Surgical treatment of moderate to severe hallux valgus with distal chevron osteotomy associated with distal soft tissue release

Abstract

Objective: To evaluate the patient’s satisfaction with respect to chevron distal osteotomy and lateral soft tissue release in moderate to severe hallux valgus deformities. Methods: Twenty-one patients (31 feet) were retrospectively assessed using the radiographic method for measuring hallux valgus angle (HVA) ?25o and intermetatarsal angle (IMA) ?14o on the pre- and postoperative periods, based on Hardy and Clapham’s criteria and on the center/head/base of the first metatarsal method. Seventeen patients were given a questionnaire (visual analogue scale – VAS) specifically designed for this study, with a minimum two-year follow-up (two to six years). Results: Using the visual analogue scale, we obtained a high overall satisfaction with the procedure regarding pain, function and esthetics. Radiographic momeasurementsshowed an average HVA and IMA correction of 11.4º and 2.9º, respectively, according to the Hardy and Clapham method. The center-head/base method provided an average HVA and IMA correction value of 17.8º and 6.9º, respectively, which accounts for a better correlation of patients’ satisfaction. There were no cases of hallux varus or avascular necrosis (AVN) of the first metatarsal head. Conclusions: The chevron distal osteotomy may be performed with safe release of distal soft tissues in cases of moderate to severe hallux valgus deformities provided that the surgical technique does not impact on the vascularization of the first metatarsal’s head.