Journal of Korean Foot and Ankle Society (대한족부족관절학회지)

Korean Foot & Ankle Society (대한족부족관절학회)
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Results of Minimal Incision Distal Metatarsal Osteotomy for Moderate to Severe Hallux Valgus

중등도 이상의 무지 외반증에서 최소 절개를 이용한 원위 중족골 절골술의 결과

  • Huh, Jung-Wook (Department of Orthopedic Surgery, Busan Medical Center) ;
  • Eun, Il-Soo (Department of Orthopedic Surgery, Busan Medical Center) ;
  • Ko, Young-Chul (Department of Orthopedic Surgery, Busan Medical Center) ;
  • Park, Man-Jun (Department of Orthopedic Surgery, Busan Medical Center) ;
  • Park, Sook-Hyun (Department of Orthopedic Surgery, Busan Medical Center)
  • Received : 2015.04.06
  • Accepted : 2015.05.27
  • Published : 2015.06.15
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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 $37.7^{\circ}$ and $15.9^{\circ}$ at last follow-up. The mean first intermetatarsal angle of preoperation and last follow-up were $15.2^{\circ}$ and $8.3^{\circ}$. The mean distal metatarsal articular angle changed from $12.6^{\circ}$ at preoperation to $7.8^{\circ}$ 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 $37^{\circ}$ and 13o, 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 $37^{\circ}$ and distal metatarsal articular angle under $13^{\circ}$ can lead to good clinical results without recurrence.

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References

  1. Robinson AH, Limbers JP. Modern concepts in the treatment of hallux valgus. J Bone Joint Surg Br. 2005;87:1038-45. https://doi.org/10.2106/JBJS.D.02060
  2. Radwan YA, Mansour AM. Percutaneous distal metatarsal osteotomy versus distal chevron osteotomy for correction of mildto-moderate hallux valgus deformity. Arch Orthop Trauma Surg. 2012;132:1539-46. https://doi.org/10.1007/s00402-012-1585-5
  3. Borton DC, Stephens MM. Basal metatarsal osteotomy for hallux valgus. J Bone Joint Surg Br. 1994;76:204-9.
  4. Coughlin MJ, Grebing BR, Jones CP. Arthrodesis of the first metatarsophalangeal joint for idiopathic hallux valgus: intermediate results. Foot Ankle Int. 2005;26:783-92. https://doi.org/10.1177/107110070502601001
  5. Klosok JK, Pring DJ, Jessop JH, Maffulli N. Chevron or Wilson metatarsal osteotomy for hallux valgus. A prospective randomised trial. J Bone Joint Surg Br. 1993;75:825-9. https://doi.org/10.2106/00004623-199306000-00004
  6. Sammarco GJ, Brainard BJ, Sammarco VJ. Bunion correction using proximal Chevron osteotomy. Foot Ankle. 1993;14:8-14. https://doi.org/10.1177/107110079301400102
  7. Bosch P, Markowski H, Rannicher V. Technik und erste ergebnisse der subkutanen distalen metatarsale-I-osteotomie. Orthop Praxis. 1990;26:51-6.
  8. Faour-Mart n O, Mart n-Ferrero MA, Valverde Garc a JA, Vega-Castrillo A, de la Red-Gallego MA. Long-term results of the retrocapital metatarsal percutaneous osteotomy for hallux valgus. Int Orthop. 2013;37:1799-803. https://doi.org/10.1007/s00264-013-1934-1
  9. B sch P, Wanke S, Legenstein R. Hallux valgus correction by the method of Bosch: a new technique with a seven-to-ten-year follow-up. Foot Ankle Clin. 2000;5:485-98.
  10. Kissel CG, Unroe BJ, Parker RM. The offset "V" bunionectomy using cortical screw and buried Kirschner wire fixation. J Foot Surg. 1992;31:560-77.
  11. Magnan B, Pezz L, Rossi N, Bartolozzi P. Percutaneous distal metatarsal osteotomy for correction of hallux valgus. J Bone Joint Surg Am. 2005;87:1191-9. https://doi.org/10.2106/JBJS.D.02280
  12. Kadakia AR, Smerek JP, Myerson MS. Radiographic results after percutaneous distal metatarsal osteotomy for correction of hallux valgus deformity. Foot Ankle Int. 2007;28:355-60. https://doi.org/10.3113/FAI.2007.0355
  13. Huang PJ, Lin YC, Fu YC, Yang YH, Cheng YM. Radiographic evaluation of minimally invasive distal metatarsal osteotomy for hallux valgus. Foot Ankle Int. 2011;32:S503-7. https://doi.org/10.3113/FAI.2011.0503
  14. Angthong C, Yoshimura I, Kanazawa K, Hagio T, Ida T, Naito M. Minimally invasive distal linear metatarsal osteotomy for correction of hallux valgus: a preliminary study of clinical outcome and analytical radiographic results via a mapping system. Arch Orthop Trauma Surg. 2013;133:321-31. https://doi.org/10.1007/s00402-012-1665-6
  15. Ozan F, Bora OA, Filiz MA, Kement Z. Interposition arthroplasty in the treatment of hallux rigidus. Acta Orthop Traumatol Turc. 2010;44:143-51. https://doi.org/10.3944/AOTT.2010.2243
  16. Hawkins FB, Mitchell CL, Hedrick DW. Correction of hallux valgus by metatarsal osteotomy. J Bone Joint Surg Am. 1945;27:387-94.
  17. Mann RA, Coughlin MJ. Hallux valgus--etiology, anatomy, treatment and surgical considerations. Clin Orthop Relat Res. 1981;(157):31-41.
  18. Shapiro F, Heller L. The Mitchell distal metatarsal osteotomy in the treatment of hallux valgus. Clin Orthop Relat Res. 1975;(107):225-31.
  19. Trnka HJ, Zembsch A, Easley ME, Salzer M, Ritschl P, Myerson MS. The chevron osteotomy for correction of hallux valgus. Comparison of findings after two and five years of follow-up. J Bone Joint Surg Am. 2000;82:1373-8. https://doi.org/10.2106/00004623-200010000-00002
  20. Wu KK. Wu's bunionectomy: a clinical analysis of 150 personal cases. J Foot Surg. 1992;31:288-97.
  21. Giannini S, Faldini C, Nanni M, Di Martino A, Luciani D, Vannini F. A minimally invasive technique for surgical treatment of hallux valgus: simple, effective, rapid, inexpensive (SERI). Int Orthop. 2013;37:1805-13. https://doi.org/10.1007/s00264-013-1980-8
  22. Portaluri M. Hallux valgus correction by the method of B sch: a clinical evaluation. Foot Ankle Clin. 2000;5:499-511.
  23. Mann RA, Donatto KC. The chevron osteotomy: a clinical and radiographic analysis. Foot Ankle Int. 1997;18:255-61. https://doi.org/10.1177/107110079701800502
  24. Sanhudo JA. Extending the indications for distal chevron osteotomy. Foot Ankle Int. 2000;21:522-3. https://doi.org/10.1177/107110070002100614
  25. Bonnel F, Canovas F, Poir e G, Dusserre F, Vergnes C. Evaluation of the Scarf osteotomy in hallux valgus related to distal metatarsal articular angle: a prospective study of 79 operated cases. Rev Chir Orthop Reparatrice Appar Mot. 1999;85:381-6.
  26. Pontious J, Mahan KT, Carter S. Characteristics of adolescent hallux abducto valgus. A retrospective review. J Am Podiatr Med Assoc. 1994;84:208-18. https://doi.org/10.7547/87507315-84-5-208
  27. Okuda R, Kinoshita M, Yasuda T, Jotoku T, Kitano N, Shima H. Postoperative incomplete reduction of the sesamoids as a risk factor for recurrence of hallux valgus. J Bone Joint Surg Am. 2009;91:1637-45. https://doi.org/10.2106/JBJS.H.00796
  28. Veri JP, Pirani SP, Claridge R. Crescentic proximal metatarsal osteotomy for moderate to severe hallux valgus: a mean 12.2 year follow-up study. Foot Ankle Int. 2001;22:817-22. https://doi.org/10.1177/107110070102201007
  29. Deenik AR, de Visser E, Louwerens JW, de Waal Malefijt M, Draijer FF, de Bie RA. Hallux valgus angle as main predictor for correction of hallux valgus. BMC Musculoskelet Disord. 2008;9:70. https://doi.org/10.1186/1471-2474-9-70