Proximal metatarsal osteotomy and distal soft tissue reconstruction as treatment for hallux valgus deformity

A series of 28 cases with a moderate to severe hallux valgus deformity and intermetatarsal angle of 14° or greater was followed an average of 5½ years to determine whether any significant loss of correction occurred. All feet were treated with a distal soft tissue procedure and proximal metatarsal osteotomy. The average correction of the intermetatarsal angle was 13.2° (7–20°), and the average loss of correction was 1.4°; the average correction of the hallux valgus angle was 26.7° (−2° to 48°), and the average loss of correction was 3.8°. In three cases, a recurrent deformity developed; in three other cases, a hallux varus deformity developed, two of which were symptomatic. Patient satisfaction was 85%. This study indicates that in most patients with a hallux valgus deformity and an intermetatarsal angle of 14° or greater, there is sufficient inherent stability of the first metatarsocuneiform joint that it does not require stabilization to obtain a satisfactory long-term result.

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Rotated Insertion Metatarsal Osteotomy with Distal Soft Tissue Procedure for Severe Hallux Valgus Deformity ―Novel Procedure of the 1st metatarsal osteotomy―

Foot & Ankle Orthopaedics ◽

10.1177/2473011417s000348 ◽

2017 ◽

Vol 2 (3) ◽

pp. 2473011417S0003

Author(s):

Norihiro Samoto ◽

Yasuhito Tanaka ◽

Ryuhei Katsui ◽

Kazuya Sugimoto

Keyword(s):

Soft Tissue ◽

Hallux Valgus ◽

Locking Plate ◽

Valgus Deformity ◽

Metatarsal Osteotomy ◽

Rigid Fixation ◽

Soft Tissue Procedure ◽

Hallux Valgus Deformity ◽

The Mean ◽

Severe Hallux Valgus

Category: Bunion Introduction/Purpose: Hallux valgus deformity is recently a common disease involved in the foot and ankle and many procedures are recommended globally. However it is controversial about the operative treatment for severe hallux valgus. Many authors have reported the technical difficulties and various complications. We performed rotated insertion metatarsal osteotomy with the distal soft tissue procedure for severe hallux valgus deformity since January 2008. The purpose of this study is to evaluate the medium-term outcome of this procedure. Methods: Two hundred thirty-two feet in 173 patients were enrolled in this study and followed them up for a mean of 44.5 months. The mean age at the operation was 64.5 years. Hallux valgus angle(HVA) and intermetatarsal angle(IMA) were measured. This procedure consists of the rotated insertion metatarsal osteotomy and the distal soft tissue procedure. This diaphysial longitudinal metatarsal oblique osteotomy was performed from proximally- medial site of the first metatarsal directed to distally- lateral site through the dorsal exposure. The tip of osteotomized proximal metatarsal was formed at the dorso-distal site to insert in the central intramedullary aspect of osteotomized distal metatarsal. The second triangular cut of one third of dorso-plantar thick was made about 10 to 15 mm length from the lateral tip of osteomized proximal metatarsal. The internal fixation was performed with locking plate with screws. As a result, osteotomized sites were locked each other such as a puzzle. Results: The mean preoperative HVA and IMA were 43.8 degrees and 20.1 degrees. The mean postoperative HVA and IMA were decreased to 9.0 degrees and 6.1 degrees. AOFAS scores improved from 49.3 to 89.7. All cases were obtained complete union. Postoperative displacement was in 12 feet (5.2%) and followed under-correction (or recurrence). Overcorrection (hallux varus) occurred in 10 feet (4.7%). Wound healing was delayed in 21 feet (9.1%). In general, we found no severe complication and unsatisfactory result. Conclusion: This procedure provided satisfactory result for severe hallux valgus deformity. Especially the rigid fixation at the site of metatarsal osteotomy was much stronger because of the insertion and locking plate. However the further more outcomes in detail are essential for longer term follow-up.

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Compare the Initial Result of One Screw or Two Screws Fixation for Proximal Crescentic Metatarsal Osteotomy with Distal Soft Tissue Reconstruction in Severe Hallux Valgus Treatment

10.21203/rs.3.rs-132132/v1 ◽

2021 ◽

Author(s):

Haijiao Mao ◽

Linger Wang ◽

Jiahui Li

Keyword(s):

Soft Tissue ◽

Hallux Valgus ◽

Screw Fixation ◽

Metatarsal Osteotomy ◽

Soft Tissue Reconstruction ◽

Single Screw ◽

Tissue Reconstruction ◽

Group 2 ◽

Severe Hallux Valgus ◽

Group 1

Abstract Proximal crescentic metatarsal osteotomy and distal soft tissue reconstruction have been introduced to correct severe hallux valgus (HV). The intrinsically unstable proximal first crescentic osteotomy depends on enough force fixation for stability. It is necessary to judge the number of fixation’s screw for osteotomy. Fifty two feet from 50 adult patients with severe HV were included in this study. The treatment was proximal crescentic metatarsal osteotomy with a single screw and distal soft tissue reconstruction in Group 1. The fixation with two screws with distal soft tissue reconstruction in Group 2. Clinical and radiological follow-ups were assessed after 4 and 12 months of operation. In Group 1, hallux valgus angle (HVA) was decreased from 46.4 ±3.28 to 19.9 ±4.70 after 12 months of operation. HVA was decreased from 45.1 ±3.45 to19.1 ±4.70 for group 2. For intermetatarsal angle (IMA) in Group 1, it was changed from 18.5 ±1.98 to 9.25 ±1.11 after 12 months of operation. For group 2, it was decreased from 18.3 ±1.81 to 9.53 ±1.70. Meanwhile, the American Orthopedic Foot and Ankle Society (AOFAS) score was improved from 63.1 to 83.9 after 12 months of operation for group1, and was improved from 64.3 to 82.8 for group2. Furthermore, the visual analogue scale (VAS) score was reduced from 4.5±1.01 to 1.7± 0.43 for group 1, and it was reduced from 4.7±0.92 to 1.7±0.55 for group 2 after 12 months of operation. The first metatarsal dorsal elevation was occurred in 4 feet in Group1, and no metatarsal dorsal elevation was occurred in Group 2. There were no significant differences identified among Group1 and Group 2 in terms of VAS and AOFAS scores, and HVA and IMA measurements. However, there is less complication in two-screw fixation for crescentic osteotomy compared to a single screw fixation.

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Brachymetatarsia: Congenitally Short Third and Fourth Metatarsals Treated by Distraction Lengthening—A Case Report and Literature Summary

Foot & Ankle International ◽

10.1177/107110079801901012 ◽

1998 ◽

Vol 19 (10) ◽

pp. 713-718 ◽

Cited By ~ 26

Author(s):

Jon F. Robinson ◽

Tye J. Ouzounian

Keyword(s):

Case Report ◽

Soft Tissue ◽

Valgus Deformity ◽

Soft Tissue Reconstruction ◽

The Third ◽

Chevron Osteotomy ◽

Hallux Valgus Deformity ◽

Tissue Reconstruction ◽

Uncommon Condition ◽

Second Toe

Brachymetatarsia is an uncommon condition, and when present, it is usually asymptomatic. A case report demonstrating the use of distraction lengthening for symptomatic multiple congenital short metatarsals is presented. A 15-year-old female with congenital short third and fourth metatarsals was treated for painful transfer lesions under the second and fifth metatarsal heads and a secondary hallux valgus deformity. Surgical correction with a chevron osteotomy, soft tissue reconstruction of the second toe, and distraction lengthening of the third and fourth metatarsals was performed. Three years after treatment, the patient has an excellent clinical correction, with no evidence of recurrent transfer lesions. To our knowledge, this is the first report demonstrating the use of distraction lengthening without supplemental bone graft for multiple short metatarsals in a single extremity.

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Hallux Valgus in Men: Effect of the Distal Metatarsal Articular Angle on Hallux Valgus Correctiong

Foot & Ankle International ◽

10.1177/107110079701800802 ◽

1997 ◽

Vol 18 (8) ◽

pp. 463-470 ◽

Cited By ~ 70

Author(s):

Michael J. Coughlin

Keyword(s):

Soft Tissue ◽

Hallux Valgus ◽

Valgus Deformity ◽

Metatarsal Osteotomy ◽

Hallux Valgus Angle ◽

First Metatarsal ◽

Soft Tissue Procedure ◽

Hallux Valgus Deformity ◽

Valgus Angle ◽

Mtp Joints

The results of hallux valgus correction were reviewed for 34 male patients (41 feet). The severity of the preoperative deformity determined the operative technique of correction. A distal soft tissue procedure with proximal first metatarsal osteotomy was performed in 30 patients (35 feet) with an average correction of the hallux valgus angle of 22°. A chevron procedure was performed in five cases and a McBride procedure in one other case, all with less severe deformities. Complications included one deep wound infection, one broken screw at the metatarsal osteotomy site, and three cases of hallux varus. No patients underwent reoperation. Undercorrection was noted in 10 of 35 cases (29%) where a distal soft tissue procedure with proximal first metatarsal osteotomy was performed. A nonsubluxated (congruent) metatarsophalangeal (MTP) joint associated with a hallux valgus deformity was present in 15 of 41 (37%) of all cases and 10 of 35 (29%) of cases that underwent a distal soft tissue procedure with proximal metatarsal osteotomy (DSTR with PMO). A subluxated (noncongruent) MTP joint associated with hallux valgus was present in 26 of 41 (63%) of all cases and 25 of 35 (71 %) of cases undergoing a DSTR with PMO. There was a highly significant difference in the average distal metatarsal articular angle (DMAA) as measured in the nonsubluxated (congruent) MTP joints (20.7°) and the subluxated (noncongruent) MTP joints with hallux valgus (10°) ( P = 0.0001). The average distal metatarsal articular angle for all cases undergoing DSTR with PMO was 13°. When the postoperative hallux valgus angle was compared with the DMAA, the average residual hallux valgus angle was 10.1°. With a subluxated (noncongruent) first MTP joint with hallux valgus (a low DMAA), the percent of hallux valgus correction (hallux valgus correction [in degrees])preoperative hallux valgus deformity [in degrees]) was 77%. In patients with a nonsubluxated (congruent) first MTP joint with hallux valgus (a high DMAA), the percent correction was 46%, an almost twofold difference in percent correction. There was a close correlation between the preoperative DMAA and the postoperative hallux valgus angle in both the subluxated and congruent subgroups ( P = 0.0003). With an intra-articular repair (a DSTP with PMO), the magnitude of correction of a hallux valgus deformity is limited at the MTP joint by the distal metatarsal articular angle.

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Salvage Treatment of Failed Hallux Valgus Operations with Proximal First Metatarsal Osteotomy and Distal Soft-Tissue Reconstruction

Foot & Ankle International ◽

10.1177/107110079801900302 ◽

1998 ◽

Vol 19 (3) ◽

pp. 127-131 ◽

Cited By ~ 26

Author(s):

Harold B. Kitaoka ◽

Gary L. Patzer

Keyword(s):

Soft Tissue ◽

Hallux Valgus ◽

Metatarsophalangeal Joint ◽

Salvage Treatment ◽

Activity Limitations ◽

Metatarsal Osteotomy ◽

Soft Tissue Reconstruction ◽

First Metatarsophalangeal Joint ◽

First Metatarsal ◽

Tissue Reconstruction

We reviewed the results of 15 patients (16 feet) in whom a hallux valgus procedure had failed. Salvage was by proximal crescentic first metatarsal osteotomy with distal soft-tissue reconstruction. Results based on a clinical scale considering the level of pain, activity limitations, support requirement, footwear limitations, and alignment were good in 11, fair in two, and poor in three. Patients were satisfied with the results in 10 feet, satisfied with reservations in four feet, and dissatisfied in two feet. Complications were: transfer metatarsalgia in three, hallux varus in one, and osteotomy nonunion in one. One of the patients required reoperation to bone graft a proximal osteotomy. Metatarsal osteotomy was helpful in the salvage treatment of recurrent, symptomatic hallux valgus when the first metatarsophalangeal joint was functional and painless.

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