• Journal of Korean Foot and Ankle Society
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• v.12 no.2
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• pp.140-144
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• 2008

Purpose: The purpose of this study is to compare the treatment outcomes of distal chevron osteotomy with those of proximal metatarsal closing wedge osteotomy in patients with moderate severity hallux valgus. Materials and Methods: Forty-two patients (51 feet) who were underwent either distal chevron osteotomy (Group I, 22 patients, 27 feet) or proximal metatarsal closing wedge osteotomy (Group II, 20 patients, 24 feet) for the correction of moderate hallux valgus deformity were evaluated retrospectively. We assessed the radiographic results with several parameters including hallux valgus angle (HVA), intermetatarsal angle (IMA) and distal metatarsal articular angle (DMAA). And clinical results with modified AOFAS score at last follow-up. Results: There were no significant differences in IMA, HVA and DMAA between two groups preoperatively. We can achieve the good results with both procedures, but mean HVA and IMA of group II was significantly lower than those of group I. There was some loss of correction in group I at the last follow-up. There was no significant difference in clinical results according to modified AOFAS scoring between two groups at the last follow-up. Conclusion: The proximal metatarsal closing wedge osteotomy for the hallux valgus with moderate severity is better treatment option to achieve better radiographic correction and to prevent loss of correction or recurrence than distal chevron osteotomy.

• Journal of Korean Foot and Ankle Society
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• v.12 no.1
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• pp.14-19
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• 2008

Purpose: We tried to understand the effects of the derotational closing wedge Akin osteotomy during the operation for the hallux valgus with pronation of great toe. Materials and Methods: Eighty five patients who had undergone Akin osteotomy among the eighty seven patients who had been treated with Scarf osteotomy with hallux valgus were included in this study. Derotational supination was added on the medial closing wedge Akin osteotomy at the base of proximal phalanx and it was secured with K-wire, headless screw or staple. We measured and analyzed pre- and post-operative hallux primus valgus angle and hallux pronational rotatory angle. Results: The hallux primus valgus angle improved an average of $14{\pm}2.98$ degrees to $-1{\pm}1.68$ degrees with the hallux pronational rotatory angle respectively from $24.8{\pm}7.64$ degrees to $4.7{\pm}4.22$ degrees. Conclusions: After the metatarsal osteotomy for the treatment of the hallux valgus with the pronation of great toe, derotational closing wedge Akin osteotomy can give us a belief that it can correct the hallux primus valgus angle and hallux pronational rotatory angle also and it can be a helpful method for minimizing the recurrence rate of the hallux valgus deformity.

• Journal of Korean Foot and Ankle Society
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• v.12 no.2
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• pp.134-139
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• 2008

Purpose: The purpose of this study was to evaluate the radiological and clinical results of modified scarf osteotomy for hallux valgus with lesser metatarsalgia. Materials and Methods: Total 19 patients (24 feet) were reviewed by medical records and radiographs. All patients were female and the mean age at the time of operation was 46.4 years. The mean follow-up time was 14.8 months. We modified original scarf osteotomy by adding the procedure of closing wedge osteotomy at the medial side of distal fragment for achieving of the supination of the first metatarsal head. Additionally, Akin osteotomy of the first proximal phalanx was done in 16 patients (20 feet) and no lesser metatarsal operation was done. First-second intermetatarsal, hallux valgus and distal metatarsal articular angles were analyzed radiologically before and after the operation. And 3-dimensional CT was used to evaluate the supination of the first metatarsal head. Clinical results were assessed by American Orthopaedic Foot and Ankle Society (AOFAS) score and persistence of lesser metatarsalgia. Results: First-second intermetatarsal and hallux valgus angles were reduced from the mean pre-operative values of $14.2^{\circ}$ and $32.5^{\circ}$ to $8^{\circ}$ and $12.5^{\circ}$, respectively, 12 months after the operation. And the supination of the first metatarsal head was confirmed by 3-dimensional CT. The mean AOFAS score improved from 41.4 points pre-operatively to 87.2 points at follow-up. Lesser metatarsalgia still remained in 2 patients (2 feet). Conclusion: Modified scarf osteotomy would be an effective surgical procedure, especially, for achieving downward displacement and supination of the first metatarsal head in hallux valgus with lesser metatarsalgia.