Among patients with moderate-to-severe hallux valgus and increased intermetatarsal angle, proximal opening wedge osteotomy with wedge-plate fixation and proximal chevron osteotomy in combination with a distal soft-tissue procedure both offered predictably successful results, according to study results.
Researchers randomly assigned 75 patients with hallux valgus with an increased intermetatarsal angle to receive a proximal opening wedge osteotomy of the first metatarsal with wedge-plate fixation or a proximal chevron osteotomy fixed with two mini-fragment screws only and no plate. Clinical outcome scores of the SF-36, the American Orthopaedic Foot & Ankle Society forefoot questionnaire, and VAS for pain, activity and patient satisfaction were collected, and patients were assessed prior to surgery and at 3, 6 and 12 months postoperatively. Using questionnaires and operative times required for each procedure, the researchers evaluated surgeon preference.
Study results showed no significant differences for any of the patients’ clinical outcome measurements between the two procedures. The researchers found the proximal opening wedge osteotomy lengthened the first metatarsal, whereas the proximal chevron osteotomy shortened the first metatarsal.
After a proximal opening wedge osteotomy, the intermetatarsal angles decreased significantly from 14.8° to 9.1°. The intermetatarsal angles also decreased significantly after a proximal chevron osteotomy, from 14.6° to 11.3°, according to the researchers.
The researchers also found the operative times required for performing both types of procedures were similar.
Disclosure: See the study for a full list of all authors’ relevant financial disclosures.