ChevronOsteotomy with Lateral Release and Adductor Tenotomy For Hallux Valgus

Potenza, Vito; Caterini, Roberto; Farsetti, Pasquale; Forconi, F; Savarese, Eugenio; Nicoletti, Simone; Ippolito, Ernesto

doi:10.3113/fai.2009.0512

Cited by 46 publications

(32 citation statements)

References 20 publications

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“…[9][10][11][12][13][14][15] This includes our previous report demonstrating that the combined method provides an effective and reliable means of correcting moderate to severe hallux valgus deformity with high levels of patient satisfaction and a low incidence of complications. 15 Potenza et al 16 reported that distal chevron osteotomy with lateral release and adductor tenotomy could be used in patients with an increased IMA with satisfactory results. Our results of distal chevron osteotomy are similar to previous studies of proximally placed osteotomy for severe hallux valgus deformity as shown in Table V.…”

Section: Discussionmentioning

confidence: 99%

“…[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.…”

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confidence: 99%

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

et al. 2013

The Bone & Joint Journal

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Severe hallux valgus deformity is conventionally treated with proximal metatarsal osteotomy. Distal metatarsal osteotomy with an associated soft-tissue procedure can also be used in moderate to severe deformity. We compared the clinical and radiological outcomes of proximal and distal chevron osteotomy in severe hallux valgus deformity with a soft-tissue release in both. A total of 110 consecutive female patients (110 feet) were included in a prospective randomised controlled study. A total of 56 patients underwent a proximal procedure and 54 a distal operation. The mean follow-up was 39 months (24 to 54) in the proximal group and 38 months (24 to 52) in the distal group. At follow-up the hallux valgus angle, intermetatarsal angle, distal metatarsal articular angle, tibial sesamoid position, American Orthopaedic Foot and Ankle Society (AOFAS) hallux metatarsophalangeal-interphalangeal score, patient satisfaction level, and complications were similar in each group. Both methods showed significant post-operative improvement and high levels of patient satisfaction. Our results suggest that the distal chevron osteotomy with an associated distal soft-tissue procedure provides a satisfactory method for correcting severe hallux valgus deformity.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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

et al. 2013

The Bone & Joint Journal

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“…From the literature review, proximal metatarsal osteotomy has been chosen as a major operation for moderate to severe HV, due to its superior power of correction; however, potential barriers are complicated surgical technique, longer incision, longer operating time and higher sequential complications when compared with DMO [4,25,27]. On the other hand, DMO has been popularized in some regions of the world because it is easier, requires a shorter incision, has fewer complications and improves pain and functional ability in a wider range of deformities [4,28,29]. In general, DMO is recommended for mild to moderate HV [4,29].…”

Section: Discussionmentioning

confidence: 99%

Comparing proximal and distal metatarsal osteotomy for moderate to severe hallux valgus

Chuckpaiwong

2012

International Orthopaedics (SICOT)

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Purpose This study compared results of distal and proximal metatarsal osteotomy for moderate to severe hallux valgus in terms of radiographic correction and functional outcome. Methods We analyzed 125 moderate to severe hallux valgus surgeries. Patients were divided into two groups. Group 1 underwent distal metatarsal osteotomy, and group 2 underwent proximal metatarsal osteotomy. Patients were interviewed for functional scores before and one year after surgery. The anteroposterior (AP) weight-bearing radiography of the foot was taken before and one year after surgery. Results There were no significant differences in pain and function after one year in either group. Both groups experienced significant pain reduction and increase in all functional scores. There was significant improvement of hallux valgus and intermetatarsal angle corrections in group 2. There was less improvement in radiographic correction in group 1. Conclusion Either distal or proximal metatarsal osteotomy is an appropriate pain-relieving procedure and can increase functional outcome in moderate to severe hallux valgus. However, distal metatarsal osteotomy provides lower correction power.

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“…This soft tissue procedure aims to restore the physiological balance of capsular, ligamentous and muscular structures around the first metatarsophalangeal (MTP) joint. During the last decades worldwide scientific discussions, clinical surveys [1][2][3][4][5][6][7][8], anatomical studies [9,10] and experimental set-ups [11][12][13][14] have helped to clarify open questions about soft tissue procedures: is it necessary in every case of bunion surgery and is there a technique superior in respect of high efficiency and low risk? Certain reservations exist regarding the combination of distal soft tissue procedures and distal metatarsal osteotomies.…”

Section: Introductionmentioning

confidence: 99%

Distal soft tissue procedure in hallux valgus surgery: biomechanical background and technique

Schneider¹

2013

International Orthopaedics (SICOT)

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The distal soft tissue procedure has evolved into an indispensable additional surgical procedure to increase the corrective effect in hallux valgus surgery. Considering the biomechanical development of hallux valgus deformity, degenerative changes of the soft tissues around the first metatarsophalangeal joint contribute much more to the deformity than changes in the bony structures which can rather be seen as degenerative changes secondary to the deformity. Thus the principles in hallux valgus correction should aim to reverse all pathogenetic steps leading to deformity: release of the contracted lateral soft tissue structures, tightening of the torn-out medial structures and reduction and rebalancing the first metatarsal head onto the sesamoid complex. The scientific discussion over the last decades has clarified the impact of different surgical steps and methods on the efficacy of the lateral release, the risk of creating overcorrection or instability of the joint and the risk of avascular necrosis of the first metatarsal head. According to anatomical and clinical data, a lateral soft tissue release can be combined with a distal metatarsal osteotomy, provided that the osteotomy is performed in a defined safe zone without increasing the risk for avascular necrosis of the first metatarsal head. Transecting the lateral metatarsosesamoid suspensory ligament is the key to a successful lateral release in hallux valgus surgery. Release of the deep transverse metatarsal ligament and the adductor hallucis muscle does not contribute to hallux valgus correction. The lateral short sesamophalangeal ligament and the plantar attachment of the articular capsule should be preserved to avoid possible joint instability. Thus today, the distal soft tissue procedure cannot be seen only as a supplementary surgical procedure in cases where the bony procedure needs additional correction, but rather is an indispensable procedure to restore the physiological situation and function of the first metatarsophalangeal joint.

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ChevronOsteotomy with Lateral Release and Adductor Tenotomy For Hallux Valgus

Cited by 46 publications

References 20 publications

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

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

Comparing proximal and distal metatarsal osteotomy for moderate to severe hallux valgus

Distal soft tissue procedure in hallux valgus surgery: biomechanical background and technique

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