title: High Rate of Recurrence Following Proximal Medial Opening Wedge Osteotomy for Correction of Moderate Hallux Valgus.
abstract: BACKGROUND
  The proximal medial opening wedge (PMOW) osteotomy has become more popular to treat moderate to severe hallux valgus with the recent development of specifically designed, low-profile modular plates. Despite the promising results previously reported in the literature, we have noted a high incidence of recurrence in patients treated with a PMOW. The purpose of this study was to report the clinical and radiographic outcomes of an initial cohort of patients treated with a PMOW osteotomy for moderate hallux valgus.
  
  
  METHODS
  We retrospectively analyzed prospectively gathered data on a cohort of 17 consecutive patients who were treated by the senior author using a PMOW osteotomy for moderate hallux valgus deformity. Average time to follow-up was 2.4 years (range, 1.0-3.5 years). The intermetatarsal angle (IMA), the hallux valgus angle (HVA), and the distal metatarsal articular angle (DMAA) were assessed on standard weightbearing radiographs of the foot preoperatively and at all follow-up visits. The Foot and Ankle Outcome Score (FAOS) was collected on all patients preoperatively and at final follow-up.
  
  
  RESULTS
  Despite demonstrating good correction of their deformity initially, 11 of the 17 patients (64.7%) had evidence of recurrence of their hallux valgus deformity at final follow-up. Patients who recurred had a greater preoperative HVA (P = .023) and DMAA (P = .049) than patients who maintained their correction. Improvement in the quality-of-life subscale of the FAOS was noted at final follow-up for all patients (P = .05). There was no significant improvement in any of the other FAOS subscales.
  
  
  CONCLUSIONS
  There was a high rate of recurrence of the hallux valgus deformity in this cohort of patients. Recurrence was associated with greater preoperative deformity and an increased preoperative DMAA. The PMOW without a concomitant distal metatarsal osteotomy may be best reserved for patients with mild hallux valgus deformity without an increased DMAA.
  
  
  METHODS
  Level IV, retrospective case series.
authors.affiliation: Hospital for Special Surgery, New York, NY, USA.
authors.forename: Sravisht
authors.initials: S
authors.lastname: Iyer
authors.affiliation: Hospital for Special Surgery, New York, NY, USA demetracopoulos.md@gmail.com.
authors.forename: Constantine A
authors.initials: CA
authors.lastname: Demetracopoulos
authors.affiliation: Hospital for Special Surgery, New York, NY, USA.
authors.forename: Carolyn M
authors.initials: CM
authors.lastname: Sofka
authors.affiliation: Hospital for Special Surgery, New York, NY, USA.
authors.forename: Scott J
authors.initials: SJ
authors.lastname: Ellis
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006215:Hallux Valgus / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008682:Metatarsal Bones / Q000601:surgery*; D008875:Middle Aged; D010027:Osteotomy / Q000379:methods*; D011788:Quality of Life; D011859:Radiography; D016059:Range of Motion, Articular; D012008:Recurrence; D012042:Registries; D012189:Retrospective Studies; D017211:Treatment Failure; D055815:Young Adult
keywords: hallux valgus; proximal medial opening wedge osteotomy; proximal metatarsal osteotomy; recurrent hallux valgus