Outcomes of horizontal versus Akin Osteotomy of the proximal phalanx for hallux valgus.

Background: Currently, Akin osteotomy is widely used for hallux valgus. However, it is associated with several complications such as prolonged fusion, pseudarthrosis, overcorrection, and big toe shortening. To prevent such issues, a novel method can be used. In 2019, horizontal osteotomy of the proximal phalanx (HOPP) was established. The current study aimed to assess the outcomes of Akin osteotomy and HOPP for hallux valgus.

Methods: Akin osteotomy was performed on 20 feet (Akin group) and HOPP on 14 feet (HOPP group).

Results: One year after the surgery, the bone union rates of the Akin and HOPP groups were 95 % and 100 %, respectively. The average bone union period of the HOPP group (3.2 months, standard deviation: 0.80) was significantly shorter than that of the Akin group (5.8 months, standard deviation: 3.53) (P < 0.05). The 3-month bone union rate of the HOPP group was significantly higher than that of the Akin group (93 % vs. 45 %, P < 0.05). The mean shortening of the lateral proximal phalanx did not significantly differ between the Akin and HOPP groups (P = 0.46). However, the HOPP group had a significantly lesser medial shortening of the lateral proximal phalanx than the Akin group (P < 0.05). Moreover, the HOPP group had reduced shortening of the proximal phalanx. None of the patients in the HOPP group developed complications. However, some patients in the Akin group presented with complications such as osteotomy dissection, screw abduction, and protrusion.

Conclusion: HOPP is an excellent option as it has a high bone union rate, can facilitate easy angle adjustment, and does not cause significant shortening of the lateral proximal phalanx.

Level of evidence: Level III, retrospective comparative series.