Results of treatment of hallux valgus deformity by mean of a first metatarsal proximal osteotomy with soft tissue plasty of I MTP joint

Abstract

Approximately 40 to 50% of the civilized population may expect feet disorders, and in 90% localized in the forefoot. Hallux valgus (H.V.) deformity is not a single malformation, but a complex problem affecting the first ray of foot, frequently accompanied by deformities and symptoms of the lesser toes. Proximal osteotomy and soft tissue release of I metatarsophalangeal joint (MTP) provides adequate correction of intermetatarsal angle and joint alignment. Material and methods. 66 patients (56 women and 10 men) with 84 hallux valgus deformities treated by surgical corrections with proximal wedge osteotomy of the first metatarsal bone and soft tissue plasty of I MTP joint were evaluated. The average age of the patients was 52.8 years (±12.4) and the mean follow-up was 4.2 years (±1.0). Mann criteria were used to assess the radiological stage of the disease. Treatment results were assessed by means of numerical AOFAS scale. On the basis of the sum of points obtained for each criterion, the treatment result was qualified as: excellent, good, fair or poor. In the radiological assessment the alteration of the valgus angle (HVA) and the intermetatarsal angle (IMA) of the hallux were evaluated. Results. Exacerbation of hallux valgus deformity in radiological examination was moderate or severe in accordance to the Mann criteria. 21 feet accompanied by deformities of lesser toes had additionally surgical procedure for the treatment of them. The mean score in AOFAS scale was 91.2pts (±11.2) with percentage of 80.6% excellent and good results. Higher percentage of fair and poor results in AOFAS scale was due to restricted motion of first MTP joint in 8 patients, out of who due to persistent pain ailments in 6. In case of 4 feet, cosmetic improvement was unsatisfactory, and 4 patients had problems with wearing commercial shoes. Average correction value of the hallux valgus angle was 21° (from 33.5° to 12.5°). Foot metatarsal angle correction was 9° (from 16.2° to 7.2°). Conclusions. Proximal osteotomy of the first metatarsal bone with soft tissue release of I metatarso-phalangeal joint allows for good correction of the hallux valgus deformity with good functional results.