First Metatarsal Proximal Opening Wedge Osteotomy for Correction of Hallux Valgus Deformity: Comparison of Straight versus Oblique Osteotomy

Background: Many surgical procedures have been described for the correction of metatarsus primus varus associated with hallux valgus deformity. The purpose of this study was to present the results of the proximal metatarsal opening wedge (PMOW) osteotomy using the Arthrex LPS® first metatarsal system. Materials and Methods: Eighty-four patients (90 feet) underwent PMOW osteotomy with distal bunionectomy. There were 78 patients (93%) and 84 (93%) feet available for followup. Mean followup was 2.4 (range, 2.0 to 3.2) years from the time of the index surgery. Pre- and postoperative clinical examination, level of activity, patient derived subjective satisfaction score, radiographic measurements, and visual analogue scale (VAS) score for pain were obtained and evaluated retrospectively. Results: The mean preoperative VAS score was 5.9 (± 2.2), compared with a mean postoperative score of 0.5 (± 0.8). The mean 1–2 IMA preoperatively was 14.5 (±3.3) degrees, compared with postoperative measurements of 4.6 (± 2.8) degrees. The mean hallux valgus angle (HVA) improved from a mean of 30 (range, 22 to 64) degrees preoperatively to 10 (range, −15 to +18) degrees. The mean time to radiographic union was 5.9 (range, 4 to 14) weeks. There was one nonunion, one delayed union, mild hallux varus in two patients, severe hallux varus in two patients, recurrent hallux valgus in three patients (including the nonunion) and no instances of plate failure there was no significant difference in mean preoperative (74.8 degrees ± 11) compared to postoperative (67.9 degrees ± 10) total MTP joint range of motion. Ninety percent of patients reported good to excellent subjective results after the index surgery. Conclusion: We believe PMOW osteotomy was near ideal in terms of reliable, predictable correction and healing. Length of the first metatarsal was maintained and patients ambulated safely in a CAM walking boot immediately after surgery. We believe a first web space release may result in hallux varus and increased distal metatarsal articular angle (DMAA) was associated with hallux valgus recurrence. Level of Evidence: IV, Retrospective Case Series

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Treatment of Hallux Valgus by Oblique Osteotomy of the First Metatarsal

Foot & Ankle ◽

10.1177/107110079201300803 ◽

1992 ◽

Vol 13 (8) ◽

pp. 447-452 ◽

Cited By ~ 8

Author(s):

Kosaku Mizuno ◽

Masataka Hashimura ◽

Mayako Kimura ◽

Kazushi Hirohata

Keyword(s):

Hallux Valgus ◽

Metatarsophalangeal Joint ◽

Valgus Deformity ◽

X Rays ◽

Great Toe ◽

First Metatarsal ◽

Oblique Osteotomy ◽

Hallux Valgus Deformity ◽

Valgus Angle

This paper describes a simple technique of oblique osteotomy of the first metatarsal for treatment of symptomatic hallux valgus deformity. The osteotomy is performed at a 30° angle from the long axis of the metatarsal shaft. The head of the metatarsal is then displaced laterally to provide correction of the hallux valgus. This is an uncomplicated procedure for the treatment of hallux valgus. From 1984 through 1989, 53 feet in 31 patients were treated with an oblique osteotomy of the first metatarsal. A total of 49 feet in 27 patients were followed up more than 2 years. The follow-up x-rays and clinical examinations revealed a good result in 43 feet. In six feet of three patients, all of whom had simultaneous oblique osteotomies of both the first and second metatarsals, a fair or poor result was obtained. It was learned that oblique osteotomy for hallux valgus greater than 40° provided insufficient correction of the valgus angle or limitation of motion at the metatarsophalangeal joint of the great toe.

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Clinical Outcomes of Proximal Opening-Wedge Osteotomy and Distal Chevron Osteotomy in the Treatment of Moderate Hallux Valgus Deformity

Journal of Medical Science And clinical Research ◽

10.18535/jmscr/v7i2.131 ◽

2019 ◽

Vol 7 (2) ◽

Author(s):

Mustafa Akkaya ◽

Keyword(s):

Clinical Outcomes ◽

Hallux Valgus ◽

Valgus Deformity ◽

Wedge Osteotomy ◽

Opening Wedge ◽

Chevron Osteotomy ◽

Hallux Valgus Deformity

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First Metatarsal Rotation in Hallux Valgus Deformity

Foot & Ankle International ◽

10.1177/1071100721997149 ◽

2021 ◽

Vol 42 (4) ◽

pp. 510-522

Author(s):

Jesse Steadman ◽

Alexej Barg ◽

Charles L. Saltzman

Keyword(s):

Hallux Valgus ◽

Potential Role ◽

Axial Rotation ◽

Valgus Deformity ◽

Measurement Methods ◽

Advanced Imaging ◽

Level Of Evidence ◽

First Metatarsal ◽

Hallux Valgus Deformity ◽

Biplanar Radiographs

Rotation of the first metatarsal (M1) as a potential etiological factor of hallux valgus (HV) deformity was described relatively early in the description of HV pathoanatomy. However, because biplanar radiographs have been the standard method for imaging HV, clinicians primarily developed measurement methods and corrective operations confined to 2 dimensions, medial-lateral and inferior-superior. Recently, as our understanding of HV pathoanatomy has further developed, aided in part by advanced imaging technology, M1 rotation about its axis (“axial rotation”) and its implications for HV deformity and treatment has reemerged. The goal of this review is to summarize M1 rotation in HV from a historical perspective, to present the current understanding of its potential role in the etiology/pathogenesis of HV, and to summarize relevant imaging and operative considerations with respect to M1 rotation. Level of Evidence: Level III, systematic review.

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