Use of Minimally Invasive Distal Metatarsal Osteotomy for Correction of Hallux Valgus

Abstract

Purpose Minimally invasive surgeries have become increasing popular in Orthopaedics. This study evaluated the clinical and radiographic outcomes of application of the concept for correction of mild-to-moderate hallux valgus deformity. Methods From November 2005 to Feb 2010, 20 patients with hallux valgus deformity had distal metatarsal osteotomy performed using the minimally invasive surgical techniques described by P. Bosch. Three patients had bilateral operation done at the same setting. The patient age ranged from 29 years to 75 years (mean 55.1 years) with 2 men and 18 women. One 2 mm Kirschner wire was used to splint the osteotomy site, which was removed after 4 weeks to 5 weeks. The mean followup time was 22 months. Results All except one foot showed excellent to good grading using the American Orthopaedic Foot and Ankle Society Hallux Scale (total 100 points). The mean score improved from preoperative 53.0 points to postoperative 91.8 points. The hallux valgus angle improved from a preoperative mean of 31.3° to 15.7°, and the first intermetatarsal angle improved from 16.7° to 7.7°. There was no major complication encountered. All patients showed bony union with no avascular necrosis. Three patients had mild pin tract infection. Two patients had backing out of the K-wire and one of them required reinsertion. So far, no patients required reoperation due to recurrence. Conclusion Good clinical and radiographic results have been achieved with minimally invasive techniques for treatment of hallux valgus. This is an acceptable alternative operation for mild-to-moderate hallux valgus.

Bösch technique for hallux valgus surgery in a tropical setting

“…According to Bö sch an HV between 5 and 25 is in general cosmetically accepted. 7 We have used like Tong et al 15 the method proposed by Hiroakiet al 14 to measure the HVA though this was described for crescentic osteotomy. Since the distal segment is lateralized after osteotomy, the reference points to define the longitudinal axis need to be adjusted.…”

“…Since the distal segment is lateralized after osteotomy, the reference points to define the longitudinal axis need to be adjusted. 14,15 The reference points used are distal and proximal to the osteotomy. These points are not influenced by the type and position of the osteotomy.…”

“…These points are not influenced by the type and position of the osteotomy. 14,15 We have performed the operations in a private clinic where an image intensifier was available. The patients were also able to pay for their care.…”

A New Minimally Invasive Surgery of Hallux Valgus: Technique and Preliminary Outcomes

“…The rates of the complications were diverse widely even within the same technique. The Bosch technique was reported to have 0% complication rates [21] or 22% [22] or27.2% [23]. The Reverdin-Isham technique was reported to vary from a 5% [24] to a 73% [25] rate of complications.…”

Anatomical Study of Minimally Invasive Lateral Release Techniques for Hallux Valgus Treatment

“…Although some authors recommend LR, 6,10,14,26,37 others do not consider LR a necessary part of HV correction. 4,17,25,28,39 Furthermore, as direct visualization of the anatomical structures is not obtained during MI procedures, it is difficult to be absolutely certain about the structures claimed to be released *. It is known that the anatomy of the lateral part of the first MTP joint is complex.…”