Proximal Wedge Shelf Osteotomy for HAV

NewsBot · Jan 24, 2012

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A Study of the Proximal Wedge Shelf Osteotomy for Correction of Large IM Angle HAV Deformity.
Fabrikant J, Colarco J.
Foot Ankle Spec. 2012 Jan 20.

Many procedures have been identified to correct hallux abducto valgus deformity of the foot. Due to surgical skill level, complexity, and risk of complications, more procedures have been defined for distal than proximal correction. The senior author has used an alternative proximal procedure to correct larger hallux abducto valgus deformities, which may prove to be as effective as traditional procedures. The purpose of this study was to examine the short-term clinical and radiographic results of the proximal wedge shelf osteotomy and evaluate its potential as a satisfactory option for correction of larger bunion deformities. The study revealed many positive outcomes as measured radiographically in preoperative and postoperative hallux abductus, intermetatarsal and metatarsal elevation/declination angles, and clinically by first metatarsophalangeal joint scores and patients' subjective postoperative responses. From a review of the literature and results of the study, the authors conclude that the wedge shelf osteotomy can be used as an effective alternative for correcting larger bunion deformities with an intermetatarsal angle as large as 20° and a hallux valgus angle up to 38°. The advantages of this procedure include ability to correct in more than one plane, good bone-to-bone contact, and ease of fixation with 2 screws in an easily visible dorsal-to-plantar area. Disadvantages include the technical challenge of the procedure and its learning curve and some shortening of the first metatarsal.
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NewsBot · Oct 2, 2012

BASAL OSTEOTOMY FOR HALLUX VALGUS, WITH DISTAL SOFT TISSUE CORRECTION
Samer Morgan, Sherif Abdalla and Andrew Jarvis
J Bone Joint Surg Br 2012 vol. 94-B no. SUPP XXXVII 274

Introduction Trends in hallux valgus surgery continue to evolve. Basal metatarsal osteotomy theoretically provides the greatest correction, but is under-represented in the literature. This paper reports our early experience with a plate-fixed, opening- wedge basal osteotomy, combined with a new form of distal soft tissue correction (in preference to Akin phalangeal osteotomy).

Materials and Methods Thirty-three patients are reported here. The basal metatarsal osteotomy is fixed with the ‘Low Profile’ Arthrex titanium plate. No bone graft or filler is required, providing the osteotomy is within about 12mm of the base.

Distal soft tissue correction comprised a full lateral release, and then proximal advancement of a complete capsular ‘sleeve’ on the medial side. The plate serves as a rigid anchoring point for the tensioning stitches. Using this technique, almost any degree of hallux valgus can be corrected, and there is even potential for over-correction.

Functional outcome was assessed using the Manchester-Oxford foot and ankle score (MOXF). Radiographically the intermetatarsal angle was evaluated pre-operatively and at least 6 months postoperatively. Patients’ satisfaction and complication rates were recorded.

Results Clinical 87% (29 of 33) reported high satisfaction with the functional and cosmetic outcome. The opening basal wedge osteotomy slightly lengthens the first ray and as result none of our patients developed transfer metatarsalgia.

Results Radiology Hallux valgus angle (HVA) and inter-metatarsal angle (IMA) were measured on pre- and post-operative weight bearing radiographs. The radiological correction seen was very striking The mean correction of the IMA was 14 degrees; mean HVA correction was … degrees.

Complications One osteotomy was too distal, leading to a non-union, which required revision and bone grafting. Swelling and stiffness were seen in some patients, but these problems resolved steadily, with physiotherapy if needed.

Discussion This operation is a combined proximal/distal, bone/soft tissue procedure. It can obtain correction of almost any degree of hallux valgus. The slight first- ray lengthening is an advantage, as it neutralizes potential second ray problems. However, this is a very early result and long-term outcomes are as yet unknown.
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NewsBot · Jul 20, 2013

Proximal Oblique Sliding Closing Wedge Osteotomy for Hallux Valgus.
Wagner E, Ortiz C, Gould JS, Naranje S, Wagner P, Mococain P, Keller A, Valderrama JJ, Espinosa M.
Foot Ankle Int. 2013 Jul 17.

BACKGROUND:
The proximal oblique sliding closing wedge osteotomy (POSCOW) technique was developed to address moderate to severe hallux valgus deformity. We present a retrospective multicenter study to analyze the midterm radiological and clinical outcomes of patients treated with this type of proximal osteotomy fixed with plates.
MATERIALS AND METHODS:
One hundred and forty-four patients (187 feet) were operated on between May 2005 and June 2010 in 2 separate centers. Inclusion criteria were symptomatic moderate to severe incongruent hallux valgus deformity, no significant restriction in the first metatarsophalangeal joint movement, none to minimal degenerative changes in the first metatarsophalangeal or the tarsometatarsal joints, and no hypermobility. The median age was 60 years. The preoperative hallux valgus angle (HV) was 35.6 degrees, intermetatarsal angle (IM) was 15.3 degrees, AOFAS score was 53 points. The median follow-up was 35 months (range, 12-73). A POSCOW osteotomy was performed in all patients and fixed with plates. We recorded the satisfaction rate, postoperative clinical and radiological results, and complications.
RESULTS:
The patient satisfaction rate was 87%. The mean postoperative HV angle was 12.3 degrees, IM angle 4.8 degrees, AOFAS score 89 points. The mean decrease in the first metatarsal length was 2.2 mm (range, 0-8). Twelve feet (6.4%) with recurrence of the deformity required revision surgeries. Removal of complete or partial hardware was needed in 23 feet (12.3%) for symptomatic hardware. Five feet (2.6%) developed hallux varus but only 2 required surgery. Transfer metatarsalgia was noted in 9 feet (4.8%).
CONCLUSIONS:
The POSCOW osteotomy was an effective and reliable method for relieving pain and improving function. A learning curve was present, as most of the complications happened in the initial cases. To our knowledge, this is the largest reported series of proximal closing wedge osteotomy for hallux valgus deformities.
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NewsBot · Jul 25, 2014

Correction of Moderate to Severe Hallux Valgus With Isometric First Metatarsal Double Osteotomy
Werner Siekmann, MD; Troy S. Watson, MD; Matthias Roggelin, MD
Foot & Ankle International July 23, 2014

Background: The operative treatment for the moderate to severe bunion continues to present challenges. The indications for a single, double, or triple first ray osteotomy remain controversial. In addition, it is not clear whether an opening wedge osteotomy leads to clinically relevant arthritis at the first metatarsophalangeal joint. However, it is this theoretical concern that has led the authors to develop an isometric correction of the first ray.
Methods: Thirty-two patients underwent operative correction of hallux valgus with a double osteotomy of the first metatarsal using an opening wedge proximally and a closing wedge distally. The mean follow-up period was 59.3 months with a range of 55 to 65 months.
Results: The 1-2 intermetatarsal angle preoperatively was a mean of 18.9 degrees (range 17-23), correcting postoperatively to a mean angle of 8.6 degrees (range 5-12), for an average correction of 10.4 degrees (range 6-16). The postoperative AOFAS scores were 39.4 out of 40 points for pain, 42.4 out of 45 points for function, and 15 points for alignment. The total score was excellent with 94.2 out of 100 possible points. Radiographic union occurred in all cases. There was one case of painful edema of the foot and two cases of early avascular necrosis (AVN) diagnosed by residual pain at the hallux metatarsophalangeal joint and transient osteopenia of the metatarsal head on radiographs. No late sequelae associated with AVN such as arthritis or metatarsal head collapse were noted with long-term follow-up. These healed within months without specific treatment.
Conclusion: A double osteotomy of the first metatarsal with a nonlocking, low-profile plate was an effective procedure for correcting severe hallux valgus that carried a low complication rate and high patient satisfaction. It has clear advantages over isolated opening wedge procedures, including potentially better correction especially in those bunions associated with an increased distal metatarsal articular angle.
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NewsBot · Jul 3, 2020

Correction of Hallux Abducto Valgus Deformity Using Closing Base Wedge Osteotomy: A Study of 101 Patients
Hannah Khlopas, DPM & Lawrence M. Fallat, DPM, FACFAS
JFAS: July 01, 2020

Hallux abducto valgus is a functionally disabling deformity with lateral deviation of the hallux and medial prominence of the first metatarsal head. Various surgical techniques have been used in the treatment of this deformity. In this retrospective review, we assess the outcomes of proximal closing base wedge osteotomy (CBWO). A single-surgeon database was reviewed for patients who underwent proximal CBWO between January 1, 2012, and December 31, 2017. A total of 101 patients were identified with a mean age of 49 years (range 13 to 80) and mean body mass index of 29 kg/m 2 (range 19 to 53). The medical records were reviewed for smoking status, time to heal, rates of nonunion, shortening of the first metatarsal, intermetatarsal angle, hallux valgus angle, elevatus, mean loss of correction, complication rates, and pain scores. Pre- and postoperative variables were compared using Student's t test for continuous variables. The mean pre- and postoperative intermetatarsal angles were 15.46° (range 10° to 21°) and 3.77° (range 0° to 10°; p < .05). The mean pre- and postoperative hallux abductus valgus angles were 34.57° (range 12° to 60°) and 9.24° (range, 0° to 30°; p < .05). The mean metatarsal length shortening was 3.72 mm, and the mean postoperative elevatus was 2.73 mm. We have demonstrated excellent outcomes of CBWO with correction of intermetatarsal and hallux valgus angles. This procedure allows for superior reduction of moderate to severe intermetatarsal angles in rigid first rays. The mean postoperative elevatus of 2.73 did not result in any adverse sequelae.
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NewsBot · Aug 14, 2021

Modified Crescentic Proximal Metatarsal Osteotomy and Distal Soft Tissue Procedures in Hallux Valgus
Kirdemir, Vecihi
MILITARY MEDICINE

The results of a modified crescentic proximal metatarsal osteotomy and distal soft tissue procedures for patients with symptomatic, incongruent, metatarsophalangeal joint, hallux valgus deformity were reviewed. Forty-nine feet of 41 patients were evaluated. All of the patients were male military personnel of different ranks, and their mean age was 23 years (range, 20-43 years). The mean follow-up period was 25 months (range, 10-60 months). The patients were evaluated according to the American Orthopedic Foot and Ankle Society forefoot scoring system. The mean preoperative score was 54.4, and the mean postoperative score was 95.4. The mean hallux valgus angle was 39.4° before surgery and 12.8° after surgery (26.6° correction); the mean intermetatarsal angle was 15.9° before surgery and 7.1 after surgery (8.8° correction). A total of 93.8% of the patients were satisfied with the results of the procedure. Complications included delayed union in one case and superficial wound infections in two cases. We also emphasize small modifications performed while shifting the metatarsal shaft laterally and compare the results of our study with those of similar studies.
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NewsBot · Apr 10, 2022

Percutaneous, implantless basal closing wedge osteotomy for hallux valgus: Surgical technique and preliminary results in 114 patients
ChristianBaertich et al
Foot and Ankle Surgery; 20 March 2022

Background
Percutaneous, implantless basal closing wedge osteotomy (PIBCO) is a new technique for hallux valgus (HV) deformity correction that does not need internal fixation. We present this technique and its short-term clinical outcomes for moderate-to-severe HV deformities.

Methods
A retrospective review of 162 feet in 114 patients who underwent PIBCO of the first metatarsal (MT1) was conducted. Follow-up averaged 18.5 months. Outcomes were assessed using the visual analog scale (VAS), hallux valgus angle (HVA), intermetatarsal angle (IMA), and radiologic union. Complications were also assessed.

Results
Average VAS score improved from 6.2 to 1.0 (P < 0.001). HVA improved from 29.8° to 7.6° (P < 0.001). IMA improved from 14.5° to 6.3° (P < 0.001). A total of 8 major complications were noted (4.9%).

Conclusions
Satisfactory HV deformity correction was achieved. However, some instances may require internal fixation in order to avoid complications related to instability and noncompliance of postoperative rehabilitation protocols.
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