[Valgus osteotomy of the first metatarsal by a bone graft.]

The authors describe their experience of valgus osteotomy of the first metatarsal in hallux valgus - metatarsus primus varus (HV-MTPV). It is based on the Stamm technique consisting in the resection of one third of the base of the proximal phalanx of the great toe. From the resected part they make a wedge-shaped bone graft. Subsequently, they extend the section and perform a two-third transversal osteotomy of the first metatarsal (MT) 1 cm distal to the cuneometatarsal joint. The rest of the bone is broken into valgus position by pressure. Afterwards, the bone graft is inserted in the open osteotomy line from the medial side. Valgus position is fixed a wire loop. In contrast to the Stamm procedure the authors perform no additional operations on the tendon apparatus. They put emphasis on a stable fixation and an early rehabilitation of the metatarsal joint. Since 1991 they have performed in total 69 valgus osteotomies on 51 patients. In eight cases only osteotomy was performed without the resection of the base, the bone graft was made from the resected bone prominence of the head of the first metatarsal and the adductor of the great toe was released. In case of metatarsalgia this procedure is combined with Helal or Wolf osteotomy. The operation has proved successful in the most severe defects with hallux valgus angle (HVA) exceeding 40 degrees , intermetatarsal angle (IMA) above 16 degrees and incongruency of the MTP joint. Lateralisation of sesame bones is spontaneously corrected after the surgery. Six months after operation 90 % of patients were satisfied with the result. In four patients the surgery did not bring the expected effect. The first after valgus revision of the great toe and varus revision of the metatarsal. In his case osteotomy was combined with Silver operation without resection of the base. Insufficient release of the adductor of the great toe resulted in the recurrence of the defect. In the second patient there occurred necrosis of the head and in the third patient the MTP joint got rigid as a result of the inadequate resection of the base of the phalanx of the great toe. The fourth patient was lost to follow-up. The surgical lengthening of the first metatarsal is 1 mm. The authors evaluated its relative length together with HVA and IMA angles and compared the group of patients with healthy population. They came to the conclusion that a longer first metatarsal potentiates the development of the defect. A detailed statistic analysis of these measurements will be presented in the next publication. Key words: hallux valgus, metatarsus primus varus (HV-MTPV), osteotomy of the first metatarsal.