Avascular Necrosis of the First Metatarsal Head: Incidence in Distal Osteotomy Combined with Lateral Soft Tissue Release

Abstract

The incidence of avascular necrosis of the metatarsal head following distal first metatarsal osteotomy combined with adductor tendon release has not been documented in a large series of patients. Of 82 consecutive procedures in 64 patients performed between 1986 and 1988, 42 patients (58 procedures) were available for clinical and radiographic examination. Average follow-up was 2.5 years (range 1.0-4.2 years). There were 35 L-shaped and 23 chevron osteotomies which were combined with a lateral soft tissue release that included adductor tenotomy. Preoperative hallux valgus angle averaged 25 degrees (range 15-40 degrees), and intermetatarsal angle averaged 12 degrees (range 5-24 degrees). Follow-up amount of correction averaged 13 degrees and 5 degrees, respectively. Eighty-four percent of patients were satisfied with their result. There was one case of avascular necrosis. The patient was asymptomatic at 4.2 years' follow-up, and the remaining patients included two with infections, one hallux varus, and no nonunions.

The Relationship Between the Sesamoid Complex and the First Metatarsal After Hallux Valgus Surgery Without Lateral Soft-Tissue Release: A Prospective Study

“…These data were supported by findings from magnetic resonance imaging studies (27,48). In contrast, other investigators have found no association between necrosis and wide soft tissue release during hallux valgus surgery (11,(49)(50)(51)(52)(53).…”

Comparison of outcomes between proximal and distal chevron osteotomy, both with supplementary lateral soft-tissue release, for severe hallux valgus deformity

“…10 However, the indications for distal chevron osteotomy are said to be limited to a hallux valgus angle (HVA) < 30° and a firstsecond intermetatarsal angle (IMA) < 15°. [10][11][12][13] Several recent studies have demonstrated that distal chevron osteotomy in conjunction with a distal soft-tissue procedure could enhance the amount of correction, suggesting that this combination can be applied to more severe deformities with a successful outcome. [9][10][11][12][13][14][15][16] However, a risk associated with a distal chevron osteotomy is avascular necrosis of the metatarsal head, 5,17 and an osteotomy combined with a distal softtissue procedure might increase the incidence of avascular necrosis.…”

“…[10][11][12][13] Several recent studies have demonstrated that distal chevron osteotomy in conjunction with a distal soft-tissue procedure could enhance the amount of correction, suggesting that this combination can be applied to more severe deformities with a successful outcome. [9][10][11][12][13][14][15][16] However, a risk associated with a distal chevron osteotomy is avascular necrosis of the metatarsal head, 5,17 and an osteotomy combined with a distal softtissue procedure might increase the incidence of avascular necrosis. 11,15 The purpose of the present study was to compare the clinical and radiological outcomes between proximal chevron and distal chevron osteotomy combined with a soft-tissue procedure in severe hallux valgus deformity.…”

“…[9][10][11][12][13][14][15][16] However, a risk associated with a distal chevron osteotomy is avascular necrosis of the metatarsal head, 5,17 and an osteotomy combined with a distal softtissue procedure might increase the incidence of avascular necrosis. 11,15 The purpose of the present study was to compare the clinical and radiological outcomes between proximal chevron and distal chevron osteotomy combined with a soft-tissue procedure in severe hallux valgus deformity.…”

Radiographic analysis of metatarsus primus varus: 45 feet followed 15 months after distal metatarsal osteotomy and lateral soft-tissue release

“…In nonunion, delayed union and avascular necrosis of the metatarsal head the surgical procedures for distal metatarsal osteotomy should be different. Preserving (Jahss 198 1, Mann andCoughlin 198 1, Mann 1982, Home et al 1984) or performing lateral soft-tissue release (Resch et al 1992, Peterson et al 1994) results in different indications concerning more effective and acceptable limits of metatarsus primus varus (Corless 1976, Johnson et al 1979). …”