A modified less invasive double first-metatarsal osteotomy for severe hallux valgus

Minimally invasive techniques have been used successfully in mild to moderate hallux valgus (HV) deformity, while controversy exists for their use in cases with more severe involvement. The purpose of this prospective study was to evaluate the outcomes of a modified less invasive technique for management of severe HV deformity.

Between January 2010 and 2013, a total of 15 active patients (20 ft) met our selection criteria for symptomatic severe HV deformity and treated by a modified double metatarsal osteotomy technique. The procedure implied simple transverse-osteotomy, with lateral translation, of the first metatarsal both distally and proximally combined with selective distal soft-tissue procedure. Average patient’s age was 43.9 years. Radiologically, HV angle, intermetatarsal angle, distal metatarsal articular angle, tibial sesamoid position, and joint congruity were assessed preoperatively and at the final follow-up. Clinically, the American Orthopedic Foot and Ankle Society scale and the subjective patient’s satisfaction were also evaluated. All data were statistically analyzed, and the complications were reported.

The average follow-up was 22.6 months (range 16–30 months). Union was achieved in all osteotomies in a mean of 6.22 ± 0.79 weeks. Each clinical and radiological parameter showed a statistically significant improvement (P < 0.001), with a negligible first-ray shortening (P = 0.617) and a few complications. At final follow-up, none of the patient was dissatisfied.

The modified double metatarsal osteotomy technique provides a simple, reproducible, and effective alternative for correction of all components of severe HV deformity in a less invasive manner.