Combination chevron plus Akin osteotomy for hallux valgus: should age be a limiting factor?

Current literature consistently precludes the chevron osteotomy for bunion correction in patients older than age 50 years. We retrospectively reviewed 47 patients (73 bunions) with an average age of 62 years (range, 55-81 years old) who had a chevron-Akin double osteotomy. The mean follow-up was 4 years, 6 months (range, 2 years, 3 months to 8 years, 2 months). The overall satisfaction rate was 95%. No significant pain or stiffness in the first metatarsophalangeal joint occurred in comparison with other bunion procedures. Radiographic results were better for patients with a preoperative intermetatarsal angle of less than 15 degrees and tibial sesamoid position of less than or equal to 2. We disagree with the current recommendation that age older than 50 years is a contraindication to a chevron procedure. The Akin osteotomy adds additional intraoperative correction of the hallux angulation and rotation; thus, the chevron-Akin double osteotomy is a useful combination procedure. We recommend this procedure for the mild to moderate bunion deformity even in elderly patients.