title: Clinical outcome after Chevron-Akin double osteotomy versus isolated Chevron procedure: a prospective matched group analysis.
abstract: BACKGROUND
  Hallux valgus is a frequent condition of the forefoot, resulting in cosmetic deformity and pain. Chevron osteotomy (CO) is widely employed for the treatment of hallux valgus. Chevron-Akin double osteotomy (CAO) was previously described and superiority over an isolated Chevron procedure was assumed. The objective of this study was to compare the short-to-middle term outcomes of CO and CAO.
  
  
  METHODS
  This study included 72 patients with established diagnosis of mild-to-moderate hallux valgus, treated by either isolated CO or CAO. The CO group included 46 patients (mean 51.5 years) with a mean hallux valgus angle of 27°, while the CAO group included 26 subjects (mean 53.1 years) and a mean hallux valgus angle of 32° preoperatively. All patients were reviewed by physical examination, and standardized questionnaire, and pre- and postoperative standing X-rays were performed. Matched group analysis was carried out to analyze statistical differences of both techniques.
  
  
  RESULTS
  The patients were assessed and group matched at a mean of 1.37 years for the CO group and 1.04 years for the CAO group, postoperatively. Mean improvement of HVA (hallux valgus angle) was 10.6° in the CO group and the CAO group improved by 17.5°. DMAA (distal metatarsal articular angle) improved in the CO group by 5.4° and in the CAO by 13.7°. Mean AOFAS score improved by 27.9 (CO) and 21.5 (CAO). Patient satisfaction was high in both groups, with a tendency towards higher values within the CAO group.
  
  
  CONCLUSIONS
  These findings indicate that Chevron-Akin double osteotomy is a save and practicable procedure for the treatment of mild-to-moderate hallux valgus. Superiority of combined Chevron-Akin procedure over an isolated Chevron osteotomy might be limited to distinct clinical settings, but should not be generally assumed.
authors.affiliation: Klinik und Poliklinik für Orthopädie und Orthopädische Chirurgie, für die Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser Karl V Allee 3, 93077 Bad Abbach, Germany. p.lechler@asklepios.com
authors.forename: Philipp
authors.initials: P
authors.lastname: Lechler
authors.forename: Christine
authors.initials: C
authors.lastname: Feldmann
authors.forename: Franz Xaver
authors.initials: FX
authors.lastname: Köck
authors.forename: Jens
authors.initials: J
authors.lastname: Schaumburger
authors.forename: Joachim
authors.initials: J
authors.lastname: Grifka
authors.forename: Martin
authors.initials: M
authors.lastname: Handel
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D006215:Hallux Valgus / Q000601:surgery*; D006801:Humans; D008297:Male; D008682:Metatarsal Bones / Q000601:surgery*; D008875:Middle Aged; D010027:Osteotomy / Q000379:methods*; D017060:Patient Satisfaction; D011446:Prospective Studies; D050277:Toe Phalanges / Q000601:surgery*; D016896:Treatment Outcome