title: Correction of moderate to severe hallux valgus with combined proximal opening wedge and distal chevron osteotomies: a reliable technique.
abstract: OBJECTIVE
  The mainstay of surgical correction of hallux valgus is first metatarsal osteotomy, either proximally or distally. We present a technique of combining a distal chevron osteotomy with a proximal opening wedge osteotomy, for the correction of moderate to severe hallux valgus.
  
  
  METHODS
  We reviewed 45 patients (49 feet) who had undergone double osteotomy. Outcome was assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) and the Short Form (SF) -36 Health Survey scores. Radiological measurements were undertaken to assess the correction. The mean age of the patients was 60.8 years (44.2 to 75.3). The mean follow-up was 35.4 months (24 to 51).
  
  
  RESULTS
  The mean AOFAS score improved from 54.7 to 92.3 (p < 0.001) and the mean SF-36 score from 59 to 86 (p < 0.001). The mean hallux valgus and intermetatarsal angles were improved from 41.6(o) to 12.8(o) (p < 0.001) and from 22.1(o) to 7.1(o), respectively (p < 0.001). The mean distal metatarsal articular angle improved from 23(o) to 9.7(o). The mean sesamoid position, as described by Hardy and Clapham, improved from 6.8 to 3.5. The mean length of the first metatarsal was unchanged. The overall rate of complications was 4.1% (two patients).
  
  
  CONCLUSIONS
  These results suggest that a double osteotomy of the first metatarsal is a reliable, safe technique which, when compared with other metatarsal osteotomies, provides strong angular correction and excellent outcomes with a low rate of complications. Cite this article: Bone Joint J 2016;98-B:1202-7.
authors: Princess Alexandra Hospital, Hamstel Rd, Harlow CM20 1QX, UK.
authors: L
authors: L
authors: Jeyaseelan
authors: Princess Alexandra Hospital, Hamstel Rd, Harlow CM20 1QX, UK.
authors: S
authors: S
authors: Chandrashekar
authors: Barts and the London NHS Trust, Whitechapel Rd, London, Whitechapel E1 1BB, UK.
authors: A
authors: A
authors: Mulligan
authors: Homerton NHS Trust, Homerton Row, London E9, UK.
authors: H A
authors: HA
authors: Bosman
authors: Princess Alexandra Hospital, Hamstel Rd, Harlow CM20 1QX, UK.
authors: A J S
authors: AJ
authors: Watson
mesh_terms: D000328:Adult; D000368:Aged; D001863:Bone Screws; D015331:Cohort Studies; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006215:Hallux Valgus / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D008297:Male; D008682:Metatarsal Bones / Q000601:surgery*; D008683:Metatarsophalangeal Joint / Q000601:surgery*; D008875:Middle Aged; D010027:Osteotomy / Q000379:methods*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000503:physiopathology; D020127:Recovery of Function; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome
keywords: Double osteotomy; Hallux valgus; Hallux valgus angle; Intermetatarsal angle