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Outcome after distal metatarsal osteotomy for hallux valgus: a prospective randomized controlled trial of two methods
Carlos Saro1, Bodil Andrén, Zandra Wildemyr
1Department of Clinical Science, Division of Orthopaedics, Karolinska Institute at Karolinska University Hospital, Huddinge, S-141 86 Stockholm, Sweden. carlos.saro@ki.se
Background:
Although surgery is the standard treatment for hallux valgus, there is insufficient evidence from randomized trials to determine which methods of treatment are most appropriate.
Methods:
One hundred patients with hallux valgus were randomized to a Lindgren (subcapital, transverse, displacement osteotomy) or a distal chevron osteotomy. Outcome measures, such as the American Orthopaedic Foot and Ankle Society (AOFAS) clinical rating for the hallux, EuroQol (EQ-5D) for health-related quality of life, and visual analogue scales (VAS) for pain were used in addition to radiographic parameters.
Results:
The AOFAS score and VAS demonstrated significant improvement in both groups (p < 0.001) at 1-year followup. There were no differences in outcome between the two procedures regarding patient satisfaction or health-related quality of life as measured by EuroQol (EQ-5D). Patients with limitations in wearing shoes or who were not satisfied with the cosmetic result had a lower EQ-5D. The hallux valgus angle (HVA) and 1-2 intermetatarsal angles (IMA) improved considerably as a result of both operations. The postoperative improvements in HVA, IMA, and 1-2 intermetatarsal distance (IMD) were greater in the Lindgren group. A remaining postoperative HVA of more than 16 degrees was more common in the chevron group.
Conclusions:
Clinical outcomes demonstrated no differences between the procedures, but patients who had a Lindgren osteotomy showed better radiographic correction. Loss of correction was noted in both groups after 3 to 6 years. Neither of the osteotomies is recommended for patients with an HVA of more than 30 degrees or an IMA of more than 15 degrees.
