Effectiveness of double metatarsal osteotomy for severe hallux valgus with increased distal metatarsal articular angle_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WANG Xinwen ¹ , WEN Qian ² , LIU Cheng ¹ , ZHAO Kai ¹ , LI Yi ¹ ,  LIANG Xiaojun ¹

1. Department of Foot and Ankle Surgery, Honghui Hospital Affiliated to Medical School of Xi’an Jiaotong University, Xi’an Shaanxi, 710054, P.R.China;
2. Department of Prevention and Health Care, the 9th Hospital of Xi’an, Xi’an Shaanxi, 710054, P.R.China;

Corresponding author：

LIANG Xiaojun, Email: liangxj33369@163.com

Keywords：

Hallux valgus; double metatarsal osteotomy; Reverdin osteotomy; proximal metatarsal open wedge osteotomy; Akin osteotomy; distal metatarsal articular angle

DOI：

10.7507/1002-1892.201906062

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Objective To summarize the technique and effectiveness of double metatarsal osteotomy for treating severe hallux valgus with increased distal metatarsal articular angle (DMAA).Methods Between June 2014 and December 2017, 64 patients (94 feet) of severe hallux valgus with an increased DMAA were treated with the double metatarsal osteotomy (distal metatarsal Reverdin osteotomy+proximal metatarsal open wedge osteotomy) combined with Akin osteotomy and soft tissue surgery to correct the deformity. There were 10 males (15 feet) and 54 females (79 feet) with an average age of 44.5 years (range, 26-66 years), including 34 of unilateral foot and 30 of bilateral feet. The Maryland metatarsophalangeal joint score of the American Orthopaedic Foot and Ankle Society (AOFAS) was 54.3±7.4 and the visual analogue scale (VAS) score was 6.0±2.0. The pre- and post-operative AOFAS score, VAS score, DMAA, hallux valgus angle (HVA), first-second intermetatarsal angle (1-2IMA), and the first metatarsal length (FML) were recorded and compared.Results All incisions healed by first intention. All patients were followed up 12-15 months, with an average of 13.2 months. The complications occurred in 4 feet, including 1 foot of hallux stiffness, 1 foot of numbness at the edge of the wound, 1 foot of metastatic metatarsalgia, and 1 foot of metatarsal bone necrosis. At 1 year after operation, the Maryland metatarsal joint score of AOFAS was 89.2±7.4, showing significant difference compared with preoperative score (t=18.427, P=0.000); and the effectiveness was rated as excellent in 78 feet, good in 12 feet, poor in 3 feet, and bad in 1 foot, with an excellent and good rate of 95.7%. The VAS score was 1.5±2.0, showing significant difference compared with the preoperative score (t=10.238, P=0.000). The X-ray films showed that the osteotomies achieved bony healing at 3 months after operation. There were significant differences (P<0.05) in HVA, 1-2IMA, and DMAA between preoperation and 6 months and 1 year after operation; but no significant difference was found in FML between preoperation and 1 year after operation (t=0.136, P=0.863).Conclusion For the patients with severe hallux valgus with increased DMAA, the double metatarsal osteotomy can significantly relieve the clinical symptoms and improve the imaging parameters with less postoperative complications.

Citation： WANG Xinwen, WEN Qian, LIU Cheng, ZHAO Kai, LI Yi, LIANG Xiaojun. Effectiveness of double metatarsal osteotomy for severe hallux valgus with increased distal metatarsal articular angle. Chinese Journal of Reparative and Reconstructive Surgery, 2020, 34(1): 41-45. doi: 10.7507/1002-1892.201906062 Copy

1.	Smith SE, Landorf KB, Butterworth PA, et al. Scarf versus chevron osteotomy for the correction of 1-2 intermetatarsal angle in hallux valgus: a systematic review and meta-analysis. J Foot Ankle Surg, 2012, 51(4): 437-444.
2.	Schuh R, Willegger M, Holinka J, et al. Angular correction and complications of proximal first metatarsal osteotomies for hallux valgus deformity. Int Orthop, 2013, 37(9): 1771-1780.
3.	Karpe P, Killen MC, Pollock RD, et al. Shortening scarf osteotomy for correction of severe hallux valgus. Does shortening affect the outcome? Foot (Edinb), 2016, 29: 45-49.
4.	Park CH, Jang JH, Lee SH, et al. A comparison of proximal and distal chevron osteotomy for the correction of moderate hallux valgus deformity. Bone Joint J, 2013, 95-B(5): 649-656.
5.	Kitaoka HB, Alexander IJ, Adelaar RS, et al. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int, 1997, 15(7): 349-353.
6.	Munuera PV, Polo J, Rebollo J. Length of the first metatarsal and hallux in hallux valgus in the initial stage. Int Orthop, 2008, 32(4): 489-495.
7.	Nakagawa S, Fukushi J, Nakagawa T, et al. Association of metatarsalgia after hallux valgus correction with relative first metatarsal length. Foot Ankle Int, 2016, 37(6): 582-588.
8.	吕振木, 孙超, 张奉琪, 等. 合并 DMAA 增大的踇外翻治疗. 足踝外科电子杂志, 2015, 2(1): 7-9.
9.	Sirvastava S, Chockalingam N, El Fakhri T. Radiographic measurements of hallux angles: a review of current techniques. Foot (Edinb), 2010, 20(1): 27-31.
10.	Pentikainen I, Ojala R, Ohtonen P, et al. Preoperative radiological factors correlated to long-term recurrence of hallux valgus following distal chevron osteotomy. Foot Ankle Int, 2014, 35(12): 1262-1267.
11.	王正义. 踇外翻矫形的并发症及其预防. 中国骨与关节外科, 2013, 6(4): 299-304.
12.	Park CH, Ahn JY, Kim YM, et al. Plate fixation for proximal chevron osteotomy has greater risk for hallux valgus recurrence than Kirschner wire fixation. Int Orthop, 2013, 37(6): 1085-1092.
13.	Wagner E, Ortiz C. Osteotomy considerations in hallux valgus treatment: improving the correction power. Foot Ankle Clin, 2012, 17(3): 481-498.
14.	Rodriguez-Reyes G, E López-Gavito E, Pérez-Sanpablo AI, et al. Dynamic plantar pressure distribution after percutaneous hallux valgus correction using the Reverdin-Isham osteotomy. Rev Invest Clin, 2014, 66(Suppl 1): S79-S84.
15.	张小龙, 王翔宇, 杨树东, 等. 改良 Ludloff 截骨联合 Reverdin 截骨治疗中重度踇外翻. 骨科, 2018, 9(2): 132-135.
16.	Park YB, Lee KB, Kim SK, et al. Comparison of distal soft-tissue procedures combined with a distal chevron osteotomy for moderate to severe hallux valgus: first web-space versus transarticular approach. J Bone Joint Surg (Am), 2013, 95(21): e1581-e1588.
17.	Barouk LS, Barouk P, Baudet B, et al. The great toe proximal phalanx osteotomy: the final step of the bunionectomy. Foot Ankle Clin, 2005, 10(1): 141-155.
18.	Peterson HA, Newman SR. Adolescent bunion deformity treated with double osteotomy and longitudinal pin fixation of the first ray. J Pediatr Orthop, 1993, 13(1): 80-84.
19.	Aronson J, Nguyen LL, Aronson EA. Early results of the modified Peterson bunion procedure for adolescent hallux valgus. J Pediatr Orthop, 2001, 21(1): 65-69.
20.	李昕宇, 林顺福, 王剑, 等. 第一跖骨双截骨矫正重度踇外翻畸形. 中华骨科杂志, 2013, 33(4): 388-392.
21.	Kilmartin TE, O’Kane C. Combined rotation scarf and Akin osteotomies for hallux valgus: a patient focussed 9 year follow up of 50 patients. J Foot Ankle Res, 2010, 5: 2.

1. Smith SE, Landorf KB, Butterworth PA, et al. Scarf versus chevron osteotomy for the correction of 1-2 intermetatarsal angle in hallux valgus: a systematic review and meta-analysis. J Foot Ankle Surg, 2012, 51(4): 437-444.
2. Schuh R, Willegger M, Holinka J, et al. Angular correction and complications of proximal first metatarsal osteotomies for hallux valgus deformity. Int Orthop, 2013, 37(9): 1771-1780.
3. Karpe P, Killen MC, Pollock RD, et al. Shortening scarf osteotomy for correction of severe hallux valgus. Does shortening affect the outcome? Foot (Edinb), 2016, 29: 45-49.
4. Park CH, Jang JH, Lee SH, et al. A comparison of proximal and distal chevron osteotomy for the correction of moderate hallux valgus deformity. Bone Joint J, 2013, 95-B(5): 649-656.
5. Kitaoka HB, Alexander IJ, Adelaar RS, et al. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int, 1997, 15(7): 349-353.
6. Munuera PV, Polo J, Rebollo J. Length of the first metatarsal and hallux in hallux valgus in the initial stage. Int Orthop, 2008, 32(4): 489-495.
7. Nakagawa S, Fukushi J, Nakagawa T, et al. Association of metatarsalgia after hallux valgus correction with relative first metatarsal length. Foot Ankle Int, 2016, 37(6): 582-588.
8. 吕振木, 孙超, 张奉琪, 等. 合并 DMAA 增大的踇外翻治疗. 足踝外科电子杂志, 2015, 2(1): 7-9.
9. Sirvastava S, Chockalingam N, El Fakhri T. Radiographic measurements of hallux angles: a review of current techniques. Foot (Edinb), 2010, 20(1): 27-31.
10. Pentikainen I, Ojala R, Ohtonen P, et al. Preoperative radiological factors correlated to long-term recurrence of hallux valgus following distal chevron osteotomy. Foot Ankle Int, 2014, 35(12): 1262-1267.
11. 王正义. 踇外翻矫形的并发症及其预防. 中国骨与关节外科, 2013, 6(4): 299-304.
12. Park CH, Ahn JY, Kim YM, et al. Plate fixation for proximal chevron osteotomy has greater risk for hallux valgus recurrence than Kirschner wire fixation. Int Orthop, 2013, 37(6): 1085-1092.
13. Wagner E, Ortiz C. Osteotomy considerations in hallux valgus treatment: improving the correction power. Foot Ankle Clin, 2012, 17(3): 481-498.
14. Rodriguez-Reyes G, E López-Gavito E, Pérez-Sanpablo AI, et al. Dynamic plantar pressure distribution after percutaneous hallux valgus correction using the Reverdin-Isham osteotomy. Rev Invest Clin, 2014, 66(Suppl 1): S79-S84.
15. 张小龙, 王翔宇, 杨树东, 等. 改良 Ludloff 截骨联合 Reverdin 截骨治疗中重度踇外翻. 骨科, 2018, 9(2): 132-135.
16. Park YB, Lee KB, Kim SK, et al. Comparison of distal soft-tissue procedures combined with a distal chevron osteotomy for moderate to severe hallux valgus: first web-space versus transarticular approach. J Bone Joint Surg (Am), 2013, 95(21): e1581-e1588.
17. Barouk LS, Barouk P, Baudet B, et al. The great toe proximal phalanx osteotomy: the final step of the bunionectomy. Foot Ankle Clin, 2005, 10(1): 141-155.
18. Peterson HA, Newman SR. Adolescent bunion deformity treated with double osteotomy and longitudinal pin fixation of the first ray. J Pediatr Orthop, 1993, 13(1): 80-84.
19. Aronson J, Nguyen LL, Aronson EA. Early results of the modified Peterson bunion procedure for adolescent hallux valgus. J Pediatr Orthop, 2001, 21(1): 65-69.
20. 李昕宇, 林顺福, 王剑, 等. 第一跖骨双截骨矫正重度踇外翻畸形. 中华骨科杂志, 2013, 33(4): 388-392.
21. Kilmartin TE, O’Kane C. Combined rotation scarf and Akin osteotomies for hallux valgus: a patient focussed 9 year follow up of 50 patients. J Foot Ankle Res, 2010, 5: 2.

Chinese Journal of Reparative and Reconstructive Surgery

Effectiveness of double metatarsal osteotomy for severe hallux valgus with increased distal metatarsal articular angle

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