Rotational Osteotomy for Hallux Valgus. A New Technique for Primary and Revision Cases

Wagner, Pablo; Ortiz, Cristián; Wagner, Emilio

doi:10.1097/btf.0000000000000142

Cited by 33 publications

(32 citation statements)

References 17 publications

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“…The importance of MT1 rotation during HV surgery has gained attention over the years. [17] Residual postoperative lateral displacement of sesamoids has been previously associated with HV recurrence, [10][11][12]17] walking pain and arthritis. [14] Accordingly, several attempts have been made to correct the rotational element of the HV deformity and reduce the sesamoid bones into their natural position.…”

Section: Discussionmentioning

confidence: 99%

“…Nyska et al [18] studied different Ludloff osteotomy angles in order to nd the optimal cut in which a correction of the pronation could be obtained. Wegner et al [17] proposed an osteotomy technique that aimed to address the three-dimensional complexity of the HV deformity by a proximal rotational metatarsal osteotomy (PROMO). Okuda presented a proximal supination osteotomy that would simultaneously correct both the varus and the pronation of the MT1.…”

Section: Discussionmentioning

confidence: 99%

“…We used standing x-ray radiographs for sesamoid evaluation, although standing CT scans could have better demonstrated the exact sesamoid location. [17] In our hospital this is the common practice for these patients and, therefore, this was the imaging modality that was available for us in this retrospective series. Because this was a solely radiographic study, we did not present the clinical outcomes or union rates of our patients.…”

mentioning

confidence: 99%

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A Modified Minimally Invasive Osteotomy for Hallux Valgus Allows Reduction of Malpositioned Sesamoid Bones

Palmanovich

Ohana

Slevin

et al. 2020

Preprint

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Background: Current minimally invasive distal metatarsal osteotomy for hallux valgus (HV) is V-shaped, which prevents correcting the rotational metatarsal head deformity and reduction of sesamoid bones. Methods: We retrospectively reviewed the records of 53 patients that underwent HV surgery by a single surgeon from 2017 to 2019 to compare outcomes of three techniques: open chevron osteotomy (n=19), minimally invasive V-shaped osteotomy (n=18), and a modified, straight minimally invasive osteotomy (n=16). Sesamoid position was graded using the Hardy and Clapham method based on standing radiographs. Results: Postoperative sesamoid position scores were significantly lower (better) following the modified osteotomy, compared with the two other techniques (1.44±0.81 vs 3.74±1.48 and 4.61±1.09, P<0.001), and mean change in score was greater (P<0.001). The modified technique yielded the largest improvements in inter-metatarsal and HV angles (P<0.05).Conclusion: The modified minimally invasive osteotomy was superior in the correction of HV deformity in all planes, including sesamoid reduction.Level of Evidence: IV

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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A Modified Minimally Invasive Osteotomy for Hallux Valgus Allows Reduction of Malpositioned Sesamoid Bones

Palmanovich

Ohana

Slevin

et al. 2020

Preprint

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“…A recent Level V case series described a new rotational osteotomy technique for hallux valgus. 95 The proximal rotational metatarsal osteotomy involves a single oblique osteotomy through the proximal metatarsal. After rotational correction is achieved in the frontal plane, a lag screw and medial locking plate are placed to secure the osteotomy.…”

Section: Operative Managementmentioning

confidence: 99%

Hallux Valgus

Ray

Friedmann

Hanselman

et al. 2019

Foot & Ankle Orthopaedics

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Hallux valgus is a common condition that results from a complex positional deformity of the first ray. The bunion or medial prominence that results from the lateral deviation and pronation of the hallux is only one component of the 3-dimensional deformity. Hallux valgus can lead to considerable pain and altered joint mechanics. The precise biomechanical etiology remains under debate. Predisposing factors include female sex, age, constricting footwear, and family history. Metatarsus adductus, equinus contracture, hammertoe deformity, and pes planus often coexist with hallux valgus. Nonoperative treatment involves patient education, shoe modifications, toe pads and positioning devices, and activity modifications. Surgery is considered in patients who fail nonoperative treatment with the goal of pain relief, correction of the deformity, improved first ray stability, and improved quality of life. More than 100 different procedures have been described to treat hallux valgus; they include combinations of soft tissue balancing, metatarsal osteotomies, and fusion of either the metatarsophalangeal (MTP) or tarsometatarsal (TMT) joint. The choice of procedures depends on the severity and location of the deformity as well as surgeon preference. Recent advances in operative techniques include minimally invasive surgery and correction of rotational deformity.

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“…The surgical technique was slightly modified from the previous published technique (Wagner et al). 25 Once the varus and metatarsal rotation angle have been determined, on the calculations table (Table 1), the correct osteotomy angulation was located that the osteotomy needed to follow. In this case, an example with 15 Approach: A medial approach was performed from the metatarsal base to the mid-diaphysis (3 cm approximately).…”

Section: Surgical Techniquementioning

confidence: 99%

Proximal Rotational Metatarsal Osteotomy for Hallux Valgus (PROMO)

Wagner

2018

Foot & Ankle Orthopaedics

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Background: Hallux valgus deformity consists of a lateral deviation of the great toe, metatarsus varus, and pronation of the first metatarsal. Most osteotomies only correct varus, but not the pronation of the metatarsal. Persistent postoperative pronation has been shown to increase deformity recurrence and have worse functional outcomes. The proximal rotational metatarsal osteotomy (PROMO) technique reliably corrects pronation and varus through a stable osteotomy, avoiding fusing any healthy joints. The objective of this research is to show a prospective series of the PROMO technique. Methods: Twenty-five patients (30 feet) were operated with the PROMO technique. The sample included 22 women and 3 men, average age 46 years (range 22-59), for a mean prospective follow-up of 1 year (range 9-14 months). Inclusion criteria included symptomatic hallux valgus deformities, absence of severe joint arthritis, or inflammatory arthropathies, with a metatarsal malrotation of 10 degrees or more, with no tarsometatarsal subluxation or arthritis on the anteroposterior or lateral foot radiograph views. The mean preoperative and postoperative Lower Extremity Functional Scale (LEFS) score, metatarsophalangeal angle, intermetatarsal angle, metatarsal malrotation, complications, satisfaction, and recurrence were recorded. Results: The mean preoperative and postoperative LEFS scores were 56 and 73. The median pre-/postoperative metatarsophalangeal angle was 32.5/4 degrees and the intermetatarsal angle 15.5/5 degrees. The metatarsal rotation was satisfactorily corrected in 24 of 25 patients. An Akin osteotomy was needed in 27 of 30 feet. All patients were satisfied with the surgery, and no recurrence or complications were found. Conclusions: PROMO is a reliable technique, with good short-term results in terms of angular correction, satisfaction, and recurrence. Long-term studies are needed to determine if a lower hallux recurrence rate occurs with the correction of metatarsal rotation in comparison with conventional osteotomies. Level of evidence: IV, prospective case series.

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Rotational Osteotomy for Hallux Valgus. A New Technique for Primary and Revision Cases

Cited by 33 publications

References 17 publications

A Modified Minimally Invasive Osteotomy for Hallux Valgus Allows Reduction of Malpositioned Sesamoid Bones

A Modified Minimally Invasive Osteotomy for Hallux Valgus Allows Reduction of Malpositioned Sesamoid Bones

Hallux Valgus

Proximal Rotational Metatarsal Osteotomy for Hallux Valgus (PROMO)

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