The Results of Triple Osteotomy in Adult Hallux Valgus Patients with Highly Increased Distal Metatarsal Articular Angle

Lee, Kyung Tai; Cha, Seung Do; Young, Ki Won; Kim, Jae Young; Joh, Joo Won

Abstract

PURPOSE: To evaluate the clinical and radiographical results of triple osteotomy as a treatment for adult hallux valgus with highly increased distal metatarsal articular ankle (DMAA).
MATERIALS AND METHODS
From October 2003 to April 2005, we retrospectively reviewed 7 hallux valgus patients (3 cases: moderate, 4 cases: severe) treated with triple osteotomy and followed-up for more than 1 year after operation. The mean follow up was 15.1 months. The hallux valgus angle (HVA), intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA) and the length of 1:2 metatarsal bone were measured. Proximal chevron osteotomy and distal biplanar chevron osteotomy were done in 1st metatarsal bone. Akin osteotomy was added to the base of the proximal phalanx. The clinical result was assessed using the AOFAS Hallux score, tenderness on the medial eminence, ROM of 1st metatarsophalangeal joint, calluses and patient satisfaction.
RESULTS
The mean HVA and IMA was improved from 37.5 degrees and 13.4 degrees to 10.5 degrees and 6.2 degrees respectively. The mean DMAA was corrected from 34.2 degrees to 11.2 degrees and mean shortening of 1st metatarsal was 2.4 mm (0.9-5.8 mm). The mean AOFAS hallux score was improved from 66.4 to 92.5 and VAS score (pain on the medial eminence) from 4.3 points to 0.4 points. Metatarsalgia disappeared in all cases and there was no complications such as necrosis of the metatarsal head.
CONCLUSION
Triple osteotomy for adult hallux valgus with a highly increased DMAA is effective and should be considered as a part of the treatment armamentarium.