Valgus Deformity

Category: Bunion, Midfoot/Forefoot Introduction/Purpose: Hallux valgus combines two deformities, the metatarsus varus and metatarsal internal rotation. The rotational deformity is seldom corrected during surgery, but is a known recurrence factor. Most techniques only correct the metatarsus varus (scarf, chevron, etc). We present a prospective case series using a novel metatarsal rotational osteotomy called PROMO (proximal rotational metatarsal osteotomy) which simultaneously corrects the metatarsal internal rotation and varus deformity by rotating the metatarsal through an oblique plane osteotomy. This is performed with no bone resection. Our objective was to report this new technique, preliminary results, its advantages and complications. Methods: 20 consecutive patients (17 women) with Hallux Valgus, average age 45 (25-55), were operated using this technique. The average preoperative intermetatarsal angle (IMA) was 15 degrees with an average Hallux internal malrotation of 30 degrees and a sesamoid malposition of grade V or more in all cases. Postoperatively, sesamoids position, Hallux rotation, IMA and metatarsal length were registered. They were followed for 1 year (8-14 months). The surgical technique is described, with its potential benefits and drawbacks. The radiological outcome, postoperative LEFS score, recurrence rate (IMA increase >5 degrees) and complications were registered. Results: Well positioned sesamoids (grade IV or less) were obtained in all patients postoperatively, with a complete Hallux rotational correction. Postoperative IMA was 5 degrees. achieving a complete metatarsal varus correction. No metatarsal shortening was observed whatsoever. No recurrence has been observed until final follow up. Preoperative and postoperative LEFS scores were 58 and 73 respectively. Conclusion: The PROMO has the advantage over other osteotomies that it can reliable correct, both metatarsal malrotation and varus deformities, achieving a complete deformity correction and hopefully decreasing recurrence rate. The surgical technique has been studied and refined extensively, in order to simplify it and make it reliable. Although more patients and follow-up are needed, the authors believe it is a promising surgical technique which addresses a previously not considered hallux valgus deformity component.

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