The Journal of Bone and Joint Surgery (American). 2005;87:1191-1199.
doi:10.2106/JBJS.D.02280
© 2005 The Journal of Bone and Joint Surgery, Inc.
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 Foot/Ankle Test 7: Summer 2005
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Percutaneous Distal Metatarsal Osteotomy for Correction of Hallux Valgus

Bruno Magnan, MD1, Lorenzo Pezzè, MD1, Nicola Rossi, MD1 and Pietro Bartolozzi, MD1

1 Department of Orthopaedics, University of Verona, P.le L.A. Scuro 10, 37134 Verona, Italy

Investigation performed at the Department of Orthopaedics, University of Verona, Verona, Italy

A commentary is available with the electronic versions of this article, on our web site (www.jbjs.org) and on our quarterly CD-ROM (call our subscription department, at 781-449-9780, to order the CD-ROM).

Background: Distal osteotomy of the first metatarsal is indicated for the surgical treatment of mild-to-moderate hallux valgus deformity. The aim of this study was to evaluate the results of a subcapital distal osteotomy of the first metatarsal with use of a percutaneous technique.

Methods: From 1996 to 2001, 118 consecutive percutaneous distal osteotomies of the first metatarsal were performed for the treatment of painful mild-to-moderate hallux valgus in eighty-two patients. The patients were assessed with a clinical and radiographic protocol at a mean of 35.9 months postoperatively. The American Orthopaedic Foot and Ankle Society (AOFAS) hallux-metatarsophalangeal-interphalangeal scale was used for the clinical assessment.

Results: The patients were satisfied following 107 (91%) of the 118 procedures. The mean score on the AOFAS scale was 88.2 ± 12.9 points. The postoperative radiographic assessments showed a significant change (p < 0.05), compared with the preoperative values, in the mean hallux valgus angle, first intermetatarsal angle, distal metatarsal articular angle, and sesamoid position. The valgus deformity recurred after three procedures (2.5%), the first metatarsophalangeal joint was stiff but not painful after eight (6.8%), and a deep infection developed after one (0.8%). The infection resolved with antibiotic therapy.

Conclusions: The percutaneous technique proved to be reliable for the correct execution of a distal linear osteotomy of the first metatarsal for the correction of a painful mild-to-moderate hallux valgus deformity. The clinical results appear to be comparable with those obtainable with traditional open techniques, with the additional advantages of a minimally invasive procedure, a substantially shorter operating time, and a reduced risk of complications related to surgical exposure.

Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.


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Related articles in JBJS:

Percutaneous Distal Metatarsal Osteotomy for Correction of Hallux Valgus
Bruno Magnan, Riccardo Bortolazzi, Elena Samaila, Lorenzo Pezzè, Nicola Rossi, and Pietro Bartolozzi
JBJS 2006 88: 135-148. [Abstract] [Full Text]  



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Percutaneous Distal Metatarsal Osteotomy for Correction of Hallux Valgus
Carlos Pique-Vidal
JBJS Online, 1 Feb 2006 [Full text]