Proximal opening-wedge osteotomy of the first metatarsal for hallux valgus using a low profile plate.
BACKGROUND
This retrospective study was conducted to evaluate the results of the proximal (basal) opening-wedge osteotomy of the first metatarsal for correction of symptomatic hallux valgus deformity, using a low profile plate.


METHODS
The procedure was performed by a single surgeon over an 18-month period. Forty-six patients (64 feet) were treated for symptomatic hallux valgus with an average follow up of 20 months. A proximal opening-wedge osteotomy of the first metatarsal and fixation with a low profile plate in combination with a distal soft tissue release with the same postoperative protocol was used in all the patients. Improvement in the hallux valgus angle (HV) and I---II intermetatarsal angle (IM I---II) as well as the AOFAS forefoot score pre and postoperatively (obtained retrospectively from the medical records), were recorded; in particular, the length of the first metatarsal was noted pre- and postoperatively.


RESULTS
The HV and IM I---II angles improved by a mean of 14.7 degrees and 6.4 degrees, respectively. The AOFAS forefoot score improved from a mean of 51.3 to 86.8. The mean increase in the length of the first metatarsal was 2.3 mm. Of the more significant complications, five patients developed a hallux varus (early in the series), one of which was symptomatic, and there was one non-union requiring bone graft.


CONCLUSIONS
The proximal opening wedge osteotomy of the first metatarsal in combination with a distal soft tissue release and stable fixation of the low profile plate was an effective method for correcting a moderate hallux valgus deformity. Guidance provided by the "First Metatarsal Opening Wedge Angle Reference Chart'' was found to be helpful for the IM I-II angle correction.
Linksfield Park Clinic & University of the Witwatersrand, Orthopaedic Surgery, P.O. Box 1153, Highlands North, Johannesburg, Gauteng 2037, South Africa. saragas@global.co.za
Nikiforos P
NP
Saragas
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001860:Bone Plates; D005260:Female; D005500:Follow-Up Studies; D006215:Hallux Valgus / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008682:Metatarsal Bones / Q000000981:diagnostic imaging / Q000601:surgery*; D008875:Middle Aged; D010027:Osteotomy / Q000379:methods*; D011183:Postoperative Complications; D011859:Radiography; D012189:Retrospective Studies; D013977:Tibia / Q000637:transplantation; D016896:Treatment Outcome