Hallux valgus and first ray mobility. Surgical technique.

Area of Science:

• Orthopedic Surgery
• Foot and Ankle Surgery
• Skeletal Biomechanics

Background:

• Limited prospective studies exist on surgical outcomes for hallux valgus.
• Evaluating operative treatment for hallux valgus using specific osteotomy and soft-tissue techniques is crucial.

Purpose of the Study:

• To assess the efficacy of proximal crescentic osteotomy and distal soft-tissue repair for moderate to severe hallux valgus.
• To evaluate the impact on the first metatarsophalangeal joint and overall patient function.

Main Methods:

• Prospective study of adult patients with moderate/severe hallux valgus undergoing surgical repair (proximal crescentic osteotomy, distal soft-tissue reconstruction).
• Follow-up evaluation at a minimum of two years post-surgery.
• Assessment included pre- and post-operative pain scores, American Orthopaedic Foot and Ankle Society (AOFAS) scores, range of motion, first ray mobility, and radiographic measurements.

Main Results:

• Significant improvement in mean pain scores (6.5 to 1.1) and AOFAS scores (57 to 91).
• 93% of patients achieved good or excellent results, with hallux valgus angle decreasing from 30 to 10 degrees and intermetatarsal angle from 14.5 to 5.4 degrees.
• First ray mobility normalized in most cases; recurrence occurred in 6% of feet.

Conclusions:

• Proximal crescentic osteotomy with distal soft-tissue realignment is a viable surgical option for moderate to severe subluxated hallux valgus.
• The procedure effectively reduces first ray mobility without requiring metatarsocuneiform arthrodesis.
• Plantar gapping is not a reliable indicator of sagittal plane hypermobility.