Distal linear osteotomy compared to oblique diaphyseal osteotomy in moderate to severe hallux valgus

There are no comparative studies of proximal and distal osteotomy for treatment of moderate to severe hallux valgus. Our purpose was to compare the surgical outcomes of modified proximal Ludloff (oblique diaphyseal) osteotomy with modified distal Bösch (distal linear) osteotomy by a single surgeon in moderate to severe hallux valgus.

This retrospective study included feet with a hallux valgus angle greater than 30 degrees. A total of 30 feet (average age, 64.5 years) underwent Ludloff and 32 feet (average age, 61.1 years) underwent Bösch osteotomy. Both osteotomies were combined with distal soft tissue procedure. Clinical outcomes including AOFAS score and satisfaction rate were compared and radiographic parameters analyzed at 2~years of followup.

AOFAS scores were equivalent (p=0.483), with comparable satisfaction rates in both groups (p=0.418). The radiographic results including hallux valgus angle (p=0.026), intermetatarsal angle 1-2 (p<0.001), sesamoid position (p=0.008), correction of intermetatarsal angle 1-2 (p<0.001), and change of sesamoid position (p<0.001) were significantly better in the Bösch group. Correction of hallux valgus angle (p=0.308) and shortening of the first metatarsal (p=0.086) were insignificant with the numbers available. Recurrence developed in eight feet of the Ludloff group and two of the Bösch group (p=0.040). Dorsiflexion malunion occurred in four feet in the Bösch group, as compared with one in the Ludloff group.

Our study found that distal linear osteotomy was a more reliable reconstruction with equivalent function outcomes than an oblique diaphyseal osteotomy. Additional fixation may be necessary to decrease sagittal malunion in distal Bösch osteotomy.