title: Proximal reverse chevron metatarsal osteotomy, lateral soft tissue release, and akin osteotomy through a single medial incision for hallux valgus.
abstract: BACKGROUND
  Scarring on the dorsal first web space after lateral soft tissue release can be a major contributor to patient dissatisfaction following hallux valgus surgery. We hypothesized that performing distal soft tissue procedure (DSTP), proximal reverse chevron metatarsal osteotomy (PCMO), and Akin osteotomy through a single medial incision would provide better clinical and radiographic results with improved patient satisfaction compared with bunion corrections performed through 2 incisions.
  
  
  METHODS
  The study included 117 feet (of 98 patients) with moderate to severe hallux valgus. Clinically, the preoperative and final follow-up visual analog scale (VAS) pain scores, the preoperative and final follow-up American Orthopaedic Foot & Ankle Society (AOFAS) hallux metatarsophalangeal (MTP)-interphalangeal (IP) scores, first MTP joint range of motion (ROM), and patient satisfaction after the surgery were evaluated. Radiographically, the hallux valgus angle (HVA), intermetatarsal angle (IMA), hallux valgus interphalangeal angle (HIA), medial sesamoid position (MSP), and first to fifth metatarsal width (1-5MTW) were analyzed before and after surgery.
  
  
  RESULTS
  The mean AOFAS hallux score improved from 56.3 preoperatively to 90.6 at the final follow-up, and the mean VAS pain score decreased from 6.8 preoperatively to 1.5 at the final follow-up (P < .001). Ninety-five percent of the patients were satisfied with the surgery. Radiographically, the mean HVA decreased from 36.1 degrees (range, 16.0 to 44.0 degrees) preoperatively to 5.4 degrees (range, -12.4 to 29.7 degrees) at the final follow-up (P < .001), and the mean IMA decreased from 19.0 degrees (range, 9.0 to 28.0 degrees) preoperatively to 4.5 degrees (range, -5.0 to 14.2 degrees) at the final follow-up (P < .001). The mean 1-5MTW also decreased by 16% (16 mm) from 97.3 mm (range, 85.0 to 110.0 mm) preoperatively to 81.3 mm (range, 70.0 to 95.0 mm) at the final follow-up (P < .001).
  
  
  CONCLUSIONS
  We achieved very favorable clinical and radiographic outcomes with minimal complications in patients with moderate to severe hallux valgus, by treating hallux valgus using DSTP, PCMO, and Akin osteotomy through a single medial incision. The single medial incision scar improved the cosmetic results by avoiding the formation of a disfiguring dorsal first web space scar.
  
  
  METHODS
  Level IV, retrospective case series.
authors.affiliation: Department of Orthopedic Surgery, Konkuk University School of Medicine, Seoul, Korea.
authors.forename: Hong-Geun
authors.initials: HG
authors.lastname: Jung
authors.forename: Tae-Hoon
authors.initials: TH
authors.lastname: Kim
authors.forename: Jong-Tae
authors.initials: JT
authors.lastname: Park
authors.forename: Min-Ho
authors.initials: MH
authors.lastname: Shin
authors.forename: Sang-Hun
authors.initials: SH
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006215:Hallux Valgus / Q000601:surgery*; D006801:Humans; D008297:Male; D008682:Metatarsal Bones / Q000601:surgery*; D008875:Middle Aged; D010027:Osteotomy / Q000379:methods*; D010147:Pain Measurement; D017060:Patient Satisfaction; D016059:Range of Motion, Articular / Q000502:physiology; D016896:Treatment Outcome
keywords: Akin osteotomy; distal soft tissue procedure; dorsal first web space scar; hallux valgus; one medial incision; proximal reverse chevron metatarsal osteotomy