Minimally invasive double-level osteotomy of the first metatarsus for treatment of severe hallux valgus

Background
Surgery for the treatment of severe hallux valgus (HV) is commenced to correct the forefoot deformity, provide metatarsalgia relief, and provide a stable biomechanically functional foot. Many surgeons advocate moving from open surgery to minimally invasive techniques, replacing large incisions with smaller ones through which the surgeon can work. Minimally invasive techniques have been successfully used for mild to moderate HV deformities; however, controversy exists for their use in cases with more severe involvement. The aim of this prospective study was to assess the clinical and radiological outcomes of a minimally invasive technique for management of severe HV deformity.
Patients and methods
Between March 2015 and August 2017, a total of 24 feet in 18 active patients, comprising 11 female and seven male patients, with six patients having bilateral involvement, met our selection criteria for symptomatic severe HV deformity and were treated with a minimally invasive double-level metatarsal osteotomy technique. The surgery is done through simple transverse osteotomy, with lateral translation, of the first metatarsus both proximally and distally combined with selective distal soft-tissue dissection. The average age of patients was 37.7 years. Clinically, the American Orthopedic Foot and Ankle Society score and the subjective patient's satisfaction were evaluated. Radiologically, HV angle, distal metatarsal articular angle, and intermetatarsal angle and joint congruity were measured preoperatively, postoperatively, and at the end of the follow-up period. All data were statistically analyzed.
Results
The mean follow-up period was 22.7 months (range, 18–30 months). Union was achieved in all osteotomies in a mean of 6.67±0.45 weeks. Each radiological and clinical parameter showed a statistically significant improvement (<0.001), with negligible first-ray shortening (=0.547) and a few complications. At the end of follow-up period, no patient was dissatisfied.
Conclusion
Minimally invasive double-level first metatarsal osteotomy technique with selective distal soft-tissue dissection provides a simple, effective procedure, and reproducible alternative for treatment of severe HV deformity.