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

Area of Science:

• Orthopedic Surgery
• Podiatric Surgery
• Foot and Ankle Reconstruction

Background:

• Current literature often contraindicates chevron osteotomy for bunion correction in patients over 50.
• The chevron osteotomy is a common procedure for hallux valgus (bunion) correction.
• Limited data exists on the efficacy of chevron osteotomy in older adult populations.

Purpose of the Study:

• To evaluate the safety and efficacy of the chevron-Akin double osteotomy in patients older than 50 years.
• To determine patient satisfaction and functional outcomes following the procedure.
• To assess radiographic outcomes and identify predictors of success in this age group.

Main Methods:

• Retrospective review of 47 patients (73 bunions) with an average age of 62 years (range, 55-81).
• All patients underwent a chevron-Akin double osteotomy.
• Follow-up averaged 4 years, 6 months, including patient-reported satisfaction and radiographic analysis.

Main Results:

• Overall patient satisfaction rate was 95%.
• No significant first metatarsophalangeal joint pain or stiffness was reported compared to other bunion procedures.
• Better radiographic results were observed in patients with a preoperative intermetatarsal angle < 15 degrees and tibial sesamoid position ≤ 2.

Conclusions:

• The chevron-Akin double osteotomy is a viable and effective option for mild to moderate bunion deformities in patients over 50.
• Age over 50 years should not be considered an absolute contraindication for this surgical approach.
• The addition of the Akin osteotomy enhances correction of hallux angulation and rotation, making it a useful combination procedure for older adults.