Journal List > J Korean Foot Ankle Soc > v.18(2) > 1043332

J Korean Foot Ankle Soc. 2014 Jun;18(2):56-61. Korean.
Published online June 09, 2014.  https://doi.org/10.14193/jkfas.2014.18.2.56
Copyright © 2014 The Korean Foot and Ankle Society. All rights reserved.
Comparison of Operative Results of Distal Chevron Osteotomy with and without Akin Osteotomy for Moderate to Severe Hallux Valgus
Sang Soo Park, Jun Young Lee, and Woong Hee Kim
Department of Orthopaedic Surgery, College of Medicine, Chosun University, Gwangju, Korea.

Corresponding Author: Jun Young Lee. Department of Orthopaedic Surgery, Chosun University Hospital, 365 Pilmun-daero, Dong-gu, Gwangju 501-717, Korea. Tel: 82-62-220-3147, Fax: 82-62-226-3379, Email: leejy88@chosun.ac.kr
Received January 21, 2014; Revised April 29, 2014; Accepted April 30, 2014.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.


Abstract

Purpose

This study was conducted among patients with moderate to severe hallux valgus who underwent distal chevron osteotomy and groups of patients with or without Akin osteotomy were compared for evaluation of the relationship between their radiological and clinical outcomes.

Materials and Methods

From January 2009 to January 2012, among patients with moderate to severe hallux valgus who underwent distal chevron osteotomy at our institution, 28 cases with additional Akin osteotomy and 35 cases without Akin osteotomy available to follow up of more than one year were included in this study. For radiologic evaluation, hallux valgus angle, 1, 2 intermetatarsal angle, and hallux interphalangeal angle were measured before and after surgery. For clinical assessment, visual analogue scale score, American Orthopaedic Foot and Ankle Society score, subjective satisfaction of the patients, and passive range of motion of the first metatarsophalangeal joints were evaluated.

Results

At the final follow up, correction of valgus hallux angle and 1, 2 intermetatarsal angle was obtained from radiation results of both groups and it was found that patients who underwent Akin osteotomy showed radiographically larger angle correction but less subjective satisfaction.

Conclusion

Patients with moderate to severe hallux valgus who underwent distal chevron osteotomy showed not only functional but also radiographically satisfactory results, and patients who underwent additional Akin osteotomy showed decreased subjective satisfaction. Therefore, if an incongruent first metatarsophalangeal joint is not observed, distal chevron osteotomy without Akin osteotomy seems preferable.

Keywords: Hallux valgus; Chevron osteotomy; Akin procedure; Chevron-Akin double osteotomy

Figures


Figure 1
Intraoperative photos show the distal chevron osteotomy (A) and Akin osteotomy (B).
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Figure 2
The right foot of 46-year-old female shows moderate hallux valgus deformity. The deformity was corrected with distal chevron metatarsal osteotomy and distal soft tissue procedure. (A) Preoperative hallux valgus angle was 31.2°, the 1st intermetatarsal angle was 18.4°, and the hallux interphalangeal angle was 7.81°. (B) Postoperative hallux valgus angle was 3.4°, the 1st intermetatarsal angle was 8.5°, and the hallux interphalangeal angle was 7.6°. (C) At postoperative 13 months, the hallux valgus angle was 6.3°, the 1st intermetatarsal angle was 8.0°, and the hallux interphalangeal angle was 12.1°. Clinical result was good with no pain and no limitation of activity.
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Figure 3
The left foot of 54-year-old female shows severe hallux valgus deformity. The deformity was adequately corrected with distal chevron metatarsal osteotomy, distal soft tissue procedure, and Akin procedure. (A, B) Preoperative hallux valgus angle was 39.2°, the 1st intermetatarsal angle was 11.5°, and the hallux interphalangeal angle was 2.1°. (C) Postoperative hallux valgus angle was 2.0°, the 1st intermetatarsal angle was 6.1°, and the hallux interphalangeal angle was 1.16°. (D, E) At postoperative 12 months, the radiograph and the gross photo show well maintained correction of the deformity. Hallux valgus angle was 10.0°, the 1st intermetatarsal angle was 4.0°, and the hallux interphalangeal angle was 1.9°. Subjective satisfaction was very good although passive range of motion in the 1st metatarsophalangeal joint was moderately restricted.
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Figure 4
Comparison of visual analogue scale (VAS) score between the isolated distal chevron osteotomy and the distal chevron osteotomy with Akin procedure. Group I: distal chevron metatarsal osteotomy with Akin osteotomy. Group II: isolated distal chevron metatarsal osteotomy.
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Tables


Table 1
Radiographic Data after Distal Chevron Osteotomy with and without Akin Osteotomy
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Table 2
Clinical Result of AOFAS Score, VAS Score and Subjective Satisfaction
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