Proximal opening wedge metatarsal osteotomy for correction of moderate to severe hallux valgus deformity using a locking plate

Abstract

Purpose Hallux valgus is a complex deformity of the first metatarsophalangeal joint, with varus angulation of the first metatarsal, valgus deviation of the great toe and lateral displacement of the sesamoids and the extensor tendons. The aim of the surgery is to achieve correction of the varus deviation of the 1st metatarsal which is considered by some as the primary intrinsic predisposing factor to hallux valgus deformity. Methods We retrospectively reviewed 85 patients (107 feet) who underwent an opening wedge osteotomy of the 1st metatarsal for correction of moderate to severe hallux valgus and metatarsus primus varus. A medially applied anatomic precontoured locking plate was used for fixation of the osteotomy. Results The mean IMA was decreased from 15.8 (range 12-22) degrees to 7.8 (range 0-12) degrees. The mean preoperative HVA was 39 (range 21-52) degrees and the mean postoperative HVA was 11.8 (6-19) degrees. The preoperative AOFAS score was 52 (SD 3.1) and the postoperative score was 85 (SD 5.2). Conclusion The proximal opening wedge metatarsal osteotomy is a safe, effective and reproducible technique for correction of moderate to severe hallux valgus deformity. The use of a locking plate provides enough control at the fragments, enhancing healing of osteotomy and maintenance of the correction even with a violated proximal lateral cortex.

Open wedge metatarsal osteotomy versus crescentic osteotomy to correct severe hallux valgus deformity – A prospective comparative study

“…Due to the mechanical features of an open wedge osteotomy and the correction of the HV and IM angle it was expected to find a slight elongation of the 1st metatarsal compared to the 2nd metatarsal for the patients in group 2 as have been found in similar studies [16,23,24]. In these studies the lengthening has been reported to be 1.2-2.3 mm.…”

“…Numerous techniques have been introduced and published regarding correcting hallux valgus. The operation techniques can be divided into distal metatarsal osteotomy (DMO), mid-shaft osteotomies or proximal metatarsal osteotomy (PMO) [1,[12][13][14][15][16]. The Akin procedure is used to correct the pronation deviation of the proximal phalanx and to correct hallux valgus interphalangealis, when this is still persisting after Foot and Ankle Surgery xxx (2015) xxx-xxx correcting the hallux valgus (HVA) and inter-metatarsal (IMA) angle [17].…”

Biomechanical analysis of two fixation methods for proximal chevron osteotomy of the first metatarsal

“…Also, a number of authors provided clinical and biomechanical data for these implants in foot and ankle surgery [7,20,[27][28][29]. However, to the best of our knowledge, there does not exist any biomechanical data regarding mechanical properties of variable locking plate fixation compared to other types of fixation for proximal chevron osteotomy.…”

“…Therefore, the proximal procedures are recommended for more severe hallux valgus deformities [1,2,[6][7][8].…”

Localized naviculocuneiform arthrodesis combined with osteosynthesis of fracture nonunion of the tarsal navicular bone using a locked plating system

“…Low profile locked plating system has been applied in correction metatarsal osteotomy to correct moderate to severe hallux valgus deformity and first metatarsophalangeal joint arthrodesis, and acceptable results have been obtained. 8,9 We have applied the locked plating system to localized naviculocuneiform arthrodesis (the arthrodesis of the navicular, the middle cuneiform, and the lateral cuneiform) combined with osteosynthesis of fracture nonunion of the navicular, as a salvage surgery for nonunion of the body of the navicular bone associated with symptomatic osteoarthritis. Two years and 6 months after the salvage surgery, fusion of the arthrodesis of the navicular, the middle cuneiform, and the lateral cuneiform including nonunion of navicular fracture was confirmed on the radiographs.…”