First metatarsal proximal crescentic osteotomy for surgical treatment of moderate and severe hallux valgus: a retrospective study

Abstract

Objective: To evaluate qualitatively and quantitatively the potential for deformity correction of the intermetatarsal and metatarsophalangeal angles, and the rate of patient satisfaction. Methods: Fifty-six feet with symptomatic moderate or severe deformity were operated between 2002 and 2011. We evaluated 35 patients (38 feet) operated with the same technique by the same surgeon; 89% of them being female, 57.9% right foot and having 46 years as mean age. Preoperative measurements: 14.3° for intermetatarsal angle average and 31.6° for metatarsophalangeal angle average. Follow-up was of 21.7 months. X-ray measurements of the weight bearing feet in AP and lateral were analyzed and the symptoms evaluated pre and postoperatively. The protocol of the service where the study was carried out and the American Orthopaedic Foot and Ankle Society score were utilized. Three approaches were used: crescentic osteotomy of base of first metatarsal, metatarsophalangeal medial capsuloplasty and tenotomy of the adductor hallucis tendon. The osteotomies were fixed with two Kirschner wires and with one or two screws. Results: The postoperative intermetatarsal angle ranged on average 9.1º and metatarsophalangeal angle ranged on average 15.9º. Subjective evaluation showed 31 patients satisfied, 2 partially satisfied, and 2 dissatisfied. The final American Orthopaedic Foot and Ankle Society score was 92.1% with excellent or good results and 7.9% with regular results. There were no complaints of metatarsalgias postoperatively. Conclusion: The technique used in the treatment of symptomatic moderate and severe deformities was efficient in quantitative reduction of the deformity, providing high levels of patient satisfaction.