J Korean Foot Ankle Soc.  2014 Jun;18(2):56-61. 10.14193/jkfas.2014.18.2.56.

Comparison of Operative Results of Distal Chevron Osteotomy with and without Akin Osteotomy for Moderate to Severe Hallux Valgus

• Park SS
• Lee JY
• Kim WH

• KMID: 2181661
• DOI: http://doi.org/10.14193/jkfas.2014.18.2.56

Abstract

PURPOSE
This study was conducted among patients with moderate to severe hallux valgus who underwent distal chevron osteotomy and groups of patients with or without Akin osteotomy were compared for evaluation of the relationship between their radiological and clinical outcomes.
MATERIALS AND METHODS
From January 2009 to January 2012, among patients with moderate to severe hallux valgus who underwent distal chevron osteotomy at our institution, 28 cases with additional Akin osteotomy and 35 cases without Akin osteotomy available to follow up of more than one year were included in this study. For radiologic evaluation, hallux valgus angle, 1, 2 intermetatarsal angle, and hallux interphalangeal angle were measured before and after surgery. For clinical assessment, visual analogue scale score, American Orthopaedic Foot and Ankle Society score, subjective satisfaction of the patients, and passive range of motion of the first metatarsophalangeal joints were evaluated.
RESULTS
At the final follow up, correction of valgus hallux angle and 1, 2 intermetatarsal angle was obtained from radiation results of both groups and it was found that patients who underwent Akin osteotomy showed radiographically larger angle correction but less subjective satisfaction.
CONCLUSION
Patients with moderate to severe hallux valgus who underwent distal chevron osteotomy showed not only functional but also radiographically satisfactory results, and patients who underwent additional Akin osteotomy showed decreased subjective satisfaction. Therefore, if an incongruent first metatarsophalangeal joint is not observed, distal chevron osteotomy without Akin osteotomy seems preferable.

Keyword

Hallux valgus; Chevron osteotomy; Akin procedure; Chevron-Akin double osteotomy

MeSH Terms

Ankle
Follow-Up Studies
Foot
Hallux
Hallux Valgus*
Humans
Metatarsophalangeal Joint
Osteotomy*
Range of Motion, Articular

Figure

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  Figure 1. Intraoperative photos show the distal chevron osteotomy (A) and Akin osteotomy (B).

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  Figure 2. The right foot of 46-year-old female shows moderate hallux valgus deformity. The deformity was corrected with distal chevron metatarsal osteotomy and distal soft tissue procedure. (A) Preoperative hallux valgus angle was 31.2o, the 1st intermetatarsal angle was 18.4o, and the hallux interphalangeal angle was 7.81o. (B) Postoperative hallux valgus angle was 3.4o, the 1st intermetatarsal angle was 8.5o, and the hallux interphalangeal angle was 7.6o. (C) At postoperative 13 months, the hallux valgus angle was 6.3o, the 1st intermetatarsal angle was 8.0o, and the hallux interphalangeal angle was 12.1o. Clinical result was good with no pain and no limitation of activity.

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  Figure 3. The left foot of 54-year-old female shows severe hallux valgus deformity. The deformity was adequately corrected with distal chevron metatarsal osteotomy, distal soft tissue procedure, and Akin procedure. (A, B) Preoperative hallux valgus angle was 39.2o, the 1st intermetatarsal angle was 11.5o, and the hallux interphalangeal angle was 2.1o. (C) Postoperative hallux valgus angle was 2.0o, the 1st intermetatarsal angle was 6.1o, and the hallux interphalangeal angle was 1.16o. (D, E) At postoperative 12 months, the radiograph and the gross photo show well maintained correction of the deformity. Hallux valgus angle was 10.0o, the 1st intermetatarsal angle was 4.0o, and the hallux interphalangeal angle was 1.9o. Subjective satisfaction was very good although passive range of motion in the 1st metatarsophalangeal joint was moderately restricted.

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  Figure 4. Comparison of visual analogue scale (VAS) score between the isolated distal chevron osteotomy and the distal chevron osteotomy with Akin procedure. Group I: distal chevron metatarsal osteotomy with Akin osteotomy. Group II: isolated distal chevron metatarsal osteotomy.

Reference

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