[The retrocapital osteotomy ("chevron") for correction of splayfoot with hallux valgus].
OBJECTIVE
Surgical treatment of hallux valgus deformity with a distal osteotomy of the first metatarsal to address an increased intermetatarsal angle (IMA) I-II. This procedure is combined with a soft-tissue procedure at the first metatarsophalangeal joint: realignment of the first ray, lateral displacement of the first metatarsal head above the sesamoids, rebalancing of the soft tissues at the metatarsophalangeal joint.


METHODS
Pain and soft-tissue inflammation at the bunion, impaired function of the metatarsophalangeal joint, and lateral deviation of the hallux. IMA I-II <or= 15 degrees, hallux valgus angle (HVA) <or= 40 degrees, distal metatarsal articular angle (DMAA) > 10 degrees.


METHODS
Symptomatic osteoarthritis of the first metatarsophalangeal joint, assessed clinically or radiographically. Acute inflammation of the forefoot, osteoporosis of the first metatarsal. Vascular disturbance. Cosmetic indication only. Relative: hypermobility of the first ray, valgus malalignment of the hindfoot, previous retrocapital osteotomy.


METHODS
Lateral soft-tissue release. Resection of the medial pseudoexostosis. V-shaped osteotomy of the distal metatarsal I. Exostosectomy. Lateral displacement of the first metatarsal head. Screw fixation. Realignment of the metatarsophalangeal joint by tightening of the medial soft tissues.


METHODS
Postoperative shoe with full weight bearing. Active exercises of the foot and hallux. Physiotherapy. Prophylaxis of deep vein thrombosis depending on the degree of mobility. Radiographic control after 6 weeks. Bandage or orthosis to maintain toe alignment.


RESULTS
IMA I-II was reduced from 13.6 degrees preoperatively to 6.6 degrees postoperatively. HVA decreased from 29.8 degrees to 8.2 degrees postoperatively.
Gabel
Michael
M
Sektion Fuss und Sprunggelenk, Orthopädische Klinik Paulinenhilfe im Diakonie-Klinikum, Stuttgart, Germany. gabel@diak-stuttgart.de
D001864:Bone Wires; D005096:Exostoses / Q000601:surgery; D005413:Flatfoot / Q000601:surgery*; D005530:Foot Deformities / Q000601:surgery*; D006215:Hallux Valgus / Q000601:surgery*; D006801:Humans; D008682:Metatarsal Bones / Q000601:surgery; D008683:Metatarsophalangeal Joint / Q000601:surgery; D010027:Osteotomy / Q000379:methods*; D011182:Postoperative Care