The Journal of Bone and Joint Surgery 82:1373 (2000)
© 2000 The Journal of Bone and Joint Surgery, Inc.
The Chevron Osteotomy for Correction of Hallux Valgus
Comparison of Findings After Two and Five Years of Follow-up*
Hans-Jörg Trnka, M.D. ,
Alexander Zembsch, M.D.,
Mark E. Easley, M.D. ,
martin Salzer, M.D.,
Peter Ritschl, M.D. and
Mark S. Myerson, M.D.
Investigation performed at Orthopaedic Hospital Gersthof,
Vienna, Austria
A complete video supplement to this article is available from
the Video Journal of Orthopaedics. A video clip
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Journal of Orthopaedics can be contacted at (805) 962-3410.
*No benefits in any form have been received or will be received
from a commercial party related directly or indirectly to the subject
of this article. No funds were received in support of this study.
Department of Orthopaedics, Orthopaedic Hospital Gersthof, Wielemansgasse
28, Vienna 1180, Austria. E-mail address for H.-J. Trnka: hans4hallux{at}aon.at
Division of Orthopaedic Surgery, Duke University Medical Center,
Box 2950, Durham, North Carolina 27710.
§Department of Orthopaedic Surgery, The Union Memorial Hospital,
3333 North Calvert Street, Suite 400, Baltimore, Maryland 21218.
Background: The chevron osteotomy, an accepted
method for the correction of mild and moderate hallux valgus, is
generally advocated for patients younger than the age of fifty years.
The purposes of this prospective study were to compare the short-term (two-year)
and intermediate-term (five-year) results of this operation with
respect to patient satisfaction, flexion and extension of the metatarsophalangeal
joint, maintenance of correction, and development of arthrosis and
to determine whether the effectiveness of the procedure was limited
by age.
Methods: Between April 1991 and September 1992,
the chevron osteotomy was performed for the treatment of mild-to-moderate
hallux valgus deformity in sixty-six consecutive feet. Forty-three
patients (fifty-seven feet) were available for follow-up at both
two and five years postoperatively. The two-year and five-year clinical
assessments were based on the American Orthopaedic Foot and Ankle
Society's hallux-metatarsophalangeal-interphalangeal scale.
Results: Between the two-year and five-year
follow-up evaluations, there was only a minimal change in overall
patient satisfaction, and the average score on the hallux-metatarsophalangeal-interphalangeal
scale was unchanged. The passive range of motion of the first metatarsophalangeal
joint decreased between the preoperative assessment and the two-year
follow-up evaluation and was unchanged at the five-year follow-up
evaluation. Radiographic evaluation showed no changes in the hallux
valgus or intermetatarsal angle between the two-year and five-year
evaluations, although the number of feet with arthrosis of the metatarsophalangeal
joint increased slightly, from eight to eleven. Patients aged fifty
years or older did as well as younger patients.
Conclusions: At these two follow-up periods,
the chevron osteotomy was found to be a reliable procedure for the
correction of mild and moderate hallux valgus deformity, and outcome
did not differ on the basis of age.
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