Comparison of Postoperative Height Changes of the Second Metatarsal Among 3 Osteotomy Methods for Hallux Valgus Deformity Correction

Choi, Jun Young; Suh, Yu Min; Yeom, Ji Woong; Suh, Jin Soo

doi:10.1177/1071100716666566

Cited by 11 publications

(9 citation statements)

References 18 publications

(25 reference statements)

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“…3,7 The results reported in this series are comparable with previous published data for the same technique or other standard procedures such as scarf or chevron osteotomy and soft tissue release procedures. 1,3,14,17,21,22 We report a significant clinical statistical improvement on the HMIS score (AOFAS official scale for assessing forefoot pathology). Significant improvement was observed on pain and function sub-scores of the HMIS score (p < 0.05).…”

Section: Discussionmentioning

confidence: 89%

Lateral hemiepiphysiodesis of the first metatarsal for juvenile hallux valgus

Sabah¹,

Rosello²,

Clément³

et al. 2018

J Orthop Surg (Hong Kong)

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Background: Juvenile hallux valgus (JHV) frequently results in an impaired quality of life because of pain and deformity. We used a validated clinical score to investigate the efficacy of lateral hemiepiphysiodesis of the first metatarsal base as a treatment for JHV. Methods: We conducted a prospective, nonrandomized, single center cohort study of children who underwent lateral hemiepiphysiodesis for 31-IV, with a clinical and radiologic follow-up of at least 2 years. The efficiency of the procedure was assessed with the Hallux Metatarsophalangeal Interphalangeal Scale (HMIS), the metatarsophalangeal angle (MPA), and intermetatarsal angle (IMA). Results: Twelve patients (22 feet) with JHV were treated by lateral hemiepiphysiodesis between 2012 and 2015. Average age at surgery was 10 years, and average follow-up was 3.5 years. The average HMIS score increased from an average of 56 at baseline, to 92 at last follow-up (p < 0.01). The average IMA decreased by 2 , from 13 preoperatively to 11 postoperatively. Average MPA decreased from 26 at baseline to 22 after surgery. No complications occurred in the immediate postoperative period, and no patient needed an additional procedure. Conclusion: The HMIS score was significantly improved after lateral hemiepiphyslodesis, with a clear improvement in pain and functional impairment at last follow-up. We noted a stabilization of the IMA and MPA, but the radiologic benefit did not reach statistical significance. Our data support the use of lateral hemiepiphysiodesis as an effective and safe treatment of JHV.

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Section: Discussionmentioning

confidence: 89%

Lateral hemiepiphysiodesis of the first metatarsal for juvenile hallux valgus

Sabah¹,

Rosello²,

Clément³

et al. 2018

J Orthop Surg (Hong Kong)

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“…It was noticed that the callosities could be improved along with the hallux valgus deformity even if the improvement in some patients with a negative second metatarsal head after the operation was attributed to the redistribution of plantar pressure or to the decrease in pressure under the lesser metatarsal heads. Choi reported that the incidence of a persistent painful plantar callosity under the second metatarsal head after surgery was high (25.9%) compared with Scarf and proximal osteotomies 8 . However, the results of our study were different in that painful plantar callosities were alleviated, and the reason could be that although the method used was similar, most of the patients enrolled had more severe painful preoperative metatarsalgia than Choi’s patients, so they were more inclined to have benefited from POCO.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, osteotomy correcting the hallux valgus deformity with minimized shortening of the first metatarsal was recommended 12 . Nevertheless, even if the osteotomy direction is perpendicular to the first metatarsal longitudinal axis, the shortening does occur rather frequently (the bone loss from sawing) 8,12,13 . Choi considered transfer metatarsalgia to be treated by increasing the first metatarsal length or decreasing the second metatarsal length (only preferred when first metatarsal lengthening was limited by soft tissue) 8 .…”

Section: Discussionmentioning

confidence: 99%

“…Nevertheless, even if the osteotomy direction is perpendicular to the first metatarsal longitudinal axis, the shortening does occur rather frequently (the bone loss from sawing) 8,12,13 . Choi considered transfer metatarsalgia to be treated by increasing the first metatarsal length or decreasing the second metatarsal length (only preferred when first metatarsal lengthening was limited by soft tissue) 8 . In addition to the method of changing length, Guler proposed that distal oblique metatarsal osteotomy provides plantar displacement of the distal fragment of the first metatarsal to compensate for shortening of the metatarsal 12 .…”

Section: Discussionmentioning

confidence: 99%

“…In the traditional method, the direction of the Chevron osteotomy was recommended to be vertical to the plane after eliminating the osteophyte. Choi used the oblique method with Chevron osteotomy and found that there was a comparable effect with the modified scarf in correcting the height change in the second metatarsal head 8 . However, no research has focused on the relationship between the theoretical decline distance of the first metatarsal and the actual height changes of the second metatarsal head or the correctional power of the osteotomy.…”

Section: Introductionmentioning

confidence: 99%

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The plantarward oblique Chevron osteotomy: an optional method to treat hallux valgus with painful plantar callosities

Guo

Qin

Zhang

et al. 2019

Sci Rep

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Hallux valgus (HV) is a foot deformity that can be treated with Chevron osteotomy, and a modified plantarward oblique osteotomy has been proposed in recent years. However, no research has focused on the correctional power of the osteotomy. The aim of this study was to examine the character of this plantarward oblique Chevron osteotomy (POCO) and to determine the rationale of this method.Radiographs and clinical data from 65 HV patients (77 feet) with painful callosities were evaluated. The intermetatarsal angle, hallux valgus angle, and relative height of the second metatarsal were measured, and a valid width of the first metatarsal was proposed. A visual analogue scale (VAS) and the American Orthopaedic Foot and Ankle Society hallux-metatarsophalangeal interphalangeal scale (AOFAS) were used to evaluate the patients’ clinical results.There were significant differences in the HVA and IMA. The decline in the height of the second metatarsal was positively related to the decline in the height of the first metatarsal, but the changes were smaller for the first metatarsal. Painful callosities disappeared in 77 feet, 4 (5.1%) patients had no pain but a remaining plantar callosity, and 2 (2.6%) patient had relieved pain with a plantar callosity after follow-up. The VAS scores improved from 8.58 ± 0.50 to 1.96 ± 0.75 points after the operation (p < 0.001). Significant differences were demonstrated in the AOFAS scores (65.81 ± 4.05 vs 87.88 ± 3.41, p < 0.001). The modified POCO prevents the dorsal migration of the metatarsal head, preserves other lesser metatarsals and provides an opportunity for patients who may possibly need additional future deformity correction. Therefore, POCO is a safe and effective method to treat hallux valgus and offers the superior potential benefits of correction and transfer metatarsalgia.

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