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Published on: February 17, 2018
Hallux Valgus Repair with Chevron Osteotomy Significantly Narrows Forefoot Width
Raphael Lotan1,2, Benzion Shlomov1,2, Amit Dotan1,2
1Department of Orthopedic Surgery, Wolfson Medical Center, Holon 5822012, Israel.
Insights
Chevron osteotomy significantly narrows forefoot width in hallux valgus surgery, improving cosmetic outcomes and quality of life. Older patients experienced greater forefoot narrowing, potentially due to stiffer soft tissues.
Area of Science:
- Orthopedic surgery
- Foot and ankle reconstruction
- Biomechanical analysis of foot deformities
Background:
- Hallux valgus (HV) is a prevalent adult foot deformity with ongoing debate regarding surgical impact on foot width.
- The effectiveness of chevron first metatarsal osteotomy on forefoot width remains an area of investigation.
Purpose of the Study:
- To evaluate the impact of chevron first metatarsal osteotomy on forefoot width in patients with hallux valgus.
- To analyze changes in both bony and soft tissue width following the surgical procedure.
Main Methods:
- Retrospective analysis of 50 patients who underwent chevron osteotomy for hallux valgus.
- Utilized calibrated standing radiographs to measure bony width (BW) and soft tissue width (STW) preoperatively and postoperatively (3-6 months).
- Included patients with specific angular deformities (HVA > 30°, IMA > 11°, DMMA > 3°) and a minimum 6-month follow-up.
Main Results:
- Surgery significantly improved hallux valgus angle (HVA) and intermetatarsal angle (IMA).
- Mean forefoot bony width (BW) decreased by 1.2 cm (p < 0.001) and soft tissue width (STW) by 0.95 cm (p < 0.001).
- Increased patient age correlated with greater reductions in BW and STW, despite a trend towards lower IMA correction.
Conclusions:
- Chevron osteotomy is an effective procedure for significantly narrowing forefoot width in hallux valgus repair.
- The reduction in forefoot width is anticipated to enhance cosmetic results, footwear options, and overall quality of life.
- Older age appears to be associated with more pronounced forefoot narrowing, possibly attributed to differences in soft tissue elasticity.
Background:
Hallux valgus (HV) is a common adult foot deformity. There is uncertainty concerning the effect of HV surgery on foot width. We examined the effect of chevron first metatarsal osteotomy on forefoot width using calibrated pre and postoperative standing radiographs.
Methods:
A retrospective cohort of 50 patients underwent chevron osteotomy HV surgery. All had HVA > 30°, IMA > 11°, DMMA > 3°, >6-month follow-up, and calibrated pre and postoperative standing foot radiographs. Bony width (BW) and soft tissue width (STW) were used to measure the surgery's effect on foot width. Measurements were made preoperatively and 3-6 months following surgery.
Results:
The study group included 42 women with an average age of 63.4 (±8.3) and a mean BMI of 28.7 (±4.9). Preoperative HVA and IMA were 31.7° (±6.8°) and 13.4° (±2.8°), respectively. Following surgery, HVA and IMA improved significantly, by 15.6° (±5.7°) and 8.7° (±2.3°), respectively. The preoperative average BW was 9.4 cm (±0.6), and the STW was 10.6 cm (±0.7). Following surgery, significant changes in BW and STW were measured, with a mean narrowing of 1.2 cm (±0.4) in BW (p < 0.001) and 0.95 cm (±0.5) in STW (p < 0.001). Paradoxically, an increase in age led to a lower correction of the IMA (p = 0.04, r = 0.57), but higher BW and STW reductions (p = 0.01, r = 0.35 and p = 0.008, r = 0.37, respectively).
Conclusions:
This study reinforced chevron osteotomy as a valid treatment option that significantly narrows forefoot width; it is thus expected to improve cosmetic outcomes, shoe selection options, and quality of life. This study also found that older age correlates with better forefoot narrowing following hallux valgus repair, possibly due to stiffer soft tissues.
