Results of Minimal Incision Distal Metatarsal Osteotomy for Moderate to Severe Hallux Valgus / 대한족부족관절학회지

ABSTRACT

PURPOSE: Minimal incision distal metatarsal osteotomy (MIDMO) is known to be an effective surgical procedure for mild to moderate hallux valgus. However, the result of MIDMO on moderate to severe hallux valgus is controversial; therefore, we investigated the radiological and clinical results of MIDMO on moderate to severe hallux valgus. MATERIALS AND METHODS: We reviewed 51 feet (48 patients) with moderate to severe hallux valgus. The mean age was 67.0 years and the mean follow-up period was 32.2 months. Radiological data of hallux valgus angle, first intermetatarsal angle, and distal metatarsal articular angle on plain radiographs were analyzed. Recurrence, union, lateral translation of distal fragment and angulation were also analyzed. The clinical data were obtained using American Orthopaedic Foot and Ankle Society (AOFAS) score of preoperation and last follow-up. Receiver operating characteristic (ROC) curve was used to determine a cut-off value. RESULTS: The mean hallux valgus angle measured at preoperation was 37.7o and 15.9degrees at last follow-up. The mean first intermetatarsal angle of preoperation and last follow-up were 15.2degrees and 8.3degrees. The mean distal metatarsal articular angle changed from 12.6degrees at preoperation to 7.8degrees at last follow-up. Preoperative hallux valgus angle (p=0.0051) and distal metatarsal articular angle (p=0.0078) were statistically significant factors affecting postoperative AOFAS score. Cut-off value of each was 37degrees and 13degrees, respectively. Lateral translation of distal fragment in 5 recurrent cases was 23.0% compared to 45.3% of 46 non-recurrent cases. The result was statistically significant and the cut-off value was 38%. CONCLUSION: Sufficient lateral translation over 38% in MIDMO on moderate to severe hallux valgus patients with preoperative hallux valgus angle under 37degrees and distal metatarsal articular angle under 13degrees can lead to good clinical results without recurrence.