High intermetatarsal angle hallux valgus : does modified chevron osteotomy solve the problem ?

An evaluation was made to introduce the efficacy of modified chevron osteotomy, in which extended plantar limb osteotomy was applied to hallux valgus cases with a high intermetatarsal angle and no hypermobility of the 1st metatarsocuneiform and hallux interphalangeus. A total of 21 patients and 34 feet were examined. The mean age of the patients was 47.3 ± 13.4 years (range, 20-74 years). The surgery was performed on 19 (55%) right feet and 15 (45%) left feet. Extended plantar limb osteotomy and soft tissue procedures were performed on all patients from a single dorsomedial incision. Fifteen-degree angle anterior-posterior, full lateral radiographs and photographs were taken preoperatively and at 6 weeks, 6 months, 12 months and at a final postoperative follow-up examination. The hallux valgus, intermetatarsal and distal metatarsal articular angles were determined, and the HV-foot-AOFAS values showing clinical satisfaction were calculated. The mean follow-up period was 12 months, (range, 11-22 months). At the final follow-up examination, the hallux valgus angle had decreased from 37.9° to 17.2° on the right foot and from 32.2° to 11.9° on the left foot; the intermetatarsal angle had decreased from 16° to 6.6° on the right and from 15.1° to 6.6° on the left; and the distal metatarsal articular angle had decreased from 21.1° to 11.4° on the right and from 18.8° to 6.4° on the left. The mean AOFAS-HV score increased from 63 to 83.8 on the right and from 64.3 to 88.2 on the left. A statistically significant improvement was determined in all the angle values at the final follow-up examination. The AOFAS scales showing clinical satisfaction were determined as ‘good’. It was concluded that the extended plantar limb modified chevron osteotomy is an effective surgical treatment option for adult cases of hallux valgus with a high intermetatarsal angle, with no 1st metatarsal hypermobility or hallux interphalangeus and no history of recent foot surgery.

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