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Early Radiographic and Patient-Reported Outcomes of Percutaneous Distal Metatarsal Osteotomy in Adolescent Hallux
David Cieremans1, Sara Ruzzi2, Matthew Titus2
1Rutgers Health, Jersey City Medical Center, Department of Orthopedic Surgery, Jersey City, NJ, USA.
Background:
Percutaneous osteotomy for adolescent hallux valgus has become an increasingly popular technique due to its quick recovery time and effectiveness. Few studies have assessed both the radiographic and clinical outcomes of percutaneous osteotomy. We present a series that demonstrates adequate radiographic correction and favorable postoperative patient-reported outcomes.
Methods:
A retrospective review of 27 percutaneous distal metatarsal osteotomies for adolescent hallux valgus performed by two surgeons was conducted at two urban, tertiary children's hospitals. Cases were excluded if radiographic imaging information was not available. Pre- and postoperative radiographic measurements, including hallux valgus angle (HVA), intermetatarsal angle (IMA), and distal metatarsal articular angle (DMAA), were collected and analyzed. Clinical outcomes were evaluated using the Manchester-Oxford Foot Questionnaire (MOXFQ).
Results:
A total of twenty-seven cases from 2018 to 2022 were included in this analysis. Twenty (74%) were female and 7 (26%) were male. Mean age was 13.7 ± 3.4 years at time of surgery. Mean weight was 60.4 kg ± 25.0. Mean radiographic follow-up time was 53.3 ± 31.1 days for 23/27 (85%) patients. Four patients (15%) were lost to follow up and intraoperative fluoroscopy was utilized for measurements. Mean HVA correction was 26.9° (from 36.1° to 9.2°, P < .001), mean IMA correction was 7.2° (from 13.6° to 6.4°, P < .001), and mean DMAA correction was 13.6° (from 21.1° to 7.5°, P < .001). Postoperative radiographs demonstrated that twenty patients (74%) had HVA values <15°, twenty-one (78%) had IMA values <9°, and twenty-one (78%) had DMAA values <10°. Mean postoperative MOXFQ score was 11.2 ± 5.7 at a mean follow-up of 2.4 years ± 1 year. By subsection, mean walking score was 1.6 ± 1.3, mean pain score was 4.2 ± 3.5, and mean social score was 5.4 ± 3.0.
Conclusions:
Percutaneous distal metatarsal osteotomy demonstrated substantial early radiographic correction with favorable patient-reported outcomes in this cohort. Given limited radiographic follow-up and low patient-reported outcome measure (PROM) completion, these findings should be interpreted as early outcomes. Longer-term studies are required to assess recurrence risk and correction durability in adolescent patients.
Key Concepts:
(1)Percutaneous distal metatarsal osteotomy (PDMO) is increasingly used for adolescent hallux valgus, but published pediatric data remain limited.(2)In this series, PDMO demonstrated substantial early radiographic correction of HVA, IMA, and DMAA.(3)Postoperative patient-reported outcomes among responders showed low residual symptom burden.(4)Short radiographic follow-up and incomplete PROM data limit conclusions regarding recurrence and long-term durability.
Level Of Evidence:
Level IV retrospective case series.
