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Published on: February 17, 2018
Modified Chevron Osteotomy with Distal Soft Tissue Release for Treating Moderate to Severe Hallux Valgus Deformity: A
Xiao-Feng Gong1, Ning Sun1, Heng Li1
1Department of Foot and Ankle Surgery, Beijing Jishuitan Hospital, Peking University Fourth School of Clinical Medicine, Beijing, China.
Insights
Modified Chevron osteotomy with distal soft tissue release effectively corrects moderate to severe hallux valgus (HV) deformity. Pre-operative pain levels significantly predict post-operative residual pain, with minimal clinical important difference (MCID) values established for key outcome measures.
Area of Science:
- Orthopedic Surgery
- Foot and Ankle Surgery
- Biomechanical Engineering
Background:
- Hallux valgus (HV) deformity, particularly moderate to severe cases, presents significant challenges in achieving satisfactory correction and functional recovery.
- Evaluating the effectiveness of surgical interventions requires objective radiographic measures and validated subjective patient-reported outcome scores.
- Establishing minimal clinical important difference (MCID) values is crucial for interpreting the clinical significance of treatment outcomes.
Purpose of the Study:
- To assess the efficacy of modified Chevron osteotomy combined with distal soft tissue release in correcting moderate to severe hallux valgus (HV) deformity.
- To determine the minimal clinical important difference (MCID) for objective (radiographic) and subjective (patient-reported) outcome parameters following surgical correction.
Main Methods:
- Retrospective study of 40 patients (36 female, 4 male; average age 50.95 years) with moderate to severe HV deformity.
- All patients underwent modified Chevron osteotomy and distal soft tissue release.
- Pre- and post-operative data collected included American Orthopaedic Foot and Ankle forefoot score (AOFAS), Visual Analog Scale (VAS), Foot Function Index (FFI), hallux valgus angle (HVA), 1st-2nd intermetatarsal angle (IMA), and distal metatarsal articular angle (DMAA). MCID values were calculated using the distribution-based method.
Main Results:
- A high success rate of 92.5% was observed at a mean follow-up of 14.3 months, with 37 patients achieving satisfactory results.
- One case of overcorrection (hallux varus) and two instances of residual pain were reported; no nonunions occurred.
- Pre-operative VAS score >7 strongly correlated with residual post-operative pain (P < 0.01). Subjective MCID values were 9.50 for AOFAS, 18.92 for FFI, and 1.27 for VAS.
Conclusions:
- Modified Chevron osteotomy with distal soft tissue release provides satisfactory outcomes for moderate to severe hallux valgus (HV) deformity in the early follow-up period.
- Pre-operative severe pain (VAS >7) is a significant predictor of residual post-operative pain.
- Established MCID values aid in the interpretation of treatment effectiveness for AOFAS, FFI, and VAS in HV surgery.
Objective:
To explore whether modified Chevron osteotomy together with distal soft tissue release would correct moderate to severe HV deformity and what is the minimal clinical important difference (MCID) for objective and subjective evaluating parameters.
Methods:
From March 2018 to January 2019, 40 hallux valgus patients (including moderate to severe) were enrolled in this retrospective study. The cohort included four males and 36 females. The average age at surgery was 50.95 (range 22-75) years. All patients underwent modified Chevron osteotomy together with distal soft tissue release and completed at least one follow-up at clinic. The American Orthopaedic Foot and Ankle forefoot score (AOFAS, forefoot), Visual Analog Scale (VAS), and Foot Function Index (FFI) were all collected before and after surgery. Besides, the hallux valgus angle (HVA), 1st-2nd intermetatarsal angle (IMA) and distal metatarsal articular angle (DMAA) were measured both before surgery and at last follow-up. All MCID values were calculated by employing distribution-based method.
Results:
Thirty-seven patients (92.5%) showed satisfied result at a mean 14.3-month follow-up (range 13-22 month). Two patients complained about residual pain at the bunion, and overcorrection (hallux varus) occurred in one patient. Meanwhile, no patient observed nonunion. Being female, age more than 60, residual HVA deformity (>15°), and post IMA more than 9° showed no statistical relationship with the post-operation residual pain (P > 0.05). However, high VAS score before surgery (more than 7) showed strong correlation with residual pain (P < 0.01). The subjective MCID value was 9.50 for AOFAS, 18.92 for FFI, and 1.27 for VAS, respectively.
Conclusion:
The modified Chevron osteotomy together with distal soft tissue release could achieve a satisfied result for moderate to severe HV deformity at early follow-up. The residual pain was associated with severe pain before surgery (VAS more than 7).
