Percutaneous Foot Surgery without Osteosynthesis in Hallux Valgus and Outcomes

Document Type : RESEARCH PAPER

Authors

1 Ortopedia e Traumatologia, Specialist in Orthopedics and Traumatology Azienda Ospedaliero-Universitaria Pisana Pisa, Italy

2 Department of Orthopaedic and Trauma Surgery, University of Pisa, Italy

Abstract

Background: Several procedures and types of osteotomies have been described for hallux valgus (HV) correction. Percutaneous techniques may lead to an early regain of function reducing morbidity and recovery time. In this study, we aimed to evaluate the clinical and radiographic outcomes of percutaneous hallux valgus (HV) correction. Methods: One hundred and twenty-four feet treated with the percutaneous technique between May 2011 and December 2015 were included in our study. All patients underwent resection of the medial metatarsal exostosis, complete first metatarsal distal osteotomy, adductor hallucis tendon release and Akin osteotomy of the proximal phalanx. Pre- and postoperative X-rays were clinically assessed. Results: The mean hallux valgus angle (HVA) and the intermetatarsal angle (IMA) decreased significantly from the preoperative assessment to the final follow-up. The AOFAS score improved from a mean preoperative value of 70.2 to 93.8 at the final follow-up. Conclusion: Percutaneous complete distal osteotomy in hallux valgus correction is a safe, reliable and effective procedure for the correction of symptomatic mild hallux valgus. Nevertheless, it requires appropriate surgical experience and patient aftercare in order to achieve the best result. Level of evidence: IV

Keywords

References

1. Mann RA, Coughlin MJ. Hallux valgus--etiology,
anatomy, treatment and surgical con-siderations. Clin
Orthop Relat Res. 1981 ;( 157):31-41.
2. Brogan K, Voller T, Gee C, Borbely T, Palmer S. Thirdgeneration
minimally invasive correction of hallux
valgus: technique and early outcomes. Int Orthop.
2014; 38(10):2115-21.
3. Baravarian B, Briskin GB, Burns P. Lapidus bunionectomy:
arthrodesis of the first metatarsocunieform
joint. Clinics in podiatric medicine and surgery. 2004;
21(1):97-111.
4. Richardson EG. Foot in adolescent and adults.
In: Crenshaw AH, editor. Campbell’s operative
orthopedics. vol. 2. St Louis: Mosbyjems; 1992. p. 829-
988.
5. Trnka HJ. Osteotomies for hallux valgus correction.
Foot Ankle Clin. 2005; 10(1):15-33.
6. Maffulli N, Longo UG, Marinozzi A, Denaro V. Hallux
valgus: effectiveness and safe-ty of minimally invasive
surgery. A systematic review. Br Med Bull. 2011;
97:149-67.
7. Roukis TS. Percutaneous and minimum incision
metatarsal osteotomies: a systematic review. J Foot
Ankle Surg. 2009; 48(3):380-7.
8. Trnka HJ, Krenn S, Schuh R. Minimally invasive hallux
valgus surgery: a critical review of the evidence. Int
Orthop. 2013; 37(9):1731-5.
9. Bia A, Guerra-Pinto F, Pereira BS, Corte-Real N, Oliva
XM. Percutaneous Osteoto-mies in Hallux Valgus:
A Systematic Review. J Foot Ankle Surg. 2018;
57(1):123-30.
10. Smith RW, Reynolds JC, Stewart MJ. Hallux valgus
assessment: report of research committee of
American Orthopaedic Foot and Ankle Society. Foot
Ankle. 1984; 5(2):92-103.
11. Kitaoka HB, Alexander IJ, Adelaar RS, Nunley JA,
Myerson MS, Sanders M. Clini-cal rating systems for
the ankle-hindfoot, midfoot, hallux, and lesser toes.
Foot Ankle Int. 1994; 15(7):349-53.
References
are performed without direct visualization. A detailed
knowledge of foot biomechanics, indications and a
significant learning curve to achieve a reproducible
performance are necessary for the surgeon to obtain the
best possible outcome.
Patient consent: All patients signed an informed
consent as participant of the study.
Disclosure: The authors report no conflict of interest
concerning the materials or methods used in this study
or the findings specified in this paper. 
12. De Prado M, Ripoll PL, Golanó P, editors. Minimally
Invasive Foot Surgery: Surgical Techniques,
Indications, Anatomical Basis. Bilbao, Spain: About
Your Health; 2009.
13. Caravelli S, Mosca M, Massimi S, Costa GG, Lo Presti
M, Fuiano M, et al. Percutane-ous treatment of hallux
valgus: What’s the evidence? A systematic review.
Musculoskelet Surg. 2018; 102(2):111-7.
14. Restuccia G, Lippi A, Sacchetti F, Citarelli C, Casella
F, Benifei M. Percutaneous Hallux Valgus Correction:
Modified Reverdin-Isham Osteotomy, Preliminary Results.
Surg Technol Int. 2017; 31:263-6.
15. Kadakia AR, Smerek JP, Myerson MS. Radiographic
results after percutaneous distal metatarsal
osteotomy for correction of hallux valgus deformity.
Foot Ankle Int. 2007;28(3):355-60.
16. Jones KJ, Feiwell LA, Freedman EL, Cracchiolo A 3rd.
The effect of chevron osteot-omy with lateral capsular
release on the blood supply to the first metatarsal
head. J Bone Joint Surg Am. 1995; 77(2):197-204.
17. Bauer T, de Lavigne C, Biau D, De Prado M, Isham S,
Laffenétre O. Percutaneous hallux valgus surgery: a
prospective multicenter study of 189 cases. Orthop
Clin North Am. 2009; 40(4):505-ix.
18. Trnka HJ, Zembsch A, Easley ME, Salzer M, Ritschl P,
Myerson MS. The chevron osteotomy for correction of
hallux valgus. Comparison of findings after two and
five years of follow-up. J Bone Joint Surg Am. 2000;
82(10):1373-8.
19. Schneider W, Aigner N, Pinggera O, Knahr K. Chevron
osteotomy in hallux valgus. Ten-year results of 112
cases. J Bone Joint Surg Br. 2004; 86(7):1016-20.
20. Kummer FJ. Mathematical analysis of first metatarsal
osteotomies. Foot Ankle. 1989; 9(6):281-9.
21. Han SH, Park EH, Jo J, Koh YG, Lee JW, Choi WJ, et al.
First metatarsal proximal opening wedge osteotomy
for correction of hallux valgus deformity: comparison
of straight versus oblique osteotomy. Yonsei Med J.
2015; 56(3):744-52. 
The Archives of Bone and Joint Surgery
Volume 9, Issue 2
March 2021
Pages 211-216

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History

  • Receive Date: 24 March 2020
  • Revise Date: 17 September 2020
  • Accept Date: 20 September 2020

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