Chevron Osteotomy for Bunionette

Abstract

Numerous procedures have been described for the surgical treatment of symptomatic bunionettes. We describe the technique, results, and follow-up of patients treated with a chevron osteotomy of the distal fifth metatarsal. This surgical approach to the treatment of bunionette is presented as a viable alternative to other surgical procedures. Sixteen distal fifth metatarsal chevron osteotomies were performed on 12 patients. Follow-up was from 15 months to 6 years, with an average follow-up of 3.2 years. A 100-point scoring system was devised and the average score improved from 44 points before surgery (range 20-65) to 91 points after surgery (range 65-100). There was one complication of a transfer metatarsalgia. The overall results were good to excellent, except for the transfer metatarsalgia, which was rated as fair. We have used the procedure in a laterally deviated, plantar metatarsal. There is concern that alternatives be used in a laterally deviated, plantarflexed fifth metatarsal. We have continued to use the chevron osteotomy with this condition.

Subcapital Oblique Osteotomy for Correction of Bunionette Deformity

“…14,20,21,23 Perhaps the most popular distal osteotomy is the chevron osteotomy. 12,16,18,22,28 Kitaoka and colleagues reported on the long-term results of the chevron osteotomy and found that 64% of patients attained good or excellent results, with a correction of the 4-5 IM angle averaging 2.6 degrees and an average MTP 5 angle correction of 7.9 degrees.…”

“…[12][13][14][15][16][17][18][19][20][21][22][23][24][25] Although not as powerful as proximal metatarsal osteotomies for correcting lateral bowing of the diaphysis or and increased 4-5 IM angle, they do allow for more correction than lateral condylectomy or metatarsal head resection. Such procedures include a transverse osteotomy of the fifth metatarsal neck, 13,25,26 a distal closing-wedge osteotomy with Kirschner wire fixation 27 and a distal oblique osteotomy oriented from distal-lateral to proximal medial.…”

“…14,20,21,23 Perhaps the most popular distal osteotomy is the chevron osteotomy. 12,16,18,22,28 Kitaoka and colleagues reported on the long-term results of the chevron osteotomy and found that 64% of patients attained good or excellent results, with a correction of the 4-5 IM angle averaging 2.6 degrees and an average MTP 5 angle correction of 7.9 degrees.For type I bunionette deformity, the authors routinely perform a subcapital oblique osteotomy of the fifth metatarsal. [29][30][31] In a cadaveric study, this technique was found to have corrective abilities comparable with distal chevron osteotomy.…”

Subcapital Oblique Osteotomy for Correction of Bunionette Deformity

“…[11][12][13][14][15][16][17][18][19][20][21][22][23][24] Although not as powerful as proximal metatarsal osteotomies for correcting lateral bowing of the diaphysis or and increased 4-5 intermetatarsal angle (IMA), they do allow for more correction than lateral condylectomy or metatarsal head resection. Combined with distal soft tissue realignment, this technique is effective and has the advantage of allowing for elevation of the metatarsal head when increased plantar pressure presents as part of the pathology.…”

“…Combined with distal soft tissue realignment, this technique is effective and has the advantage of allowing for elevation of the metatarsal head when increased plantar pressure presents as part of the pathology. 11,15,17,21,27 Kitaoka et al 15 reported long-term results of the chevron osteotomy and found that 64% of patients attained good or excellent results, with a correction of the 4-5 IMA averaging 2.6 degrees and an average MTP 5 angle correction of 7.9 degrees. Lateral condylectomy has been commonly recommended, 1-5 although most reports are primarily anecdotal in follow-up.…”