Double osteotomy in recurrence cases with distal metatarsal articular angle increase after hallux valgus distal surgery.

Abstract

Objectives: The aim of this study was to evaluate the clinical and radiological results of the combined use of distal closed wedge and proximal open wedge osteotomies in cases of recurrent hallux valgus (HV) with an increased distal metatarsal articular angle (DMAA).

Patients and methods: Between January 2019 and December 2022, a total of 10 female patients (mean age: 48.8±10.8 years; range, 28 to 63 years) who underwent surgical treatment for recurrent HV with an increased DMAA were retrospectively analyzed. Pre- and postoperative anterior-posterior and lateral radiographs of the patients were taken. The intermetatarsal angle (IMA), DMAA, and HV angle (HVA) were measured and compared before and after surgery. The clinical outcomes of the patients were evaluated using the American Orthopaedic Foot & Ankle Society (AOFAS) score, Manchester-Oxford Foot Questionnaire (MOXFQ) score, and Maryland Foot Score (MARYLAND).

Results: The median follow-up was 33.1 (range, 24 to 78) months. Seven (70%) of the patients underwent surgery on the right side and three (30%) of the patients underwent surgery on the left side. The median time to recovery of osteotomies was 8 (range, 6 to 10) weeks. There was no loss of correction at minimal two years of follow-up. None of the patients developed postoperative infections. The postoperative HVA, IMA, DMAA values of the patients were statistically significantly lower than the preoperative values (p<0.05). The AOFAS and MARYLAND scores of the patients at six and 24 months after surgery were statistically significantly higher compared to the baseline (p<0.05). Considering the MOXFQ scores, the scores at six months and 24 months after surgery were statistically significantly lower than the scores before surgery (p=0.005 for both). Similarly, MOXFQ scores at 24 months after surgery were statistically significantly lower than those at six months (p=0.013), indicating that the clinical improvement obtained at six months continued to increase until 24 months.

Conclusion: The combination of distal closed wedge and proximal open wedge osteotomies for HV recurrence seems to be an effective surgical technique for correction of the deformity. Plate and screw fixation can increase the rate of bone union and accelerate postoperative mobilization of the patients. Further large-scale, long-term studies are needed to provide more comprehensive findings on the effectiveness of HV surgery and elucidate the effects of postoperative rehabilitation processes on recovery in order to optimize the treatment protocols.