Repair of hallux valgus with a distal-soft-tissue procedure and proximal metatarsal osteotomy

ABSTRACT

The aim of this study was to evaluate of the results of the treatment of the Hallux Valgus deformity by first metatarsal osteotomy and distal soft tissue release. Twenty-four patients [14 female patients, and 10 males] with 34 symptomatic Hallux Valgus feet were studied [21 feet for females and 13 feet for males] who ranged in age from 22 to 56 years [mean 39 years]. Average follow-up was 33 months [30 months to 45 months]. The patients in the present study were managed by release of the distal soft tissues, including the lateral capsule of the first MLP joint, and the lateral collateral ligament and release of the tendon of the adductor hallucis from the proximal phalanx, excision of the medial eminence, plication of the medial capsule, and the tendon transfer of the abductor hallucis more distally to the proximal phalanx, and a proximal wedge osteotomy of the first metatarsus. After correction crossing two Kirschner wires were applied fixing the osteotomy site. Clinical and radiological results were evaluated, comparing the preoperative and postoperative findings. The preoperative hallux valgus angle averaged 36 +/- 4.6 degree, and the postoperative angle averaged 15.2 +/- 3.6 degree. The preoperative intermetarsal angle averaged 22.4 +/- 4.3 degree, and the postoperative angle averaged 9.7 +/- 3.5 degree. No significant shortening of the first metatarsus relative to the second metatarsus postoperatively. Bone union was completed within three months in all cases. No significant difference was found between preoperative and postoperative range of motion of the first MTP joint. Lateral displacement of the sesamoids was not improved postoperatively. The complications included sensory disturbance in the medial portion of the great toe and the foot in two feet. Avascular necrosis of the metatarsal head was not encountered. Eighty-six percent of the patients were satisfied with the result of the procedure. Our clinical and radiological results concluded that the distal soft tissue release; including abductor hallucis tendon transfer to the proximal phalanx, the proximal, close wedge osteotomy of the first metatarsal and fixation of the osteotomy with Kirschner wires could be sufficient to obtain a satisfactoiy outcome for the correction of the hallux valgus deformity