scholarly journals A Comparison of First Ray Length and Dorsiflexion after Arthrodesis, Osteotomy and Suture Button Procedures for Hallux Valgus Deformity

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0021
Author(s):  
Ian Foran ◽  
Nasima Mehraban ◽  
Stephen K. Jacobsen ◽  
Daniel D. Bohl ◽  
Johnny L. Lin ◽  
...  
Keyword(s):  
Hallux Valgus ◽  
Valgus Deformity ◽  
Wedge Osteotomy ◽  
Treatment Groups ◽  
Suture Button ◽  
Hallux Valgus Deformity ◽  
Radiographic Measurements ◽  
Valgus Angle ◽  
First Ray ◽  
Postoperative Symptoms

Category: Bunion; Lesser Toes; Midfoot/Forefoot Introduction/Purpose: Shortening and dorsiflexion of the first metatarsal are a known side effect of metatarsal osteotomies for hallux valgus (HV) deformity with the potential to cause transfer metatarsalgia. We compared the effect of the first tarsometatarsal joint arthrodesis (Lapidus), proximal lateral closing wedge osteotomy (PLCWO), and intermetatarsal suture button fixation procedures on the length and dorsiflexion of the first ray. Methods: We retrospectively evaluated 123 feet in 115 patients. The average age was 54. There were 106 females. Eighty-four feet had a Lapidus procedure, 14 had a PLCWO, and 24 had intermetatarsal suture button fixation. Digital radiographic measurements were made for pre- and postoperative hallux valgus angle (HVA) and intermetatarsal angle (IMA), absolute and relative shortening of the first ray, and dorsiflexion. Results: Preoperative HVA and IMA did not differ between treatment groups (p>0.05 for each). Similar corrections of HVA (30.1 to 12.3 degrees) and IMA (14.7 to 7.0 degrees) were achieved in all three groups (p>0.05). There were significant differences in absolute first-cuneiform-metatarsal length (FCML) between Lapidus (-1.5mm), PLCWO (-2.5mm), and intermetatarsal suture button fixation (+1.1mm) (p<0.05). There were also significant differences in relative 1st metatarsal shortening between Lapidus (0.32mm relative lengthening), PLCWO (1.05mm relative shortening), and intermetatarsal suture button fixation (1.24mm lengthening) (p<0.05). Average dorsiflexion differed between the Lapidus (1.95 degrees) and PLCWO groups (0.49 degrees) (p<0.05). Conclusion: The use of the intermetatarsal suture button fixation relatively lengthens the first ray, whereas the Lapidus and PLCWO shorten it. Dorsiflexion may be higher with Lapidus and osteotomy procedures. These findings may be helpful to explain postoperative symptoms of metatarsalgia and for the surgeon’s selection of the appropriate surgical technique for preoperative planning. [Table: see text]

Radiographic Impact of Lapidus, Proximal Lateral Closing Wedge Osteotomy, and Suture Button Procedures on First Ray Length and Dorsiflexion for Hallux Valgus

2020 ◽  
Vol 41 (8) ◽  
pp. 964-971 ◽  
Author(s):  
Ian M. Foran ◽  
Nasima Mehraban ◽  
Stephen K. Jacobsen ◽  
Daniel D. Bohl ◽  
Johnny Lin ◽  
...  
Keyword(s):  
Hallux Valgus ◽  
Wedge Osteotomy ◽  
Level Of Evidence ◽  
Closing Wedge Osteotomy ◽  
First Metatarsal ◽  
Suture Button ◽  
Closing Wedge ◽  
Radiographic Measurements ◽  
Valgus Angle ◽  
First Ray

Background: Shortening and dorsiflexion of the first metatarsal are known potential side effects of metatarsal osteotomies for hallux valgus (HV) with the potential to cause transfer metatarsalgia. We compared the effect of the first tarsometatarsal joint arthrodesis (Lapidus procedure), proximal lateral closing wedge osteotomy (PLCWO), and intermetatarsal suture button fixation procedures on the length and dorsiflexion of the first ray. Methods: We retrospectively evaluated 105 feet in 99 patients with 30 weeks of follow-up. The average age was 54 years. Seventy-four feet had a Lapidus procedure, 12 had a PLCWO, and 19 had intermetatarsal suture button fixation. Digital radiographic measurements were made for the pre- and postoperative hallux valgus angle (HVA) and intermetatarsal angle (IMA), absolute and relative shortening of the first ray, and dorsiflexion. Results: Preoperative HVA and IMA did not differ between treatment groups ( P > .05 for each). Similar corrections of HVA (30.5-13.5 degrees) were achieved between all groups ( P > .05). The IMA was improved more in the Lapidus group (14.3-6.5 degrees) compared with the suture button fixation group (14.2-8.1 degrees) ( P = .045). There were significant differences in the change in absolute first cuneiform–metatarsal length (FCML) between the Lapidus (–1.6 mm), PLCWO (–2.3 mm), and intermetatarsal suture button fixation (+1.9 mm) procedure ( P = .004). There were also significant differences in relative first metatarsal shortening between the Lapidus (0.1 mm relative shortening), PLCWO (1.1 mm relative shortening), and intermetatarsal suture button fixation (1.3 mm lengthening) procedure ( P < .001). The average dorsiflexion differed between the Lapidus (1.8 degrees) and suture button fixation (0.4 degrees) groups ( P = .004). Conclusion: Intermetatarsal suture button fixation relatively lengthened the first ray, the Lapidus procedure maintained length, and the PLCWO relatively and absolutely shortened it. Dorsiflexion may be higher with the Lapidus and osteotomy procedures. Level of Evidence: Level III, retrospective comparative series.

scholarly journals Extended Distal Chevron Osteotomy

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0002 ◽  
Author(s):  
Chan Kang ◽  
Jaehwang Song ◽  
Donghun Kang ◽  
Chang-Kyun Noh ◽  
Ahn Ki Jun
Keyword(s):  
Hallux Valgus ◽  
Valgus Deformity ◽  
Plantar Surface ◽  
Chevron Osteotomy ◽  
Hallux Valgus Deformity ◽  
Radiographic Measurements ◽  
Valgus Angle ◽  
Group A ◽  
Group B

Category: Bunion, Midfoot/Forefoot Introduction/Purpose: Numerous corrective osteotomies have been performed for surgical treatment of hallux valgus(HV). One of these procedures is distal chevron osteotomy, traditionally indicated for correction of mild to moderate HV. We proposed a new modification of the chevron osteotomy, extended distal chevron osteotomy, to provide even greater stability by extend the contact surface, as well as more effective and accurate correction of the angulation and rotational profile than conventional osteotomy. Methods: Between July 2013 and June 2014, the extended distal chevron osteotomy (DCO) was performed for the treatment of mild-to-moderate hallux valgus deformity in 63 feet (Group A) by the same surgeon. For the extended chevron, the first osteotomy was performed to cut 5-10 mm from the head of metatarsal to the proximal upper 1/3 of the neck. The second osteotomy was performed to cut 2.5~3.0 cm from the upper 1/3 of the neck toward horizontal plane of the plantar surface with an angle of 45~50 degree. Standard foot radiographic measurements, hallux valgus angle(HVA) and intermetatarsal angle(IMA), were recorded to compare with the values of 37 patients (Group B) who were treated by the traditional DCO technique. Results: Mean patient age was 45.3 (range 15–78) years, and 54 patients were available for follow-up at both one and two years postoperatively. Mean follow-up duration was 13.7 (range 4–26) months. In group A, mean HVA decreased from 32.3° preoperatively to 8.4° at final follow-up, while the angle of group B decreased from 32.4° to 11.4°. Mean IMA decreased from 15.1° preoperatively to 7.3° at final follow-up in group A, while the IMA decreased from 15.1° to 8.9° in group B. That way we could verify that the extended chevron osteotomy is more effective for stability and correcting of the angulation and rotational profile than traditional DCO. Conclusion: The extended chevron osteotomy achieved even greater stability and accurate correction of the deformity. Furthermore, it was more effective than traditional chevron osteotomy in terms of correction of the angulation and rotational profile.

Hallux Valgus: Demographics, Etiology, and Radiographic Assessment

2007 ◽  
Vol 28 (7) ◽  
pp. 759-777 ◽  
Author(s):  
Michael J. Coughlin ◽  
Caroll P. Jones
Keyword(s):  
Hallux Valgus ◽  
Metatarsophalangeal Joint ◽  
Valgus Deformity ◽  
First Metatarsophalangeal Joint ◽  
First Metatarsal ◽  
Hallux Valgus Deformity ◽  
Valgus Angle ◽  
First Ray ◽  
The Mean ◽  
Severe Hallux Valgus

Background The purpose of the study was to preoperatively evaluate the demographics, etiology, and radiographic findings associated with moderate and severe hallux valgus deformities in adult patients (over 20 years of age) treated operatively over a 33-month period in a single surgeon's practice. Methods Patients treated for a hallux valgus deformity between September, 1999, and May, 2002, were identified. Patients who had mild deformities (hallux valgus angle < 20 degrees), concurrent degenerative arthritis of the first metatarsophalangeal joint, inflammatory arthritis, recurrent deformities, or congruent deformities were excluded. When enrolled, all patients filled out a standardized questionnaire and had a routine examination that included standard radiographs, range of motion testing, and first ray mobility measurement. A chart review and evaluation of preoperative radiographs were completed on all eligible patients. Results One-hundred and three of 108 (96%) patients (122 feet) with a diagnosis of moderate or severe hallux valgus (hallux valgus angle of 20 degrees or more) 70 qualified for the study. The onset of the hallux valgus deformity peaked during the third decade although the distribution of occurrence was almost equal from the second through fifth decades. Twenty-eight of 122 feet (23%) developed a deformity at an age of 20 years or younger. Eighty-six (83%) of patients had a positive family history for hallux valgus deformities and 87 (84%) patients had bilateral bunions. 15% of patients in the present series had moderate or severe pes planus based on a positive Harris mat study. Only 11% (14 feet) had evidence of an Achilles or gastrocnemius tendon contracture. Radiographic analysis found that 86 of 122 feet (71%) had an oval or curved metatarsophalangeal joint. Thirty-nine feet (32%) had moderate or severe metatarsus adductus. A long first metatarsal was common in patients with hallux valgus (110 of 122 feet; 71%); the mean increased length of the first metatarsal when compared to the second was 2.4 mm. While uncommon, the incidence of an os intermetatarsum was 7% and a proximal first metatarsal facet was 7%. The mean preoperative first ray mobility as measured with Klaue's device was 7.2 mm. 16 of 22 (13%) feet were observed to have increased first ray mobility before surgery. Conclusions The magnitude of the hallux valgus deformity was not associated with Achilles or gastrocnemius tendon tightness, increased first ray mobility, bilaterality or pes planus. Neither the magnitude of the preoperative angular deformity nor increasing age had any association with the magnitude of the first metatarsophalangeal joint range of motion. Constricting shoes and occupation were implicated by 35 (34%) patients as a cause of the bunions. A familial history of bunions, bilateral involvement, female gender, a long first metatarsal, and an oval or curved metatarsophalangeal joint articular surface were common findings. Increased first ray mobility and plantar gapping of the first metatarsocuneiform joint were more common in patients with hallux valgus than in the general population (when compared with historical controls).

Correlation analysis of the x-ray and functional parameters from the results of chevron (Austin) osteotomy for hallux valgus

2020 ◽  
pp. 54-63
Author(s):  
Ruslan Khairutdinov ◽  
Timur Minasov ◽  
Ekaterina Yakupova ◽  
Elvina Mukhametzyanova
Keyword(s):  
Hallux Valgus ◽  
Rating Scale ◽  
Metatarsophalangeal Joint ◽  
Valgus Deformity ◽  
First Metatarsophalangeal Joint ◽  
Chevron Osteotomy ◽  
Hallux Valgus Deformity ◽  
Valgus Angle ◽  
The Right ◽  
Bone Structures

Hallux valgus is characterized by the appearance and growth of a painful “lump” in the region of the first metatarsophalangeal joint, the development of forefoot corns, and inability to choose the right shoes, which leads to a significant decrease in the quality of life of these patients. Corrective osteotomies that preserve the metatarsophalangeal joint, for example Austin (Chevron) osteotomy, are usually used for hallux valgus deformity of the I, II degrees. Radiography with the study of the hallux valgus angle (HVA), the intermetatarsal angle (IMA), the distal metatarsal articular angle (DMAA) is a research method that shows the true correlation between bone structures. The correlation between the radiological and functional indicators of osteotomy allows us to determine possible recommendations for indications for surgical treatment of Hallux valgus. Correlation shows that the largest correction of hallux valgus in older patients occurs due to a small adjustment of the angle of DMMA and HVA. IMA had the best correction after Austin osteotomy among patients of a younger age, then the HVA, and the DMMA had minimum correction according to the AOFAS rating scale (Kitaoka). The revealed correlations allow us to determine the correct tactics for the treatment of hallux valgus by identifying the benefits of Austin osteotomy.

Rates of Revision Surgery Using Chevron-Austin Osteotomy, Lapidus Arthrodesis, and Closing Base Wedge Osteotomy for Correction of Hallux Valgus Deformity

2008 ◽  
Vol 47 (4) ◽  
pp. 267-272 ◽  
Author(s):  
Pieter M. Lagaay ◽  
Graham A. Hamilton ◽  
Lawrence A. Ford ◽  
Matthew E. Williams ◽  
Shannon M. Rush ◽  
...  
Keyword(s):  
Hallux Valgus ◽  
Revision Surgery ◽  
Valgus Deformity ◽  
Wedge Osteotomy ◽  
Hallux Valgus Deformity

Effect of Hallux Valgus Correction with Kinesiology Taping on Hindfoot Position. Pilot Study

2021 ◽  
Vol 23 (4) ◽  
pp. 295-303
Author(s):  
Tobiasz Żłobiński ◽  
Anna Stolecka-Warzecha ◽  
Magdalena Hartman-Petrycka ◽  
Barbara Błońska-Fajfrowska
Keyword(s):  
Pilot Study ◽  
Hallux Valgus ◽  
Valgus Deformity ◽  
Loading Pattern ◽  
Hallux Valgus Deformity ◽  
Valgus Angle ◽  
Position Correction ◽  
Foot Loading ◽  
Study Participants ◽  
Foot Position

Background. Hallux valgus is the most common deformity of the forefoot. It has a multifactorial aetiology, with hindfoot valgus considered one of its causes. The aim of this study was to evaluate hindfoot position and loading pattern after a treatment of Kinesiology Taping (KT) for the mechanical correction of hallux valgus. Material and methods. The study involved 25 feet with hallux valgus deformity and hindfoot valgus. The hallux valgus angle (HVA) and hindfoot angle were assessed with a 3D scanner. Hindfoot loading pattern was examined with a baropodometric platform while standing and during gait. Measurements were taken on the following three occasions: before and immediately after KT placement as well as after a month of taping. Results. The KT treatment had a significant influence on the hindfoot angle (p<0.001) and HVA (p<0.001) measured while standing and on lateral heel loading in dynamic conditions during gait (p<0.01). Conclusions. 1. KT decreased HVA and improved hindfoot position while standing in the pilot study participants. 2. KT exerted a corrective influence on the foot loading pattern in patients with hallux valgus and hindfoot pronation. 3. The foot position correction and normalisation of foot loading achieved in the pilot study provide a basis for further research on KT effectiveness in patients with hallux valgus and hindfoot pronation.

scholarly journals Natural Progression of Radiographic Indices in Juvenile Hallux Valgus Deformity

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0031
Author(s):  
Seung Yeol Lee ◽  
Soon-Sun Kwon ◽  
Moon Seok Park ◽  
Kyoung Min Lee
Keyword(s):  
Hallux Valgus ◽  
Older Patients ◽  
Valgus Deformity ◽  
Hallux Valgus Angle ◽  
Intermetatarsal Angle ◽  
Younger Patients ◽  
Hallux Valgus Deformity ◽  
Metatarsal Angle ◽  
Valgus Angle ◽  
Metatarsus Adductus

Category: Bunion Introduction/Purpose: There is a lack of quantitative studies on the progression of juvenile hallux valgus deformity. Therefore, we performed this study to estimate an annual change of radiographic indices for juvenile hallux valgus. Methods: We reviewed medical records of consecutive patients under the age of 15 with juvenile hallux valgus who underwent weight-bearing foot radiographs more than twice, and were followed over a period of one year or more. A total of 133 feet from 69 patients were included. Hallux valgus angle, hallux interphalangeal angle, intermetatarsal angle, metatarsus adductus angle, distal metatarsal articular angle, anteroposterior talo-1st metatarsal angle, anteroposterior talo-2nd metatarsal angle, and lateral talo-1st metatarsal angle were measured and were used as a study criteria. The progression rate of hallux valgus angle was adjusted by multiple factors including the use of a linear mixed model with gender and radiographic measurements as the fixed effects and laterality and each subject as the random effect. Results: Our results demonstrate that the value of hallux valgus angle on the radiographs progressed as the patients grew older. The hallux valgus angle increased by 0.8° per year (p<0.001)(Figure). The distal metatarsal articular angle also increased by 0.8 per year (p=0.003). Conversely, hallux interphalangeal angle decreased by 0.2° per year (p=0.019). Progression of the intermetatarsal angle and metatarsus adductus angle with aging were not statistically significant. There was a difference in progression of radiographic indices between older patients (≥10 years) and younger patients (<10 years). The hallux valgus angle increased by 1.5° per year (p<0.001) in younger patients, progression of the hallux valgus angle in older patients was not statistically significant (p=0.869) as children grew up. Conclusion: These results suggest that the hallux valgus angle increased in patients with juvenile hallux valgus under 10 years old, unlike the patients aged 10 or older. We believed that our results can help surgeons to determine a treatment strategy that uses the growth potential to achieve correction of deformity such as lateral hemiepiphyseodesis of the 1st metatarsal to patients with juvenile hallux valgus.

scholarly journals Tibialis Anterior Tendon Partial Release and Plantar Implant Placement for Midfoot Arthrodesis: Technique Tip

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0035
Author(s):  
Daniel Miles ◽  
Tyler W. Fraser ◽  
Neal Huang ◽  
Franklin B. Davis ◽  
Jesse F. Doty
Keyword(s):  
Hallux Valgus ◽  
Tibialis Anterior ◽  
Valgus Deformity ◽  
Wound Complications ◽  
Soft Tissue Coverage ◽  
Pes Planovalgus ◽  
Tibialis Anterior Tendon ◽  
Tarsometatarsal Joint ◽  
Hallux Valgus Deformity ◽  
First Ray

Category: Midfoot/Forefoot; Other Introduction/Purpose: Midfoot arthrodesis is a reliable procedure for deformity correction and pain relief. First tarsometatarsal arthrodesis can be used for correction of hallux valgus deformity with large intermetatarsal angles or first-ray hypermobility. Midfoot arthrodesis is also integral in correction of pes planovalgus deformity with midfoot collapse. First tarsometatarsal arthrodesis has a nonunion rate of 2-15%. Arthrodesis is completed traditionally through a dorsal approach. Due to high nonunion rates, recent studies have investigated plater based plates. These have been shown to have superior strength by creating a tension band construct as the foot is loaded. Tibialis anterior footprint is at risk when accessing first tarsometatarsal joint for arthrodesis. We explore whether the tibialis insertional footprint can be released and repaired with no deleterious effects. Methods: Patients included were undergoing first tarsometatarsal joint or naviculocuneiform joint arthrodesis with a plantar based plate and screw construct for hallux valgus deformity with large intermetatarsal angle or first-ray hypermobility, and those with first TMT joint arthritis, pes planovalgus, Lisfranc injury, or Charcot neuroarthropathy. Medial based surgical approach is centered over the first tarsometatarsal joint. Saphenous neurovascular bundle is retracted dorsally. Release of the capsular structures allowed for complete visualization and distraction of the joint. The distal-most attachment of the tibialis anterior tendon onto the first metatarsal is release in line with the capsulotomy. Primary insertion on the medial cuneiform was preserved. A cuff of released insertional tissue is preserved and reflected distally for repair. Standard tarsometatarsal arthrodesis joint preparation was completed. Plantar plate then fixed and compressed. Deep fascial layers were then closed over the plated were previous tendon release was performed. Results: In 62 patients, none had tibialis anterior tendon rupture, weakness, or irritation, with average follow-up of 36.2 months. Nine wound complications were recognized during the study. Twelve percent of patients experiencing delayed incisional healing that went on to heal with local wound care. Smokers accounted for six of the seven patients (OR 24.62, p<.05), and one of seven patients had Charcot (OR 2.08, p<.05). Deep wound complications, which required return to the operating room for formal irrigation and debridement, were seen in 3% (2 of 62). Both patients were active smokers and had removal of hardware at the time of debridement. Both underwent definitive coverage with split-thickness skin grafts and went on to successful arthrodesis and wound healing. Conclusion: One advantage of applying a plate and screw construct plantarly for midfoot arthrodesis is biomechanical stability. Multiple studies have indicated this plantar construct may be superior. Another benefit may be less hardware prominence due to increased soft-tissue coverage. Subcutaneous positions of dorsal plates have been reported to contribute to incisional irritation and symptomatic hardware. Tibialis anterior tendon damage has been suggested as a limitation of the plantar approach for midfoot arthrodesis, and the tendon insertion must be released to prepare the joint adequately to apply implants. This series shows tendon release can be safely accomplished without any deleterious effects. [Table: see text]

The Modified Lapidus Procedure for Hallux Valgus: A Clinical and Radiographic Analysis

2005 ◽  
Vol 26 (11) ◽  
pp. 913-917 ◽  
Author(s):  
Franz J. Kopp ◽  
Mihir M. Patel ◽  
David S. Levine ◽  
Jonathan T. Deland
Keyword(s):  
Hallux Valgus ◽  
Valgus Deformity ◽  
Hallux Varus ◽  
Hallux Valgus Deformity ◽  
Age At Surgery ◽  
First Ray ◽  
Foot Function ◽  
Visual Analog Pain Score ◽  
Radiographic Data ◽  
Subjective Sensation

Background: Historically, the modified Lapidus procedure has been considered technically challenging, with high rates of complications, including nonunion and malunion. The purpose of this study was to review the clinical and radiographic results of this technique for the treatment of hallux valgus associated with first ray hypermobility, specifically examining patient satisfaction and the incidence of complications. Methods: We retrospectively reviewed the results of the modified Lapidus procedure in 32 patients (38 feet). Evaluation included preoperative and postoperative questionnaires, physical examination, and radiographs. Results: Complete clinical data was available for 29 patients (35 feet) and complete radiographic data for 29 patients (34 feet). Average age at surgery was 54 (range 27 to 84) years. Average followup was 42 months (range 29 to 93) months. Average preoperative visual analog pain score was 7.2 and postoperative 2.3 ( p < 0.001). Average preoperative AOFAS Hallux MTP-IP Score was 44.8 and postoperative 87.3 ( p < 0.001). Average preoperative intermetatarsal (IM) angle was 16 degrees, and the hallux valgus (HV) angle was 34 degrees. Postoperatively, the average IM angle was 6 degrees, the HV angle 11 degrees. There were no cases of nonunion or malunion. Complications included symptomatic hallux varus in two, recurrence of hallux valgus deformity in one, deep venous thrombosis in one, and failure of fixation in one patient. Twenty-four percent of patients (7 of 29) noted the subjective sensation of midfoot stiffness and 34% (10 of 29) noted forefoot stiffness. None of these patients thought that the stiffness was a disability. Ninety percent of patients (26 of 29) were satisfied with their foot function, and 86% (25 of 29) were satisfied with the cosmetic appearance of their foot. Conclusions: The modified Lapidus procedure results in a satisfactory clinical outcome in most patients. With meticulous operative technique, rigid internal fixation, and strict postoperative weightbearing restrictions, successful union can be achieved and complications can be minimized. Care should be taken to avoid hallux varus, and patients need to be counseled regarding a potentially long convalescent period and possible postoperative stiffness.

Biplanar Chevron Osteotomy

2002 ◽  
Vol 23 (9) ◽  
pp. 792-798 ◽  
Author(s):  
Caio Nery ◽  
Rui Barroco ◽  
Cibele Réssio
Keyword(s):  
Hallux Valgus ◽  
Valgus Deformity ◽  
Average Score ◽  
Intermetatarsal Angle ◽  
Chevron Osteotomy ◽  
Hallux Valgus Deformity ◽  
Valgus Angle ◽  
Radiological Data ◽  
End Of Treatment

Results of biplanar chevron osteotomy performed on patients with mild-to-moderate hallux valgus deformity with an increased distal metatarsal articular angle (DMAA) are shown. The study included clinical data of 32 patients (54 feet) who had completed a 2-year follow-up, and radiological data of these 32 and other 29 patients (50 feet) for a total of 61 patients (104 feet, 53 right and 51 left). There were 59 females and two males with ages varying from 11 to 66 years. According to the AOFAS Hallux Rating, the preoperative average score (50) improved to 90 (average score after the surgery). The hallux valgus angle was improved from an average of 25° to 14°, the first intermetatarsal angle from 12° to 8° and the DMAA from 15° to 5°. At the end of treatment, 94% of patients were classified as having grade 0 or I sesamoid lateral sub-luxation. Given improvement in angles and 90% of patients satisfied with an average AOFAS postoperative score of 90, the technique seems indicated for treatment of symptomatic hallux valgus deformity with increased DMAA.

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