Proximal Metatarsal Wedge Osteotomy with Single Screw Fixation in Treatment of Hallux Valgus

Purpose: We conducted this study to examine the clinical results of the proximal metatarsal wedge osteotomy using a single screw fixation and the distal soft tissue procedure in patients with moderate to severe hallux valgus deformity. Materials and Methods: Between February 2002 and February 2004, we performed these procedures on 12 patients (15 cases). The 6 cases of all patients had mild to moderate instability in the first MTC (metatarsocuneiform) joint. We estimated the clinical outcomes, the radiological findings and complications. Results: AOFAS score was improved from preoperative 41.5 points to 87.7 points lastly on average. The mean correction angle of HVA and IMA was 23.8° and 6.6°, respectively. The mean position of tibial sesamoid was 2.67 before surgery and 0.87 after surgery. The mean shortening of the first metatarsal bone was 3.07 mm after surgery. There was no pain and complications on the first MTC joint except the breakage of screw in one case and instability of the first MTC joint was improved postoperatively. Conclusion: We obtained good clinical and radiographic outcomes in our series. So, proximal metatarsal wedge osteotomy using a single screw fixation and distal soft tissue procedure seems one of the good surgical treatments for moderate hallux valgus deformity.

[1]  K. Saleh,et al.  The Lapidus procedure as salvage after failed surgical treatment of hallux valgus. Surgical technique. , 2004, The Journal of bone and joint surgery. American volume.

[2]  M. Kinoshita,et al.  Distal Soft Tissue Procedure and Proximal Metatarsal Osteotomy in Hallux Valgus , 2000, Clinical orthopaedics and related research.

[3]  M. Myerson,et al.  Hypermobility of the first ray. , 2000, Foot and ankle clinics.

[4]  K. Knahr,et al.  Metatarsophalangeal and Intermetatarsal Angle: Different Values and Interpretation of Postoperative Results Dependent on the Technique of Measurement , 1998, Foot & ankle international.

[5]  M J Coughlin,et al.  Hallux valgus. , 1997, Instructional course lectures.

[6]  L. Barouk.  [Weil's metatarsal osteotomy in the treatment of metatarsalgia]. , 1996, Der Orthopade.

[7]  P. Scranton,et al.  Prognostic Factors in Bunion Surgery , 1995, Foot & ankle international.

[8]  J. Nunley,et al.  Clinical Rating Systems for the Ankle-Hindfoot, Midfoot, Hallux, and Lesser Toes , 1994, Foot & ankle international.

[9]  K. Klaue,et al.  Clinical, Quantitative Assessment of First Tarsometatarsal Mobility in the Sagittal Plane and Its Relation to Hallux Valgus Deformity* , 1994, Foot & ankle international.

[10]  N. Maffulli,et al.  Chevron or Wilson metatarsal osteotomy for hallux valgus. A prospective randomised trial. , 1993, The Journal of bone and joint surgery. British volume.

[11]  V. J. Sammarco,et al.  Bunion Correction Using Proximal Chevron Osteotomy , 1993, Foot & ankle.

[12]  D. Thordarson,et al.  Hallux Valgus Correction with Proximal Metatarsal Osteotomy: Two-year Follow-up , 1992, Foot & ankle.

[13]  M. Myerson,et al.  Metatarsocuneiform Arthrodesis for Management of Hallux Valgus and Metatarsus Primus Varus , 1992, Foot & ankle.

[14]  R. Mann,et al.  Repair of hallux valgus with a distal soft-tissue procedure and proximal metatarsal osteotomy. A long-term follow-up. , 1992, The Journal of bone and joint surgery. American volume.

[15]  E. Leventen.  The Chevron procedure. , 1990, Orthopedics.

[16]  B. Sangeorzan,et al.  Modified Lapidus Procedure for Hallux Valgus , 1989, Foot & ankle.

[17]  H. Choi,et al.  A Clinical Study of Chevron Osteotomy in Bunion - Hallux Valgus , 1989 .

[18]  Z. Yosipovitch,et al.  Late results after correction of hallux valgus deformity by basilar phalangeal osteotomy. , 1987, The Journal of bone and joint surgery. American volume.

[19]  P. Rowe,et al.  Fixation of Hohmann's osteotomy for hallux valgus. , 1985, Acta Orthopaedica Scandinavica.

[20]  J. Kenzora,et al.  The Risks and Benefits of Distal First Metatarsal Osteotomies , 1985, Foot & ankle.

[21]  J. Miller.  Distal first metatarsal displacement osteotomy. Its place in the schema of bunion surgery. , 1974, The Journal of bone and joint surgery. American volume.

[22]  Lapidus Pw.  The author's bunion operation from 1931 to 1959. , 1960 .

[23]  D. J. Morton.  HYPERMOBILITY OF THE FIRST METATARSAL BONE: THE INTERLINKING FACTOR BETWEEN METATARSALGIA AND LONGITUDINAL ARCH STRAINS , 1928 .