Radiographic evaluation of hallux valgus treated with opening wedge osteotomy

There are many techniques described for treatment of hallux valgus. The role of proximal osteotomies of the 1st metatarsal is well documented. However the opening wedge osteotomy has become less popular in contemporary practice. The purpose of this paper was to report our experience with an opening wedge osteotomy for the treatment of hallux valgus using L-Plate fixation.

Twenty-nine patients underwent 31 basal opening wedge osteotomies of the first metatarsal. Fixation was achieved with the Arthrex low profile titanium plate. The IMA on the WB radiograph preoperatively, and at least 12 months postoperatively was measured. Four patients received a 3.5-mm plate, 15 received a 4.0-mm plate, and 12 received a 5.0-mm plate.

The 3.5-mm group had a mean preoperative IMA of 13.8 degrees (range, 6 to 18), and postoperative IMA of 5.8 (range, 3 to 8), with a mean correction of 8.0. The 4.0-mm plate group had a mean preoperative IMA of 16.9 (range, 11 to 30) and postoperative IMA of 8.9 (range, 4 to 11) with a mean correction of 9.0. The 5.0-mm plate group had a mean preoperative IMA of 24.7 (range, 15 to 35) and postoperative IMA of 9.8, (range, 3 to 22) with a mean correction of 14.9.

We report on a successful method for correcting hallux valgus with a basilar first metatarsal opening wedge osteotomy. It was highly effective for correcting moderate to severe intermetatarsal deformities.