Evaluation of the results of Chevron osteotomy with plantar displacement for the correction of hallux valgus
Keywords:
Hallux Valgus, Osteotomy, Metatarsalgia, CallositiesAbstract
Introduction: We describe a modified Chevron osteotomy for hallux valgus correction, adding plantar displacement of the conventional osteotomy. The motivation to carry out such modification is based on the chevron osteotomy’s varying degrees of shortening of the first metatarsal that can lead to transfer metatarsalgia in patients with Greek foot (minus index) in which the second metatarsal is longer.
Methods: We designed a prospective descriptive study of patients diagnosed with hallux valgus associated to clinical or radiological Greek foot, metatarsalgia or plantar callus that underwent Chevron osteotomy with plantar displacement between 2008 and 2010 in the Clínica del Campestre, Medellín, Colombia. All surgeries were performed by the same surgeon. After the surgery we evaluated the presence and intensity of pain, persistent plantar callus and the presence of transverse arch. AOFAS and VASFA scales were used.
Results: We evaluated 27 surgeries, with a median follow up of 5 months (range 1 to 18 months). The median age of patients was 51 years old (range 31 to 68). Most patients were female. In pre-surgical evaluation, 93% had clinical Greek foot type and 96% radiological (minus index). The transverse arch type was convex in 59%, concave in 22.5%, flat in 18.5%. 78% had metatarsalgia, 85% had plantar callus and 29% had second toe deformity. The median angles IM and MTF were 11° (range 6° to 16°) and 27.5° (range 13° to 38°) respectively. In postoperative assessment, 7 cases were still presenting a casual metatarsalgia and 1 case a plantar callus. 95% recovered and maintained the transverse arch. 86% had no limitation or this was minimal with the use of footwear. In terms of activity, 80% had no limitations whatsoever.
Discussion: The results of this series of patients showed positive findings in the short term, loss of plantar callus and recovery of the transverse arch with improvement in symptoms.
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