Distal chevron metatarsal osteotomy is a viable treatment option for hallux valgus with metatarsus adductus-multicentre retrospective study

Abstract

Purpose The purpose of this study was to evaluate the radiographic and clinical outcomes of patients with hallux valgus (HV) with concomitant metatarsus adductus (MA) treated with distal chevron metatarsal osteotomy (DCMO), without any procedure for the second or third metatarsal. Methods A multicentre retrospective study involving four hospitals was conducted. A total of 45 feet from 38 patients who had received DCMO for HV with MA with at least one year post-operative follow-up were analysed. HV angle (HVa), inter-metatarsal angle (IMa), MA angle (MAa), and the lateral sesamoid grade were measured. Foot function index (FFI) and visual analogue scale (VAS) were recorded. Patients were divided into mild (18 degrees <= MAa < 20 degrees) and moderate (20 degrees <= MAa) MA groups, and results were compared. Results The mean HVa and IMa improved significantly from 35.1 degrees and 14.4 degrees pre-operatively to 10.6 degrees and 7.1 degrees one year post-operatively (p < 0.001). There were no differences in pre-operative HVa, IMa, or the sesamoid grade, and also no difference in post-operative HVa or the sesamoid grade between mild and moderate MA groups. Only the mean post-operative IMa showed a difference between the two groups (8.3 degrees vs. 6.3 degrees; p = 0.019). All clauses of FFI and VAS improved significantly (p < 0.001). When the extent of improvement was compared between the two groups, there were no significant differences in any category (p > 0.05). The total rate of recurrence (HVa >= 20 degrees) was 11.1% (5/45), and although the moderate group (4/29, 13.8%) had a higher proportion than the mild group (1/16, 6.3%), this was not statistically significant (p = 0.641). Conclusion DCMO for patients with HV with MA had satisfactory radiographic and clinical outcomes with minimal recurrence. Except in cases of severe combined deformity, we recommend performing DCMO alone without any additional procedure or manipulation of the other metatarsals as a viable treatment option.