Comparison of the crescentic and Mau osteotomies

NewsBot · Jun 5, 2008

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A comparison of the crescentic and Mau osteotomies for correction of hallux valgus.
Hyer CF, Glover JP, Berlet GC, Philbin TM, Lee TH
J Foot Ankle Surg. 2008 Mar-Apr;47(2):103-11

We retrospectively compared crescentic and Mau osteotomies used to treat a total of 39 cases of hallux abductovalgus. Follow-up was possible in 10 of the crescentic cases (mean 228 days) and 24 of the Mau cases (mean 245 days). Preoperatively, the mean first intermetatarsal and hallux abductus angles were 17.5 degrees and 35.4 degrees , respectively, in the crescentic group; and 16.6 degrees and 31.3 degrees , respectively, in the Mau group. Postoperatively, these same radiographic angles were 11.7 degrees and 18.9 degrees , respectively, in the crescentic group; and 9.8 degrees and 12.9 degrees , respectively, in the Mau group, and these differences were not statistically significant. Complications included metatarsus primus elevatus (crescentic 7, Mau 2), lesser metatarsal transfer lesion (crescentic 1, Mau 0), nonunion (crescentic 5, Mau 1), revisional surgery (crescentic 0, Mau 1), and transarticular hardware (crescentic 3, Mau 0). The incidence of complications in the crescentic group was 60%, whereas that in the Mau group was 37.5%; this difference was not statistically significant (P = .276). Analysis by the type of complication revealed statistically significant differences between the crescentic and Mau groups in regard to metatarsus primus elevatus (70% versus 8.3%, P = .001), transarticular hardware (30% versus 0%, P = .02), and nonunion (50% versus 4.2%, P = .006). In conclusion, crescentic and Mau osteotomies satisfactorily corrected the first intermetatarsal and hallux abductus angles in patients that fit our inclusion criteria, although the incidence of postoperative metatarsus primus elevatus, delayed union, and transarticular hardware placement, was higher in the crescentic osteotomy group
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NewsBot · Feb 6, 2010

Crescentic distal metatarsal osteotomy for the treatment of hallux valgus: a prospective, randomized, controlled study of two different fixation methods.
Tonbul M, Baca E, Adaş M, Ozbaydar MU, Yurdoğlu HC.
Acta Orthop Traumatol Turc. 2009;43(6):497-503.

OBJECTIVES: This study was designed to draw attention to a distal metatarsal osteotomy technique, which has been somewhat overlooked for the treatment of hallux valgus, and to compare the clinical and radiographic results of two different fixation methods.

METHODS: The study included 16 feet of 13 patients (11 women, 2 men) who were treated with crescentic distal metatarsal osteotomy for mild-to-moderate hallux valgus (<35 degrees ). The patients were randomized to two fixation methods with two cross K-wires (group 1; 7 patients, 8 feet) and a compressive screw (group 2; 6 patients, 8 feet). The results were evaluated using the AOFAS (American Orthopaedic Foot and Ankle Society) clinical rating scale for hallux, and a visual analog scale for pain. Radiographic measurements included the hallux valgus angle (HVA), first/second intermetatarsal angle (IMA), and distal metatarsal articular angle (DMAA), before and 12 months after surgery.

RESULTS: There were no significant differences between the two groups with regard to pre- and postoperative AOFAS scores and pain scores, which showed significant improvements in both groups at the end of one-year follow-up (p<0.001). The HVA and IMA significantly decreased from 32 degrees to 19 degrees and from 12 degrees to 6 degrees in group 1, and from 30 degrees to 17 degrees and from 12 degrees to 8 degrees in group 2, respectively (p<0.001). A similar improvement was also seen in the DMAA (p<0.001). Postoperative radiographic improvements were similar in both groups. One patient in group 1 underwent revision surgery with the same technique due to recurrence, and one patient in group 2 had delayed union.

CONCLUSION: Crescentic distal metatarsal osteotomy may be an appropriate technique in the treatment of mild-to-moderate hallux valgus.
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NewsBot · Dec 3, 2013

The early functional outcome of Mau osteotomy for the correction of moderate-severe hallux valgus
Tanujan Thangarajah, Usman Ahmed, Shahbaz Malik, Abhay Tillu Sandwell
Orthopedic Reviews 2013; volume 5:e37

Hallux valgus is one of the commonest conditions
of the foot and has been reported to
affect nearly half of the adult population. It is
most effectively treated by a corrective osteotomy
of which there a numerous subtypes. The
Mau osteotomy confers the greatest structural
stability but is not thought to provide adequate
correction of moderate-severe deformities.
Accordingly, complications such as under correction
and non-union are common. The aim
of this study was to determine the functional
outcome in patients with moderate-severe hallux
valgus following a Mau osteotomy. A retrospective
review of 23 patients with moderatesevere
hallux valgus treated by Mau osteotomy
was conducted. Patients were assessed clinically
by the American Orthopedic Foot and
Ankle Society (AOFAS) scoring system and
radiologically by measuring the first intermetatarsal
(IM) and hallux abductovalgus
angles (HAV). The mean AOFAS score had
improved from 47 preoperatively to 92 postoperatively
(P<0.01). Additionally, preoperative
HAV and IM angles improved from 39o and 15o
respectively to 15o and 9o respectively
(P<0.01). There were no cases of undercorrection
or non-union. In this series, the Mau
osteotomy was able to achieve good correction
of the IM and HAV angles in patients with moderate-
severe hallux valgus. This was reflected
in a significantly higher postoperative AOFAS
score. Contrary to other studies there were no
cases of undercorrection and despite allowing
patients to fully weight-bear postoperatively
there were no cases of non-union.
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NewsBot · Dec 15, 2015

Patent just granted:
FIXATION DEVICE FOR A MAU-TYPE OSTEOTOMY PROCEDURE

An internal plate fixation device is provided for load bearing and non-load bearing fixation for the Mau-type osteotomy procedure for hallux valgus correction in the first metatarsal bone of the foot. The preferred example includes a set design plate having screw holes for attachment of the plate to the first metatarsal bone of the foot. Screw holes are located on the plate, including screw holes on top of the plate and screw holes at the ends of the plate. A temporary small holding wire hole is located in the plate to hold the plate to the bone temporarily. This plate allows both angled screw fixation of the Mau osteotomy and locking screw hole capability to ensure stability when fixating the Mau osteotomy.
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NewsBot · Mar 15, 2020

Proximal crescentric osteotomy in the treatment of severe hallux valgus deformity
Deniz GÜL, Serkan AKPANCAR
Chirurgia 2020 February;33(1):36-9

BACKGROUND: Hallux valgus is the most common foot deformity and various surgical methods have described in the treatment of the deformity. The purpose of this study was to analyze the effectiveness of crescentric osteotomy combined soft tissue procedures in the treatment of severe hallux valgus deformity.
METHODS: Twenty-eight feet of 23 patients (five men, 18 women) with severe hallux valgus deformity were operated using “proximal crescentric osteotomy” with distal soft tissue procedures. Preoperative and postoperative hallux valgus angle (HVA) and intermetatarsal angle (IMA) were evaluated on weight bearing anteroposterior foot radiography. The Visual Analog Scale (VAS) and the American Orthopedic Foot and Ankle Society (AOFAS) scales were also evaluated.
RESULTS: Preoperative VAS sores and AOFAS scores were significantly improved (P<0.01). Radiologic parameters (IMA and HVA values) were significantly decreased when compared to preoperative values (P<0.01).
CONCLUSIONS: Proximal crescentric osteotomy can significantly correct the deformity as well as the ankle functions of the patients with severe hallux valgus deformity. The surgical procedure is quite simple with relatively few complications.
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NewsBot · Jun 9, 2020

Evaluation of radiographic results in geriatric population with moderate to severe degree hallux valgus intervened with surgical technique of Lelièvre and Vidalot
Agreda-Santana AJ, Díaz-Carballeda JD, Rodríguez-Ramos A
Acta Ortop Mex 2019; 33 (6)

Background: Hallux valgus (HV) defines a valgo deviation from the metatarsophalangeal joint and in a varo of the first metatarsal. The surgery aims to restore joint congruence, correct deformity and decrease pain. There is little literature on the results in the geriatric population. The purpose of this study is intended to demonstrate that the open surgical technique of Lelièvre and Vidalot achieves acceptable radiographic results in that population. Material and methods: 68 patients between 60 and 85 years of age were involved with Lelièvre Technique and Vidalot for moderate to severe HV of Isham, between January 2014 and January 2017. Immediate postoperative and six month radiographs were evaluated with conventional radiometry for this condition; All measurements were made in digital system. The data was entered in Microsoft Excel. p values ‹ 0.05 were considered statistically significant. Results: Out of 68 patients (54 women and 14 men), average age 68.0 years. 12 had bilateral concern. 28 second finger claw. The metatarsphasopalangic angle with a preoperative mean was 36.6o, increased by 100% of cases of intermetatarsal angle 1-2, with a correlation p ‹ 0.05 between intermetatarsal angle and metatarsal angle increase. Immediate and six-month post-surgical results with a correlation of p = 0.3107. Conclusions: The treatment of moderate to severe HV in our geriatric population under technique Lelièvre and Vidalot achieves an acceptable correction demonstrated radiographically in the immediate postoperative period and at six month, this translates a viable option of surgical treatment in these population.
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NewsBot · Sep 1, 2020

Plantar pressure distribution in hallux valgus feet after a first metatarsal proximal crescentic osteotomy with a lesser metatarsal proximal shortening osteotomy
KoshoTogeiHiroakiShimaToshitoYasudaSeiyaTsujinakaGenNakamuraMasashiNeo
Foot and Ankle Surgery; 31 August 2020

Highlights
•Hallux valgus feet with metatarsalgia underwent a first metatarsal proximal crescentic osteotomy and a lesser metatarsal proximal shortening osteotomy simultaneously.
•Lesser metatarsal proximal shortening osteotomy decreased the length and elevated the height of the lesser metatarsal.
•We compared plantar pressure between postoperative, preoperative and healthy feet.
•A first metatarsal proximal crescentic osteotomy with a lesser metatarsal proximal shortening osteotomy improves the plantar pressure for both the great toe and central forefoot.
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Background
Plantar pressure distribution after the first metatarsal proximal crescentic osteotomy (FMPCO) with lesser metatarsal proximal shortening osteotomy (LMPSO) for hallux valgus with metatarsalgia has not been previously described.

Methods
The pre- (Pre) and postoperative (Post) groups comprised of 18 patients who underwent unilateral FMPCO with LMPSO; fifteen healthy volunteers constituted the control (C) group. For each of the 10 regions, peak pressure (Peak-P), maximum force (Max-F), contact time (Con-T), contact area (Con-A), and force-time integral (FTI) were measured.

Results
The mean Peak-P of the second metatarsal head was significantly lower in the Post group than the Pre group. The mean Peak-P, Max-F, Con-T, and FTI were not significantly different between the Post and C groups. The mean Con-A was significantly lower in the Post group than the C group.

Conclusion
FMPCO with LMPSO may improve the plantar pressure of the central forefoot comparable to healthy subjects.
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