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

Abstract

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.

Triplanar Chevron Osteotomy: A Newly Proposed Method to Treat Hallux Valgus Deformities

“…The research enriched our understanding of the morphology and pathology of HV, defined a safe range of hallux operations, and improved the understanding of HV for young clinical orthopaedic surgeons. Hallux valgus is not only a deformity with medial deviation of the first metatarsal and lateral deviation of the sesamoids but also widely considered a triplanar deformity, with involvement of the transverse, sagittal, and frontal planes 6,12 . The literature describes many treatment strategies for HV with the same degree of severity.…”

“…Hallux valgus is not only a deformity with medial deviation of the first metatarsal and lateral deviation of the sesamoids but also widely considered a triplanar deformity, with involvement of the transverse, sagittal, and frontal planes 6, 12 . The literature describes many treatment strategies for HV with the same degree of severity.…”

“…To solve these problems, a modified POCO was proposed in our previous research. It corrected the deformity in the sagittal plane and had good follow‐up results, but it was observed that the length of the first metatarsal was shortened significantly after the operation 6 . The main reason for the shortening was the operation and bone remodeling process after osteotomy.…”

“…4). To mimic deformity correction, the distal fragment was laterally translated, and the first metatarsal head was unchanged in normal chevron osteotomy but lowered in plantar and triplanar osteotomy 6 . The distal fracture was placed laterally, and then the axial, sagittal, and coronal pictures were illustrated.…”

“…As we mentioned in our previous research, HV is a deformity represented in three different planes (coronal, sagittal, and transverse planes). We proposed a modified plantarward oblique chevron osteotomy (POCO) procedure to increase the plantar migration of the metatarsal head; it was proven to be a safe and effective method to treat HV and to offer potential benefits through correction and prevention of transfer metatarsalgia 6 . In addition, the modified POCO procedure corrected the deformities in the coronal and sagittal planes.…”