First metatarsal base osteotomy fixed with “Puddu” like plate to treat hallux valgus

Abstract

Objective: Hallux valgus corresponds to a lateral deviation of the hallux associated with medial deviation of the first metatarsal head. The aim of this study is to evaluate for improvement in radiographic parameters of the intermetatarsal angle between first and second metatarsal. Methods: The authors evaluated and followed 18 patients (23 feet), out of which 13 were female and 5 male, with moderate to severe hallux valgus surgically treated with the technique of osteotomy of 1st metatarsal and implementation of the national classifiwedge plate, type “Puddu”, associated with the repair of distal soft tissue and minimum monitoring for a period of 24 months. All patients were evaluated for improvement in radiographic parameters of the intermetatarsal angle between first and second metatarsal (AIM) and answered the questionnaire AOFAS for hallux valgus in two different moments: in the appointment for marking the surgery; and 24 months after the surgery. Results: Their ages ranged between 27 and 71 years (average of 47 years). In applying the AOFAS scale, 75% of patients had scores between 20 and 49 (average: 37.65) points before surgery reaching; after surgery, scores were between 60 and 100 (average: 87.00), when reapplied to the same scale.In the radiological study, AIM showed an average improvement of 6.44 degrees. Conclusion: The base osteotomy of the first metatarsal and the application of the national wedge plate Puddu, for the treatment of moderate to severe hallux valgus, has proved to be a safe and effective method, reducing the pre-existing radiographic AIM and leading to satisfactory surgical outcomes in most patients, however, the national plate had to be removed in a significant portion of these, due to its high profile.