The Modified Subcapital Metatarsal Osteotomy in the Treatment of Hallux Valgus Recurrence

Abstract

The purpose of the present study is to illustrate the use of a modified subcapital metatarsal osteotomy (MSMO) in the treatment of hallux valgus (HV) recurrence. The article reports the clinical and radiological outcomes of a cohort of 52 consecutive patients presenting with recurrent HV, treated with MSMO. A total of 52 patients (54 feet) underwent operations between May 2010 and November 2015. The mean time of follow-up was 2.5 years (range 5.5-1.0 years), and the mean age was 49 years (range 22-76 years). The patient cohort comprised 46 female and 6 male patients. The results of this research show that MSMO is a reliable technique for the correction of HV recurrence. The postoperative radiographic assessments show a statistically significant postoperative improvement of the HV angle (P < .05) and the intermetatarsal angle (P < .05). The postoperative position of the tibial sesamoid was significantly improved (P < .1). The distal metatarsal articular angle was improved (P < .001), though assessment may be affected by the previous operations performed on the first metatarsophalangeal joint. The statistical analysis shows that the postoperative American Orthopaedic Foot and Ankle Society Hallux Metatarsophalangeal-Interphalangeal Scale parameters were significantly improved (P < 0.001). Results of this study indicate that the minimally invasive MSMO is effective in restoring anatomical alignment and improving patient outcomes in recurrent cases of HV. Levels of Evidence: Level III: Case-control study

A Systematic Review of Open and Minimally Invasive Surgery for Treating Recurrent Hallux Valgus

“…Of the 195 osteotomy procedures performed, 23 (11.8%) were identified involving MIS techniques (distal first metatarsal osteotomies)—with percutaneous HV correction using an Reverdin–Isham osteotomy (9) and Bosch–Magnan osteotomy (14). 15 …”

“…Out of the 301 feet, 86 (28.6%) underwent revision with MIS techniques—with 32 undergoing a distal first metatarsal osteotomy 14 and 54 undergoing a modified subcapital metatarsal osteotomy (MSMO). 15 Open revision techniques included 80 scarf osteotomies (26.6%), 51 Lapidus procedures (16.9%), and 84 first MTP joint arthrodesis (27.9%). Four studies indicated if their patients/feet included had had multiple revisions following primary correction of HV prior to the planned revision procedure as part of their study—this included 2 bunionectomies prior to MSMO and 4 bunionectomies prior to first MTP arthrodesis.…”

Outcomes of V‐cut Osteotomy on the First Metatarsal Head Combined with Fixation in Mortise‐shaped Bone Groove‐Plasty and Akin Osteotomy on the First Toe for Hallux Valgus Correction

“…Although numerous operative approaches have been proposed aiming at treating HV recurrence, including Scarf osteotomy, 14 modified subcapital metatarsal osteotomy, 15 and lengthening Scarf osteotomy. 16 The recurrence of HV increases the healthy and economic burden of patients, leading to the double hit to patients.…”

“…Taking Chevron osteotomy as an example, it has been reported that recurrent asymptomatic hallux valgus appears in both proximal chevron osteotomy (6.5%) and distal chevron osteotomy (2.2%). 13 Although numerous operative approaches have been proposed aiming at treating HV recurrence, including Scarf osteotomy, 14 modified subcapital metatarsal osteotomy, 15 and lengthening Scarf osteotomy. 16 The recurrence of HV increases the healthy and economic burden of patients, leading to the double hit to patients.…”