Outcome after distal metatarsal osteotomy for hallux valgus: a prospective randomized controlled trial of two methods.
BACKGROUND
Although surgery is the standard treatment for hallux valgus, there is insufficient evidence from randomized trials to determine which methods of treatment are most appropriate.


METHODS
One hundred patients with hallux valgus were randomized to a Lindgren (subcapital, transverse, displacement osteotomy) or a distal chevron osteotomy. Outcome measures, such as the American Orthopaedic Foot and Ankle Society (AOFAS) clinical rating for the hallux, EuroQol (EQ-5D) for health-related quality of life, and visual analogue scales (VAS) for pain were used in addition to radiographic parameters.


RESULTS
The AOFAS score and VAS demonstrated significant improvement in both groups (p < 0.001) at 1-year followup. There were no differences in outcome between the two procedures regarding patient satisfaction or health-related quality of life as measured by EuroQol (EQ-5D). Patients with limitations in wearing shoes or who were not satisfied with the cosmetic result had a lower EQ-5D. The hallux valgus angle (HVA) and 1-2 intermetatarsal angles (IMA) improved considerably as a result of both operations. The postoperative improvements in HVA, IMA, and 1-2 intermetatarsal distance (IMD) were greater in the Lindgren group. A remaining postoperative HVA of more than 16 degrees was more common in the chevron group.


CONCLUSIONS
Clinical outcomes demonstrated no differences between the procedures, but patients who had a Lindgren osteotomy showed better radiographic correction. Loss of correction was noted in both groups after 3 to 6 years. Neither of the osteotomies is recommended for patients with an HVA of more than 30 degrees or an IMA of more than 15 degrees.
Saro
Carlos
C
Department of Clinical Science, Division of Orthopaedics, Karolinska Institute at Karolinska University Hospital, Huddinge, S-141 86 Stockholm, Sweden. carlos.saro@ki.se
Andrén
Bodil
B
Wildemyr
Zandra
Z
Felländer-Tsai
Li
L
D005260:Female; D006215:Hallux Valgus / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008682:Metatarsal Bones / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D010027:Osteotomy / Q000379:methods*; D017060:Patient Satisfaction; D011446:Prospective Studies; D011788:Quality of Life; D016896:Treatment Outcome