Intraoperative incidence of hallux valgus interphalangeus following basilar first metatarsal osteotomy and distal soft tissue realignment.
BACKGROUND
The premise of this study was that after the correction of hallux-metatarsophalangeal pronation, the intraoperative interphalangeal angle (HIA) increases significantly, and that an additional Akin osteotomy (AO) is often needed. Therefore, the purpose of this study was to evaluate whether HIAs in hallux valgus (HV) feet were underestimated, and to assess the need for AO during HV correction.


METHODS
This study was conducted on 54 feet with moderate to severe HV treated from June 2007 to December 2008. HIAs and medial sesamoid subluxations (MSS) were measured initially and intraoperatively after a distal soft tissue procedure (DSTP) and proximal chevron metatarsal osteotomy (PCMO). An intraoperative technique was used to evaluate the incongruency of the metatarsophalangeal joint (MTPJ) to determine the need for additional AO.


RESULTS
After performing DSTP and PCMO, HIAs significantly increased from an average of 9 to 13.3 degrees and MSS reduced from average grade 2.5 to 0.5 (p < 0.05). AO was added in 44 (81%) feet. After an average followup of 13.2 months in Akin group, average VAS pain score decreased from 5.7 to 1.2 and average AOFAS score increased from 57.8 to 90.2 (p < 0.05). Final hallux MTPJ dorsiflexion in the Akin group was significantly larger than in the without-Akin group (p < 0.05).


CONCLUSIONS
Average HIA significantly increased after DSTP and PCMO for moderate to severe HV necessitating additional AO, to achieve ideal HV correction and, to preserve MTPJ motion.
Jae-Yong
JY
Park
Hong-Geun
HG
Jung
Tae-Hoon
TH
Kim
Min-Seok
MS
Kang
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003238:Connective Tissue / Q000601:surgery*; D005260:Female; D006215:Hallux Valgus / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery*; D006801:Humans; D015994:Incidence; D007432:Intraoperative Period; D008297:Male; D008682:Metatarsal Bones / Q000601:surgery*; D008875:Middle Aged; D010027:Osteotomy; D011403:Pronation / Q000502:physiology; D050277:Toe Phalanges; D016896:Treatment Outcome; D016474:Weight-Bearing / Q000502:physiology; D055815:Young Adult