A modified Austin/chevron osteotomy for treatment of hallux valgus and hallux rigidus

Abstract

The purpose of this brief paper is to present the preliminary results of a modified Austin/chevron osteotomy for treatment of hallux valgus and hallux rigidus. In this procedure, the dorsal arm of the osteotomy is performed orthogonal to the horizontal plane of the first metatarsal, the main advantage being that this allows much easier and more accurate multiplanar correction of first metatarsal deformities. From 2010 to 2013, 184 consecutive patients with symptomatic hallux valgus and 48 patients with hallux rigidus without severe metatarsophalangeal joint degeneration underwent such modified chevron osteotomy. Mean patient age was 54.9 (range 21-70) years, and mean follow-up duration was 41.7 (range 24-56) months. Ninety-three percent of patients were satisfied with the surgery. Mean American Orthopaedic Foot and Ankle Society (AOFAS) score improved from 56.6 preoperatively to 90.6 at last follow-up, and mean visual analog scale (VAS) pain score decreased from 5.7 preoperatively to 1.6 at final follow-up (p < 0.05). In patients treated for hallux valgus, mean hallux valgus angle decreased from 34.1° preoperatively to 6.2° at final follow-up, and mean intermetatarsal angle decreased from 18.5° preoperatively to 4.1° at final follow-up (p < 0.05). One patient developed postoperative transfer metatarsalgia, treated successfully with second-time percutaneous osteotomy of the minor metatarsals, whilst one patient had wound infection that resolved with systemic antibiotics.

Level of evidence: Level IV.

Keywords: Austin/chevron; Hallux rigidus; Hallux valgus; Modified chevron; Osteotomy.

Fig. 1

The dorsal arm of the osteotomy is performed orthogonal to the horizontal plane of the first metatarsal (approximately parallel to the MTPJ surface)

Fig. 2

The plantar arm of the osteotomy is cut proximal to the attachment of the joint capsule to preserve the plantar vascular bundle directed to the metatarsal head fragment

Fig. 3

Performance of the dorsal cuts orthogonal to the horizontal plane of the first metatarsal allows one to easily obtain a precise trapezoidal wedge for accurate PASA correction

Fig. 4

This technique allows easy performance of a precise rectangular wedge according to the desired shortening of the first metatarsal

Fig. 5

Shortened first metatarsal in hallux rigidus for MTPJ decompression. In this case, a trapezoidal wedge was necessary for PASA correction, without shifting the distal fragment laterally (therefore not affecting the IMA)