Results of Hallux Abducto Valgus Surgical Correction Using Two 1.1mm Mini TightRope Constructs

Hallux valgus represents an acquired foot deformity defined by medial deviation of the first metatarsal bone combined with lateral shift of the hallux and medial metatarsophalageal joint eminence enlargement. The functional impairment and metatarsalgia generated stem from the biomechanical imbalance which does not allow for normal transfer of weight trough the first ray during walking. The results generated with our experience with the 1.1mm Mini TightRope� Disposable Kitin the treatment of hallux valgus are analyzed in this paper. A total number of 24 feet (12 bilateral cases) with hallux valgus, surgically treated in our department were followed for a period of minimum twelve months and evaluated. The results showed an improvement of the mean preoperative IMA 14.6�to 7.9� postoperatively and 9.2� at six months after surgery. The preoperative measured HVA was reduced from 28.4to 14.2� at once and 16.1� after six months. The AOFAS hallux metatarsophalangeal-interphalangeal score resulted improvement reflects the functional benefits. These results confirm the good correction potential of the technique and support it as avalid treatment option for mild to moderate severity hallux valgus.

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Shortened First Metatarsal Bone and Newly Developed Second Metatarsalgia after Parallel-shaped Modified Scarf Osteotomy for Hallux Valgus Deformity

Foot & Ankle Orthopaedics ◽

10.1177/2473011417s000381 ◽

2017 ◽

Vol 2 (3) ◽

pp. 2473011417S0003 ◽

Cited By ~ 1

Author(s):

Jae Wan Suh ◽

Ho-Seong Jang ◽

Hyun-Woo Park ◽

Sung Bae Park

Keyword(s):

Propensity Score ◽

Hallux Valgus ◽

Valgus Deformity ◽

Metatarsal Bone ◽

First Metatarsal ◽

Scarf Osteotomy ◽

Hallux Valgus Deformity ◽

Second Metatarsal ◽

The Mean

Category: Bunion Introduction/Purpose: The scarf osteotomy has gained in popularity for the treatment of a symptomatic hallux valgus deformity due to its inherent stability, versatility of correction and early mobilization. We have reported parallel-shaped modified scarf osteotomy(PSMSO) with good functional outcomes and no complication as stress fracture or troughing. However, we encountered second transfer metatarsalgia after the osteotomy. The scarf osteotomy can be shortened, but there was no specific amount of shortening that will produce transfer metatarsalgia in limitation of our literature review. In this study, we measured the shortening of first metatarsal length and investigated the relation of first metatarsal length and second transfer metatarsalgia after PSMSO for hallux valgus deformity. Methods: We retrospectively reviewed 168 consecutive PSMSOs performed in 124 patients with hallux valgus deformity between March 2009 and August 2015. Concomitant other pathologies of foot or previous second metatarsalgia were excluded. After excluding 45 cases, 123 cases in 88 patients were included. For clinical assessment, VAS, the AOFAS Hallux Metatarsophalangeal-Interphalangeal (AOFAS Hallux MTP-IP) Scale were obtained. The hallux valgus angle (HVA), the intermetatarsal angle (IMA), the distal metatarsal articular angle (DMAA), the first metatarsal length measured by a modified Davies and Saxby’s method and the protrusion of second metatarsal relative to first metatarsal using the Maestro’s method were assessed on standard weight bearing radiographs of the foot. For evaluation of the development of second transfer metatarsalgia, callosity or tenderness beneath the second metatarsal head was investigated. After identifying the lesion, we divided two groups with and without second transfer metatarsalgia and compared the variables after propensity score matching. Results: Mean follow-up period was 20.6±7.8 (12-66) months. The mean VAS and AOFAS Hallux MTP-IP score improved significantly (p<0.001). Significant corrections in the HVA, IMA and DMAA were obtained and the mean shortening of the first metatarsal length and the mean relative lengthening of second metatarsal protrusion were -3.1±2.5 mm and +2.5±2.8 mm at last follow-up (p<0.001, p<0.001). Eleven (8.9%, 11/123) cases developed second transfer metatarsalgia after PSMSO. After propensity score matching considered baseline characteristics, 9 cases with second transfer metatarsalgia were compared to 31 cases without it. The group with transfer metatarsalgia showed significant shortening in first metatarsal length and lengthening of second metatarsal protrusion relative to first metatarsal compared to those without the transfer lesion (-4.8±3.8 vs -2.0±2.1, p=0.013, +4.2±1.6 vs +1.9±2.1, p=0.005). Conclusion: Transfer metatarsalgia is one of numerous possible complications after scarf osteotomy. To avoid complications, we suggest that shortening of first metatarsal bone length should be minimized within -2 mm and second metatarsal protrusion relative to first metatarsal kept within +1.9 mm with considering the metatarsal parabola. If the shortening of first metatarsal was done over -4.8 mm, the additional procedure for second metatarsal may be considered.

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Hallux Valgus: Demographics, Etiology, and Radiographic Assessment

Foot & Ankle International ◽

10.3113/fai.2007.0759 ◽

2007 ◽

Vol 28 (7) ◽

pp. 759-777 ◽

Cited By ~ 253

Author(s):

Michael J. Coughlin ◽

Caroll P. Jones

Keyword(s):

Hallux Valgus ◽

Metatarsophalangeal Joint ◽

Valgus Deformity ◽

First Metatarsophalangeal Joint ◽

First Metatarsal ◽

Hallux Valgus Deformity ◽

Valgus Angle ◽

First Ray ◽

The Mean ◽

Severe Hallux Valgus

Background The purpose of the study was to preoperatively evaluate the demographics, etiology, and radiographic findings associated with moderate and severe hallux valgus deformities in adult patients (over 20 years of age) treated operatively over a 33-month period in a single surgeon's practice. Methods Patients treated for a hallux valgus deformity between September, 1999, and May, 2002, were identified. Patients who had mild deformities (hallux valgus angle < 20 degrees), concurrent degenerative arthritis of the first metatarsophalangeal joint, inflammatory arthritis, recurrent deformities, or congruent deformities were excluded. When enrolled, all patients filled out a standardized questionnaire and had a routine examination that included standard radiographs, range of motion testing, and first ray mobility measurement. A chart review and evaluation of preoperative radiographs were completed on all eligible patients. Results One-hundred and three of 108 (96%) patients (122 feet) with a diagnosis of moderate or severe hallux valgus (hallux valgus angle of 20 degrees or more) 70 qualified for the study. The onset of the hallux valgus deformity peaked during the third decade although the distribution of occurrence was almost equal from the second through fifth decades. Twenty-eight of 122 feet (23%) developed a deformity at an age of 20 years or younger. Eighty-six (83%) of patients had a positive family history for hallux valgus deformities and 87 (84%) patients had bilateral bunions. 15% of patients in the present series had moderate or severe pes planus based on a positive Harris mat study. Only 11% (14 feet) had evidence of an Achilles or gastrocnemius tendon contracture. Radiographic analysis found that 86 of 122 feet (71%) had an oval or curved metatarsophalangeal joint. Thirty-nine feet (32%) had moderate or severe metatarsus adductus. A long first metatarsal was common in patients with hallux valgus (110 of 122 feet; 71%); the mean increased length of the first metatarsal when compared to the second was 2.4 mm. While uncommon, the incidence of an os intermetatarsum was 7% and a proximal first metatarsal facet was 7%. The mean preoperative first ray mobility as measured with Klaue's device was 7.2 mm. 16 of 22 (13%) feet were observed to have increased first ray mobility before surgery. Conclusions The magnitude of the hallux valgus deformity was not associated with Achilles or gastrocnemius tendon tightness, increased first ray mobility, bilaterality or pes planus. Neither the magnitude of the preoperative angular deformity nor increasing age had any association with the magnitude of the first metatarsophalangeal joint range of motion. Constricting shoes and occupation were implicated by 35 (34%) patients as a cause of the bunions. A familial history of bunions, bilateral involvement, female gender, a long first metatarsal, and an oval or curved metatarsophalangeal joint articular surface were common findings. Increased first ray mobility and plantar gapping of the first metatarsocuneiform joint were more common in patients with hallux valgus than in the general population (when compared with historical controls).

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The Radiographic Morphology of Foot Deformities in Patients with Fibrodysplasia Ossificans Progressiva

Foot & Ankle International ◽

10.1177/107110070502601107 ◽

2005 ◽

Vol 26 (11) ◽

pp. 937-941 ◽

Cited By ~ 7

Author(s):

Richard J. Harrison ◽

J. David Pitcher ◽

Mark S. Mizel ◽

H. Thomas Temple ◽

Sean P. Scully

Keyword(s):

Hallux Valgus ◽

Proximal Phalanx ◽

Metatarsal Head ◽

Length Ratio ◽

Fibrodysplasia Ossificans Progressiva ◽

Foot Deformities ◽

First Metatarsal ◽

First Ray ◽

The Mean ◽

And Gender

Background: The most consistent deformities that allow early diagnosis of fibrodysplasia ossificans progressiva are the presence of bilateral short first rays and hallux valgus. The purpose of this study was to describe the radiographic features observed in the feet of patients with fibrodysplasia ossificans progressiva. Methods: The radiographs of 26 feet (15 patients with fibrodysplasia ossificans progressiva) were reviewed to evaluate the radiographic changes that occur in the first ray. Variables analyzed were the hallux valgus (HV) angle, the distal metatarsal articular (DMA) angle, the proximal phalangeal articular (PPA) angle, the intermetatarsal (IM) angle, ratio of the lengths of the first and second metatarsal lengths (MT1:MT2), and the first and second ray length ratio. The length ratios were then subtracted from similar ratios in radiographs of age- and gender-matched normal patients previously reported. Results: The proximal phalanx was consistently shortened but morphologically dissimilar from subject to subject. Asymmetry was noted in some patients with bilateral radiographs. The mean HV angle was 28 degrees, and the mean IM angle was 10 degrees. The mean DMA angle was 33 degrees, and the mean PPA angle was 14 degrees. The MT1:MT2 ratio was 0.89, and the mean first ray to second ray length ratio was 0.87. The mean of the differences in the MT1:MT2 and first and second ray length ratios in patients with fibrodysplasia ossificans progressiva compared to the normal controls were 0.05 and 0.01, respectively. Fusion occurred between the abnormal tibial epiphysis of the proximal phalanx and metatarsal head with advancing age, and 68% of the metatarsal heads were fused with the abnormal proximal phalangeal epiphysis. Conclusions: Foot pathology in patients with fibrodysplasia ossificans progressiva is variable but consistently involves an abnormality of the tibial aspect of the proximal phalangeal epiphysis of the hallux. This results in the clinical observation of hallux valgus in these patients. The first metatarsal is consistently shortened, and fusion between the epiphysis of the abnormal proximal phalanx and the shortened first metatarsal head occurs with advancing age.

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Mobility Changes in the First TMT Joint after Proximal First Metatarsal Osteotomy for Hallux Valgus Evaluated by Weightbearing CT and a 3D Analysis System

Foot & Ankle Orthopaedics ◽

10.1177/2473011417s000244 ◽

2017 ◽

Vol 2 (3) ◽

pp. 2473011417S0002

Author(s):

Tadashi Kimura ◽

Makoto Kubota ◽

Hidekazu Hattori ◽

Kazuhiko Minagawa ◽

Naoki Suzuki ◽

...

Keyword(s):

Hallux Valgus ◽

Three Dimensional ◽

Metatarsal Osteotomy ◽

First Metatarsal ◽

Valgus Angle ◽

Medial Cuneiform ◽

First Ray ◽

The Mean ◽

Weightbearing Ct

Category: Bunion Introduction/Purpose: In a previous study, we found that feet with hallux valgus show significantly greater three-dimensional mobility than normal feet in all joints of the first ray. Displacement was particularly pronounced in the first TMT joints, indicating that this is the primary cause of first ray hypermobility. We developed a plate used specifically for proximal first metatarsal osteotomy to perform three-dimensional correction of hallux valgus and associated deformities. In this study, we evaluated changes in mobility of the first TMT joints after surgery in 3D using weightbearing CT. Methods: The subjects were 5 feet of 5 female patients with hallux valgus (mean age 56 years, mean hallux valgus angle 38°). We performed non-weightbearing and weightbearing (using a load equivalent to body weight) CT scans before surgery using an original loading device (Fig a). We reconstructed 3D models from captured images by segmentation and defined axial coordinate system (Fig b). Next, we measured the three-dimensional displacement of the first metatarsal bone relative to the medial cuneiform bone under weightbearing conditions. At 1 to 1.5 years after proximal metatarsal osteotomy for all patients, we performed a follow-up CT scans using the same method and compared preoperative and postoperative displacement. Student’s t- test was performed to statistically compare data and statistical significance was set at p < 0.05. Results: Postoperatively (when performing a follow up CT), the mean hallux valgus angle improved from 38° to 10° and the mean first-second metatarsal angle improved from 23° to 7°. The mean score on the Japanese Society for Surgery of the Foot hallux scale improved from 62 points to 97 points. Displacement of the first metatarsal bone relative to the medial cuneiform bone between non-weightbearing and weightbearing conditions decreased significantly in all directions, from 4.2° ± 1.8° to 1.6° ± 1.1° of dorsiflexion (p = 0.02), 4.9° ± 1.8° to 0.7° ± 0.9° of inversion (p = 0.001), and 4.4° ± 1.9° to 1.7° ± 0.8° of adduction (p = 0.01). Conclusion: Displacement of the first TMT joints under weightbearing conditions decreased after our surgery. This indicates that the surgery corrected hallux valgus and associated pes planus and produced favorable functional outcomes by improving the shape of the foot and hypermobility of the first ray through correction of the orientation and tension of surrounding tendons and ligaments and the plantar aponeurosis. In the future, we plan to further examine the pathology and treatment of hallux valgus with a focus on postoperative changes in soft tissue orientation.

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Geometric Data of Hallux Valgus Feet

Foot & Ankle International ◽

10.1177/107110079601700907 ◽

1996 ◽

Vol 17 (9) ◽

pp. 548-554 ◽

Cited By ~ 19

Author(s):

Kenneth S. Lamur ◽

Anton Huson ◽

Chris J. Snijders ◽

Rob Stoeckart

Keyword(s):

Hallux Valgus ◽

Least Squares Method ◽

Metatarsal Bone ◽

Flexor Hallucis Longus ◽

Independent Variables ◽

First Metatarsal ◽

Linear Dependency ◽

Geometric Data ◽

Longus Muscle ◽

Stepwise Procedure

The aim of this study is to find basic quantitative geometric data that may contribute to the understanding of the etiology of hallux valgus. Embalmed specimens with existing hallux valgus (N = 39) were dissected; 28 variables were measured with a Vernier caliper gauge and toe goniometer. Correlations between pairs of independent variables were calculated. Linear dependency of the hallux angle, varus angle, and the width of the forefoot on a number of independent variables was analyzed by multiple linear regression. A least squares method and a stepwise procedure were used. The distance from the tendon of the flexor hallucis longus muscle to the head of the first metatarsal bone explains more than other variables the variation in hallux angle and width of the forefoot. A widened forefoot is significantly correlated with both hallux and varus angles. The interrelation of the predictor parameters illustrates the complicated hallux valgus phenomenon.

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Radiographic Impact of Lapidus, Proximal Lateral Closing Wedge Osteotomy, and Suture Button Procedures on First Ray Length and Dorsiflexion for Hallux Valgus

Foot & Ankle International ◽

10.1177/1071100720925438 ◽

2020 ◽

Vol 41 (8) ◽

pp. 964-971 ◽

Cited By ~ 1

Author(s):

Ian M. Foran ◽

Nasima Mehraban ◽

Stephen K. Jacobsen ◽

Daniel D. Bohl ◽

Johnny Lin ◽

...

Keyword(s):

Hallux Valgus ◽

Wedge Osteotomy ◽

Level Of Evidence ◽

Closing Wedge Osteotomy ◽

First Metatarsal ◽

Suture Button ◽

Closing Wedge ◽

Radiographic Measurements ◽

Valgus Angle ◽

First Ray

Background: Shortening and dorsiflexion of the first metatarsal are known potential side effects of metatarsal osteotomies for hallux valgus (HV) with the potential to cause transfer metatarsalgia. We compared the effect of the first tarsometatarsal joint arthrodesis (Lapidus procedure), proximal lateral closing wedge osteotomy (PLCWO), and intermetatarsal suture button fixation procedures on the length and dorsiflexion of the first ray. Methods: We retrospectively evaluated 105 feet in 99 patients with 30 weeks of follow-up. The average age was 54 years. Seventy-four feet had a Lapidus procedure, 12 had a PLCWO, and 19 had intermetatarsal suture button fixation. Digital radiographic measurements were made for the pre- and postoperative hallux valgus angle (HVA) and intermetatarsal angle (IMA), absolute and relative shortening of the first ray, and dorsiflexion. Results: Preoperative HVA and IMA did not differ between treatment groups ( P > .05 for each). Similar corrections of HVA (30.5-13.5 degrees) were achieved between all groups ( P > .05). The IMA was improved more in the Lapidus group (14.3-6.5 degrees) compared with the suture button fixation group (14.2-8.1 degrees) ( P = .045). There were significant differences in the change in absolute first cuneiform–metatarsal length (FCML) between the Lapidus (–1.6 mm), PLCWO (–2.3 mm), and intermetatarsal suture button fixation (+1.9 mm) procedure ( P = .004). There were also significant differences in relative first metatarsal shortening between the Lapidus (0.1 mm relative shortening), PLCWO (1.1 mm relative shortening), and intermetatarsal suture button fixation (1.3 mm lengthening) procedure ( P < .001). The average dorsiflexion differed between the Lapidus (1.8 degrees) and suture button fixation (0.4 degrees) groups ( P = .004). Conclusion: Intermetatarsal suture button fixation relatively lengthened the first ray, the Lapidus procedure maintained length, and the PLCWO relatively and absolutely shortened it. Dorsiflexion may be higher with the Lapidus and osteotomy procedures. Level of Evidence: Level III, retrospective comparative series.

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Radiographic Outcomes after Fixation of Distal Metatarsal Osteotomy for Hallux Valgus Using a Tension Band Construct

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00428 ◽

2019 ◽

Vol 4 (4) ◽

pp. 2473011419S0042

Author(s):

Alexander Volpi ◽

Robert Zbeda ◽

Christopher Katchis ◽

Lon Weiner ◽

Stuart Katchis

Keyword(s):

Hallux Valgus ◽

Postoperative Period ◽

Weight Bearing ◽

Line Tension ◽

Tension Band ◽

Metatarsal Osteotomy ◽

First Metatarsal ◽

Distal Metatarsal Osteotomy ◽

The Mean

Category: Bunion Introduction/Purpose: Hallux valgus is a common deformity of the forefoot. There are over 130 procedures described to correct hallux valgus. Classically, the treatment of mild to moderate hallux valgus is with a distal metatarsal osteotomy. A variety of fixation techniques have been described for use with this osteotomy most of which require partial or non-weight bearing until the osteotomy is healed. Tension Band fixation is a well-known principle in orthopedic surgery. The goal of the present study is to radiographically assess the maintenance of distal first metatarsal osteotomy fixation using a novel tension band device (Re+Line tension band bunion plate system, Nextremity Solutions) with immediate post-operative weight-bearing. Methods: The patient database for one surgeon was retrospectively reviewed for patients that underwent hallux valgus correction with the Re+Line tension band device between 2014 and 2017. Postoperative protocol included a soft dressing, firm surgical shoe, and weight-bearing as tolerated with a cane. Patients were excluded if fixation was achieved with something other than a tension band construct. Radiographs were obtained and reviewed retrospectively by 3 authors. Pre and postoperative hallux valgus (HVA) and intermetatarsal angles (IMA) were measured as described previously in the literature, and the changes in correction compared. Maintenance of correction and hardware integrity were assessed at final follow-up after weight bearing as tolerated in a surgical shoe in the postoperative period. Statistical analysis was performed using a Wilcoxon signed-rank test for the changes in HVA and IMA. Results: There was a total of 72 patients and 76 toes that underwent hallux valgus correction with a tension band construct, at a mean follow-up of 4.36 months. 68 of 72 patients were female. The average age was 60.8 years old. The mean preoperative HVA was 27.1 degrees. The mean postoperative HVA was 6.14 degrees, with a mean correction of 20.22 degrees (p<0.001). The mean preoperative IMA was 14.14 degrees. The mean postoperative IMA was 6.10 degrees, with a mean correction of 7.98 degrees (p<0.001). There was loss of reduction found in 6 of 76 toes (7.89%).There were zero cases of hardware failure. All osteotomies healed at final follow-up. Conclusion: This study shows successful radiographic outcome after hallux valgus correction using a tension band construct and allowing immediate full weight-bearing in a surgical shoe in the postoperative period. Significant deformity correction was achieved and maintained and all osteotomies healed. The Re+Line tension band bunion correction system can be safely used as a successful option to fix distal first metatarsal osteotomies, while allowing patients to fully weight bear in a surgical shoe postoperatively and potentially return to activities faster than when using traditional fixation methods. Future studies are needed to assess functional outcomes and patient satisfaction with this novel technique.

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Three-Dimensional Analysis of the First Metatarsal Bone in Minimally Invasive Distal Linear Metatarsal Osteotomy for Hallux Valgus

Foot & Ankle International ◽

10.1177/1071100719875222 ◽

2019 ◽

Vol 41 (1) ◽

pp. 84-93 ◽

Cited By ~ 1

Author(s):

Hiroyuki Seki ◽

Satoshi Oki ◽

Yasunori Suda ◽

Kenichiro Takeshima ◽

Tetsuro Kokubo ◽

...

Keyword(s):

Minimally Invasive ◽

Hallux Valgus ◽

Morphological Changes ◽

Case Series ◽

Metatarsal Bone ◽

Ct Scans ◽

Metatarsal Osteotomy ◽

Level Of Evidence ◽

3 Dimensional ◽

First Metatarsal

Background: Modified Bösch osteotomy (distal linear metatarsal osteotomy [DLMO]) is one of the minimally invasive correctional surgeries for hallux valgus. The 3-dimensional correctional angles and distances of the first metatarsal bone in DLMO have not been clarified. The purpose of this study was to analyze the 3-dimensional postoperative morphological changes of the first metatarsal bone in DLMO. Methods: Twenty patients (30 feet) who underwent DLMO were enrolled. Preoperative plain radiographs and computed tomography (CT) scans of the feet were examined. Postoperative radiographs and CT scans were also obtained after bone union. The surface data of the pre- and postoperative first metatarsals were reconstructed from the CT data. The positions of the distal ends of the first metatarsals described with respect to the proximal ends were calculated using CT surface-matching technique. Results: The distal end of the first metatarsal after DLMO was significantly supinated (10.2 ± 6.0 degrees, P < .001), adducted (6.0 ± 11.8 degrees, P = .004), dorsiflexed (11.1 ± 10.9, P < .001), shortened (7.4 ± 2.5 mm, P < .001), elevated (2.3 ± 3.1 mm, P = .001), and laterally shifted (8.2 ± 3.0 mm, P < .001) compared to the preoperative metatarsal distal end. Supination correction demonstrated a significant correlation with adduction correction ( r = 0.659, P < .001) on correlation analyses between these parameters. Conclusion: The 3-dimensional corrections of the first metatarsal bone after DLMO were evaluated. Pronation and abduction were successfully corrected. Furthermore, adduction correction might be an important factor affecting correction of pronation. Level of Evidence: Level IV, retrospective case series.

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Hallux valgus correction using Scarf-Osteotomy leads to shortening of the first metatarsal

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00320 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0032

Author(s):

Christopher Lenz ◽

Paul Borbas

Keyword(s):

Hallux Valgus ◽

Consecutive Series ◽

Hallux Valgus Angle ◽

Intermetatarsal Angle ◽

First Metatarsal ◽

Valgus Angle ◽

Correction Technique ◽

Second Metatarsal ◽

First Ray ◽

Akin Osteotomy

Category: Bunion Introduction/Purpose: In hallux valgus deformity less weight can be borne by the first ray which may lead to transfer metatarsalgia and lesser toe deformities. Depending on the exact configuration of the bone cuts during the scarf procedure, an iatrogenic shortening of the first metatarsal may occur which may diminish weightbearing ability of the first ray as well, causing transfer metatarsalgia. The aim of the present study was therefore to determine preoperative and postoperative changes in length of the first metatarsal by using different methods of measuring metatarsal length. Methods: A consecutive series of 118 feet in 106 patients (89% female, 11% male) was enrolled, who underwent correctional osteotomy (Scarf-with/without Akin-Osteotomy) from May 2015 to July 2017 at a single institution. Patients, who underwent additional shortening osteotomy of the metatarsals, were excluded. Average age at the time of surgery was 51 years (range, 14 to 83 years). Pre- and postoperative angle measurement of hallux valgus- and intermetatarsal angle was assessed at between six weeks and three months postoperatively on standardized weight-bearing radiographs in dorsoplantar plane. We also identified early complications in hallux valgus surgery. An assessment and comparison of different methods of measuring metatarsal length (length of first metatarsal, ratio first to second metatarsal, Coughlin method) postoperatively was performed to identify the amount of shortening with this technique. Results: Hallux valgus angle was statistically significant reduced by an average of 18.6° (28.3° preoperatively to 9.7° postoperatively, p < 0.001), intermetatarsal angle by 7.7° (12.8° to 5.1°, p < 0.001). Measuring the length of the first metatarsal, in all three methods a statistically significant reduction of the first metatarsal length could be detected. Mean absolute shortening of 1.8 mm was measured (p < 0.001). The ratio of the first metatarsal to the second metatarsal averaged -0.03 (p = 0.02). The mean relative lengthening of the second metatarsal, using the method described by Coughlin, was 0.42 mm (from 4.51 to 4.89 mm, p < 0.001) on average. Of those three methods, the Coughlin method showed the highest correlation. 6 minor complications were observed (5%). Conclusion: In the current study we could demonstrate a significant reduction of hallux valgus angle and intermetatarsal angle with hallux valgus correction using Scarf-/Akin-Osteotomy, with a low complication rate. However, statistically significant shortening of the first metatarsal could be detected as well. Further research is required to improve and establish a hallux valgus correction technique without shortening of the first metatarsal.

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