F-Shaped Osteotomy Combined with Basal Opening Wedge Osteotomy for Severe Hallux Valgus

Abstract

Objective: To evaluate the safety and effectiveness of osteotomy adjacent to the articular surface of the metatarsal head combined with basal opening wedge osteotomy for severe hallux valgus.

Methods: The double osteotomy procedure was carried out in 56 patients (72 feet) with severe hallux valgus deformity, with an average follow-up of 25 months from March 2010 to February 2019. Hallux valgus angle (HVA), distal metatarsal articular angle (DMAA), intermetatarsal angle (IMA), and distal articular set angle (DASA) were measured for all patients via weight-bearing anteroposterior (AP) X-ray images. In addition, the American Orthopedic Foot & Ankle Society (AOFAS) scale was used for evaluating the function of the hallux.

Results: The HVA, IMA, and DMAA reduced from 49.30 ± 6.60, 19.33 ± 4.70, and 29.85 ± 10.96 to 13.19 ± 6.10, 5.97 ± 3.13, and 5.63 ± 3.44, respectively (P < 0.01). DASA decreased from 4.33 ± 2.34 to 4.08 ± 1.91 and did not show a statistically significant difference (P = 0.48). Among the 72 feet, 69 feet healed normally, and 3 feet had bone resorption at the osteotomy edges. No cases of bone sclerosis, bone necrosis, bone nonunion, or ankylosis were observed. On average, the AOFAS score improved from 34.66 ± 12.07 (preoperative) to 88.78 ± 5.73 (postoperative).

Conclusions: The proposed double osteotomy procedure can maintain the match metatarsophalangeal joints without ischemic necrosis of bones, and is demonstrated to be safe, effective, and feasible for correcting severe hallux valgus.

Keywords: Basal opening wedge osteotomy; Metatarsal; Metatarsophalangeal; Reverdin osteotomy; Severe hallux valgus.

Figure 1

Incision positions: the proximal line is for metatarsal basal osteotomy; the distal lateral line is for the resection portion of the dislocated sesamoid; and the distal medial line is for varus F‐osteotomy.

Figure 2

Resection of the osteophytes from the medial metatarsal head: (A) longitudinal incision of the skin; (B) horizontal and inwards Y‐V transposition incision of joint capsule; and (C) resection of osteophytes from the medial metatarsal head.

Figure 3

Varus F‐osteotomy on the medial metatarsal head: (A) F‐like shape; (B) wedge graft was removed with power saw; (C) metatarsal head was fixed with Kirchner pins after osteotomy; and (D) the schematic diagram of b, plane a, b and c, and junction d are labeled.

Figure 4

Metatarsal basal osteotomy and implantation: (A) longitudinal incision on skin and vertical incision on joint capsule; (B) wedge graft from metatarsal head was implanted in metatarsal base; (C) metatarsal base fixation; and (D) schematic diagram of total procedure of metatarsal basal dispose.

Figure 5

Graph of statistical analysis of preoperative and postoperative American Orthopaedic Foot & Ankle Society (AOFAS) scores (***,P < 0.001).

Figure 6

The results of a demonstration case preoperation and 24th months postoperation: (A, B) preoperation image and X‐ray image of right foot, respectively; (C, D) postoperation X‐ray image and picture of right foot, respectively, and preoperation X‐ray image of right foot; (E, F) preoperation image and X‐ray image of right foot, respectively; and (G, H) postoperation X‐ray image and picture of right foot, respectively.

Figure 7

Graph of statistical analysis of preoperative and postoperative different angular values: (A) hallux valgus (HVA); (B) distal articular set angle (DASA); (C) distal metatarsal articular angle (DMAA); and (D) intermetatarsal angle (IMA) (***,P < 0.001).