Results of Minimal Incision Distal Metatarsal Osteotomy for Moderate to Severe Hallux Valgus

Jung-Wook Huh; Il-Soo Eun; Young-Chul Ko; Man-Jun Park; Sook-Hyun Park

doi:10.14193/jkfas.2015.19.2.51

Journal List > J Korean Foot Ankle Soc > v.19(2) > 1043371

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Huh, Eun, Ko, Park, and Park: Results of Minimal Incision Distal Metatarsal Osteotomy for Moderate to Severe Hallux Valgus

Original Article

J Korean Foot Ankle Soc 2015;19(2):51-57.

Published online: 19 June 2015

DOI: https://doi.org/10.14193/jkfas.2015.19.2.51

Results of Minimal Incision Distal Metatarsal Osteotomy for Moderate to Severe Hallux Valgus

Jung-Wook Huh, Il-Soo Eun, Young-Chul Ko, Man-Jun Park, Sook-Hyun Park

Department of Orthopedic Surgery, Busan Medical Center, Busan, Korea

Corresponding Author: Il-Soo Eun Department of Orthopedic Surgery, Busan Medical Center, 359 Worldcup-daero, Yeonje-gu, Busan 611-706, Korea Tel: 82-51-507-3000, Fax: 82-51-507-3001, E-mail: dreun7@hanmail.net

Received 6 April 201525 April 2015 Accepted 27 April 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose:

Minimal incision distal metatarsal osteotomy (MIDMO) is known to be an effective surgical procedure for mild to moderate hallux valgus. However, the result of MIDMO on moderate to severe hallux valgus is controversial; therefore, we investigated the radiological and clinical results of MIDMO on moderate to severe hallux valgus.

Materials and Methods:

We reviewed 51 feet (48 patients) with moderate to severe hallux valgus. The mean age was 67.0 years and the mean follow-up period was 32.2 months. Radiological data of hallux valgus angle, first intermetatarsal angle, and distal metatarsal articular angle on plain radiographs were analyzed. Recurrence, union, lateral translation of distal fragment and angulation were also analyzed. The clinical data were obtained using American Orthopaedic Foot and Ankle Society (AOFAS) score of preoperation and last follow-up. Receiver operating characteristic (ROC) curve was used to determine a cut-off value.

Results:

The mean hallux valgus angle measured at preoperation was 37.7^° and 15.9^° at last follow-up. The mean first intermetatarsal angle of preoperation and last follow-up were 15.2^° and 8.3^°. The mean distal metatarsal articular angle changed from 12.6^° at preoperation to 7.8^° at last follow-up. Preoperative hallux valgus angle (p=0.0051) and distal metatarsal articular angle (p=0.0078) were statistically significant factors affecting postoperative AOFAS score. Cut-off value of each was 37^° and 13^°, respectively. Lateral translation of distal fragment in 5 recurrent cases was 23.0% compared to 45.3% of 46 non-recurrent cases. The result was statistically significant and the cut-off value was 38%.

Conclusion:

Sufficient lateral translation over 38% in MIDMO on moderate to severe hallux valgus patients with preoperative hallux valgus angle under 37° and distal metatarsal articular angle under 13° can lead to good clinical results without recurrence.

Keywords: Moderate to severe hallux valgus, Minimal incision, Distal metatarsal osteotomy

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Figure 1.

The lines are osteotomy site and skin incision line of minimal incision distal metatarsal osteotomy. M-P joint: metatarsophalangeal joint.

Figure 2.

After inserting Kirschner wire from the incision site into the soft tissue of hallus in proximal-todistal direction along the axis, insert the Kirschner wire in the opposite direction.

Figure 3.

The left foot of 59-year-old female was treated with minimal incision distal metatarsal osteotomy. Anteroposterior radiograph of preoperative (A), postoperative (B), and last follow-up (C).

Figure 4.

Receiver operating characteristic curve of recurrence and lateral translation is shown that 38% is proposed as cut-off value. CI: confidence interval, +LR: positive likelihood ratio.

Figure 5.

Receiver operating characteristic curve of American Orthopaedic Foot and Ankle Society score and preoperative hallux valgus angle (HVA) is shown that 37^° is proposed as cut-off value. CI: confidence interval, +LR: positive likelihood ratio.

Figure 6.

Receiver operating characteristic curve of American Orthopaedic Foot and Ankle Society score and preoperative distal metatarsal articular angle (DMAA) is shown that 13^° is proposed as cut-off value. CI: confidence interval, +LR: positive likelihood ratio.

Table 1.

Radiologic Data after Minimal Incision Distal Metatarsal Osteotomy

Angle (^°)	Preoperative	Postoperative	After pin removal	Follow-up			Last follow-up
Angle (^°)	Preoperative	Postoperative	After pin removal	3 mo	6 mo	1 yr	Last follow-up
HVA	37.7	―2.8	8.6	12.8	14.7	15.5	15.9
IMA	15.2	4.2	5.8	6.0	6.3	6.4	8.3
DMAA	12.6	1.1	4.1	6.6	7.9	8.5	7.8

Values are presented as mean. HVA: hallux valgus angle, IMA: intermetatarsal angle, DMAA: distal metatarsal articular angle.

Table 2.

Comparison of Recurrence and Non-recurrence Group

	Lateral translation (%)	Mean preoperative HVA (^°)
Recurrence (n=5)	23.0	39.4
Non-recurrence (n=46)	45.3	35.6
p-value*	0.0045	0.1046

Values are presented as mean. Statistical analysis by logistic regression analysis. HVA: hallux valgus angle. *Paired t-test.

Table 3.

Factors Affecting and Not Affecting AOFAS Score in Minima Incision Distal Metatarsal Osteotomy

Factors affecting	Factors not affecting
AOFAS score	AOFAS score
Preoperative HVA	Preoperative IMA
Preoperative DMAA	Postoperative HVA
	Postoperative IMA
	Postoperative DMAA
	Angulation
	Lateral translation

AOFAS: American Orthopaedic Foot and Ankle Society, HVA: hallux valgus angle, DMAA: distal metatarsal articular angle, IMA: intermetatarsal angle.

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