The Journal of Bone and Joint Surgery, Vol 77, Issue 2 197-204, Copyright © 1995 by Journal of Bone and Joint Surgery, Inc
The effect of chevron osteotomy with lateral capsular release on the blood supply to the first metatarsal head
KJ Jones, LA Feiwell, EL Freedman and A Cracchiolo
Department of Orthopaedics, University of California at Los Angeles Medical Center 90024-6902.
The chevron osteotomy is one of the most widely used distal metatarsal
osteotomies for the treatment of hallux valgus in adults. Because the
osteotomy interrupts the intraosseous blood supply to the metatarsal head,
there has always been a concern that the operation could produce
osteonecrosis of the metatarsal head, particularly if the important
extraosseous blood supply was also damaged. We used latex injection and a
modified Spalteholz technique in cadaveric specimens to demonstrate the
effect of the chevron osteotomy, with and without lateral capsular release,
on the vascular supply to the first metatarsal head. We found an extensive
network of extraosseous vasculature to the metatarsal head both proximal
and distal to the site of the osteotomy. Both of these vascular networks
were preserved when the osteotomy was done properly. Also, an extensive
plantar and plantar lateral network of vessels provided circulation to the
head. Potential technical flaws in the performance of the osteotomy
included cutting of the first dorsal metatarsal artery by overpenetration
of the saw blade and incorrect placement of the proximal arms of the
osteotomy inside the joint capsule. These technical errors, alone or in
conjunction with extensive capsular stripping, can result in damage to the
vessels that supply the metatarsal head.
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