Crescentic Proximal Metatarsal Osteotomy for Moderate to Severe Hallux Valgus: A Mean 12.2 Year Follow-Up Study

Abstract

The senior author's (R.C.) first 25 patients (37 feet) treated with a combination proximal crescentic osteotomy and distal soft-tissue reconstruction made up the patient cohort. All 25 patients were reviewed at a minimum of one year post-op (short-term follow-up) and 20/25 (31/37 feet) were reviewed again at a mean 12.2 years (range 11.4 to 13.0 yrs) post-op (long-term follow-up). This allowed for a comparison of short- and long-term results and led to a long-term follow-up rate of 84% (31/37 feet, mean 12.2 yrs). Clinical, radiographic and patient outcome measures were obtained and compared pre-op and at short- and long-term follow-up. The mean preoperative hallux valgus (HVA) and intermetatarsal angles (IMA) were 37degrees and 16 degrees respectively. The mean HVA correction was 24 degrees and IMA correction 10 degrees at long-term follow-up with no tendency toward recurrence. Sesamoid position and first MTP subluxation was markedly improved postoperatively and the correction was maintained at long-term follow-up. Patients were asked about their satisfaction in terms of pain, appearance and motion. At long-term follow-up, more than 90% of patients were completely satisfied with pain and motion and greater than 80% with their appearance. Ninety-four percent of patients said they would have the operation again. The AOFAS clinical rating scale for the hallux was calculated retrospectively for pre-op and short-term follow-up and prospectively for long-term follow-up. The mean pre-op score was 37/100 (16 to 60) which significantly improved to 92/100 (67 to 100) at both follow-up periods, suggesting no evidence of decrease in outcome over time. Complications included two patients (5%) that were over-corrected into varus (one symptomatic, one asymptomatic), and four patients (11%) that were undercorrected, developing asymptomatic recurrences (>10 degrees increase HVA) at long-term follow-up. In addition, two patients (5%) developed new transfer lesions postoperatively, likely related to technical error (one varus overcorrection, one dorsiflexion malunion). In conclusion, the long-term results, with a mean follow-up of 12.2 years, of the resection realignment procedure for moderate to severe hallux valgus are generally excellent and the complication rate is low and acceptable. Attention to detail, avoiding both undercorrection, which can lead to recurrence, and overcorrection, which can cause symptomatic varus, is essential.

Plate fixation for proximal chevron osteotomy has greater risk for hallux valgus recurrence than Kirschner wire fixation

“…The second limitation of this study is that the follow-up period was short; the results may change if we had followed the patients for a longer time. However, previous studies have compared one-year radiographic results with longer-term results and concluded that results did not change after one year [28,29]. Hallux valgus angle and the intermetatarsal angle stabilised at six months after surgery in the K-wire group, although the sesamoid position continued to deteriorate in this study.…”

Correction of hallux valgus deformity with distal soft tissue realignment and proximal metatarsal osteotomy

“…Degenerative changes of the metatarsophalangeal joint increased at follow-up and were grade 2 or 3 in 20% of the cases. The same observation has been reported by others [5,8,14]. The average AOFAS score at follow-up was 87, and 86% of the results were excellent or good; 94% of the patients felt that the results of the operation were satisfactory or satisfactory with reservations.…”

“…The crescentic osteotomy originally described by Mann et al [5] has been widely used [8,[10][11][12][13][14]. This series represents our initial experience with the distal soft tissue realignment and proximal crescentic metatarsal osteotomy.…”

A minimally invasive technique for surgical treatment of hallux valgus: simple, effective, rapid, inexpensive (SERI)

“…Rarely, also young people and children can be affected by this condition [4]. Several authors have tried to assess pathogenesis and risk factors, which include biomechanical, genetic and familial factors [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]; however, the end point is impairment of the normal function of the first metatarsophalangeal joint. Clinical symptoms include pain and reduced range of motion of the first metatarsophalangeal joint, where bursitis or callosities are often present.…”