Long-term Associations Impact of Axial Alignment, Sesamoid Position, and Joint Degeneration and Recurrence and Clinical Outcomes After Hallux Valgus Correction.

Abstract

Background: The influence of postoperative axial alignment on long-term recurrence and clinical outcome after hallux valgus correction has not been well characterized. Degenerative changes within the metatarsosesamoid and first metatarsophalangeal (MTPJ) joints are common, but their association with long-term function is not well defined. This retrospective study evaluated associations between axial alignment, recurrence, joint degeneration, and long-term outcomes after distal metatarsal reversed-L (ReveL) osteotomy.

Methods: Seventy-four patients (110 feet) with mild to moderate hallux valgus deformity who underwent ReveL osteotomy between 2004 and 2012 were retrospectively evaluated at a mean follow-up of 14.4 years. Weightbearing radiographs were reviewed preoperatively and at final follow-up. Axial sesamoid radiographs obtained at long-term follow-up assessed sesamoid position, sesamoid rotation angle (SRA), and metatarsal pronation (α angle). First MTPJ and metatarsosesamoid arthritis were graded using a modified Coughlin and Shurnas classification. Clinical outcomes were assessed using Foot and Ankle Outcome Score (FAOS) and visual analog scale. Logistic regression identified predictors of recurrence, arthritis, and functional outcome.

Results: Hallux valgus recurrence occurred in 11.8% of cases and was associated with residual sesamoid displacement (P < .001) and increased SRA (P < .01), whereas the α angle showed no relationship. In multivariable analysis, SRA greater than 6.2° demonstrated an odds ratio of 6.9 for recurrence, although this association was not statistically significant (P = .07). All axial parameters demonstrated univariate associations with metatarsosesamoid arthritis, but none correlated with MTPJ arthritis. Recurrence (odds ratio [OR] 4.8; P = .03) and SRA greater than 6.2° (OR 3.7; P = .04) independently predicted metatarsosesamoid arthritis. Higher grades of MTPJ arthritis were associated with significantly poorer FAOS scores, whereas metatarsosesamoid arthritis selectively affected the quality-of-life domain.

Conclusion: First MTPJ arthritis was most strongly associated with long-term pain and function after hallux valgus correction. Postoperative axial malalignment was not statistically significantly associated with recurrence in this cohort. Although hallux valgus recurrence and residual axial malalignment were associated with metatarsosesamoid degeneration, these factors did not adversely affect overall clinical outcomes.

Level of evidence: Level IV, case series.