Increased Displacement Maximizes the Utility of the Distal Chevron Osteotomy for Hallux Valgus Deformity Correction

2008 ◽  
Vol 29 (2) ◽  
pp. 155-163 ◽  
Author(s):  
Daniel E. Murawski ◽  
James L. Beskin
Keyword(s):  
Hallux Valgus ◽  
Deformity Correction ◽  
Valgus Deformity ◽  
Chevron Osteotomy ◽  
Hallux Valgus Deformity

Correlation analysis of the x-ray and functional parameters from the results of chevron (Austin) osteotomy for hallux valgus

2020 ◽  
pp. 54-63
Author(s):  
Ruslan Khairutdinov ◽  
Timur Minasov ◽  
Ekaterina Yakupova ◽  
Elvina Mukhametzyanova
Keyword(s):  
Hallux Valgus ◽  
Rating Scale ◽  
Metatarsophalangeal Joint ◽  
Valgus Deformity ◽  
First Metatarsophalangeal Joint ◽  
Chevron Osteotomy ◽  
Hallux Valgus Deformity ◽  
Valgus Angle ◽  
The Right ◽  
Bone Structures

Hallux valgus is characterized by the appearance and growth of a painful “lump” in the region of the first metatarsophalangeal joint, the development of forefoot corns, and inability to choose the right shoes, which leads to a significant decrease in the quality of life of these patients. Corrective osteotomies that preserve the metatarsophalangeal joint, for example Austin (Chevron) osteotomy, are usually used for hallux valgus deformity of the I, II degrees. Radiography with the study of the hallux valgus angle (HVA), the intermetatarsal angle (IMA), the distal metatarsal articular angle (DMAA) is a research method that shows the true correlation between bone structures. The correlation between the radiological and functional indicators of osteotomy allows us to determine possible recommendations for indications for surgical treatment of Hallux valgus. Correlation shows that the largest correction of hallux valgus in older patients occurs due to a small adjustment of the angle of DMMA and HVA. IMA had the best correction after Austin osteotomy among patients of a younger age, then the HVA, and the DMMA had minimum correction according to the AOFAS rating scale (Kitaoka). The revealed correlations allow us to determine the correct tactics for the treatment of hallux valgus by identifying the benefits of Austin osteotomy.

scholarly journals Radiographic Outcomes, Union Rates, and Complications Associated With Plantar Implant Positioning for Midfoot Arthrodesis

2021 ◽  
Vol 6 (3) ◽  
pp. 247301142110271
Author(s):  
Tyler W. Fraser ◽  
Daniel T. Miles ◽  
Neal Huang ◽  
Franklin B. Davis ◽  
Burton D. Dunlap ◽  
...  
Keyword(s):  
Hallux Valgus ◽  
Skin Irritation ◽  
Case Series ◽  
Deformity Correction ◽  
Valgus Deformity ◽  
Union Rate ◽  
Radiographic Outcomes ◽  
Hallux Valgus Deformity ◽  
Metatarsal Angle ◽  
Radiographic Union

Background: Midfoot arthrodesis has long been successfully included in the treatment paradigm for a variety of pathologic foot conditions. A concern with midfoot arthrodesis is the rate of nonunion, which historically has been reported between 5% and 10%. Plantar plating has also been noted to be more biomechanically stable when compared to traditional dorsal plating in previous studies. Practical advantages of plantar plating include less dorsal skin irritation and the ability to correct flatfoot deformity from the same medial incision. The purpose of this study is to report the arthrodesis rate, the success of deformity correction, and the complications associated with plantar-based implant placement for arthrodesis of the medial column. Methods: A retrospective review was undertaken of all consecutive patients between 2012 and 2019 that underwent midfoot arthrodesis with plantar-positioned implants. Radiographic outcomes and complications are reported on 62 patients who underwent midfoot arthrodesis as part of a correction for hallux valgus deformity, flatfoot deformity, degenerative arthritis, Lisfranc injury, or Charcot neuroarthropathy correction. Results: Statistically significant improvement was seen in the lateral talus–first metatarsal angle (Meary angle) and medial arch sag angle for patients treated for flatfoot deformity correction. In patients treated for hallux valgus deformity, there was a reduction in the intermetatarsal angle from 15.4 to 6.8 degrees. The overall nonunion rate was 6.45% in all patients. The rate of nonunion was higher at the NC joint compared to the TMT joint and with compression claw plates. One symptomatic nonunion required revision surgery (1.7%). There were no nonunions when excluding neuroarthropathy patients and smokers. The odds ratio (OR) for nonunion in patients with neuroarthropathy was 6.05 ( P < .05), and in active smokers the OR was 2.33 ( P < .05). Conclusion: Plates placed on the plantar bone surface for midfoot arthrodesis achieved and maintained deformity correction with rare instances of symptomatic hardware for a variety of orthopedic conditions. An overall clinical and radiographic union rate of 94% was achieved. The radiographic union rate improved to 100% when excluding both neuroarthropathy patients and smokers. The incidence of nonunion was higher in smokers, neuroarthropathy patients, naviculocuneiform joint fusions, use of compression claw plates, and when attempting to fuse multiple joints. Incisional healing complications were rarely seen other than in active smokers. Level of Evidence: Level IV, case series.

Clinical Outcomes after Chevron Procedure are Better than Pedobarographic Results

2014 ◽  
Vol 601 ◽  
pp. 177-180
Author(s):  
Radu Prejbeanu ◽  
Dinu Vermesan ◽  
Horia Hărăgus ◽  
Simona Vermesan ◽  
Dan Ioan Stoia
Keyword(s):  
Clinical Outcomes ◽  
Hallux Valgus ◽  
Pressure Sensors ◽  
Valgus Deformity ◽  
Physical Contact ◽  
Chevron Osteotomy ◽  
Hallux Valgus Deformity ◽  
Reaction Forces ◽  
Severe Hallux Valgus ◽  
Better Than

The distal Chevron or Austin procedure, is arguably the most prominent of the distal metatarsal osteotomies. Recent studies in the literature have shown a trend in recommending this osteotomy or one if it’s modifications for even severe hallux valgus deformities. Therefore we aimed to compare the clinical and pedobarographic results after chevron osteotomy in patients with moderate hallux valgus deformity. We investigated a homogeneous lot of 10 patients undergoing hallux valgus correction using distal chevron technique. In order to quantify the improvement of the gait in these patients, several biomechanical parameters have been measured using a matrix of pressure sensors that provide us the vertical reaction forces when the foot is in physical contact with it. Results show an improvement in patient’s velocity and cadence after the surgery, and also a smaller variability in gait. Nevertheless, optimal clinical outcomes are still found to have altered ground reaction forces on pedobarographic assessment.

Single Absorbable Polydioxanone Pin Fixation for Distal Chevron Bunion Osteotomies

2001 ◽  
Vol 22 (10) ◽  
pp. 832-835 ◽  
Author(s):  
James K. DeOrio ◽  
Anthony W. Ware
Keyword(s):  
Hallux Valgus ◽  
Valgus Deformity ◽  
Kirschner Wires ◽  
Chevron Osteotomy ◽  
Hallux Valgus Deformity ◽  
Pin Fixation ◽  
Established Technique

The distal chevron osteotomy is a well-established technique for correction of symptomatic mild to moderate metatarsus primus varus with hallux valgus deformity. Fixation of the osteotomy ranges from none to bone pegs, Kirschner wires, screws, or absorbable pins. We evaluated one surgeon's (J.K.D.) results of distal chevron osteotomy fixation with a single, nonpredrilled, 1.3-mm poly-p-dioxanone pin and analyzed any differences in patients with unilateral or bilateral symptomatic metatarsus primus varus with hallux valgus deformities. All osteotomies healed without evidence of infection, osteolysis, nonunion, or necrosis. Equal correction was achieved in unilateral and bilateral procedures. The technique is quick and easy, and adequate fixation is achieved.

Biplanar Chevron Osteotomy

2002 ◽  
Vol 23 (9) ◽  
pp. 792-798 ◽  
Author(s):  
Caio Nery ◽  
Rui Barroco ◽  
Cibele Réssio
Keyword(s):  
Hallux Valgus ◽  
Valgus Deformity ◽  
Average Score ◽  
Intermetatarsal Angle ◽  
Chevron Osteotomy ◽  
Hallux Valgus Deformity ◽  
Valgus Angle ◽  
Radiological Data ◽  
End Of Treatment

Results of biplanar chevron osteotomy performed on patients with mild-to-moderate hallux valgus deformity with an increased distal metatarsal articular angle (DMAA) are shown. The study included clinical data of 32 patients (54 feet) who had completed a 2-year follow-up, and radiological data of these 32 and other 29 patients (50 feet) for a total of 61 patients (104 feet, 53 right and 51 left). There were 59 females and two males with ages varying from 11 to 66 years. According to the AOFAS Hallux Rating, the preoperative average score (50) improved to 90 (average score after the surgery). The hallux valgus angle was improved from an average of 25° to 14°, the first intermetatarsal angle from 12° to 8° and the DMAA from 15° to 5°. At the end of treatment, 94% of patients were classified as having grade 0 or I sesamoid lateral sub-luxation. Given improvement in angles and 90% of patients satisfied with an average AOFAS postoperative score of 90, the technique seems indicated for treatment of symptomatic hallux valgus deformity with increased DMAA.

Comparison of Postoperative Height Changes of the Second Metatarsal Among 3 Osteotomy Methods for Hallux Valgus Deformity Correction

2016 ◽  
Vol 38 (1) ◽  
pp. 20-26 ◽  
Author(s):  
Jun Young Choi ◽  
Yu Min Suh ◽  
Ji Woong Yeom ◽  
Jin Soo Suh
Keyword(s):  
Hallux Valgus ◽  
Deformity Correction ◽  
Metatarsal Head ◽  
Valgus Deformity ◽  
Metatarsal Osteotomy ◽  
Level Of Evidence ◽  
First Metatarsal ◽  
Scarf Osteotomy ◽  
Hallux Valgus Deformity ◽  
Second Metatarsal

Background: We aimed to compare the postoperative height of the second metatarsal head relative to the first metatarsal head using axial radiographs among 3 different commonly used osteotomy techniques: proximal chevron metatarsal osteotomy (PCMO), scarf osteotomy, and distal chevron metatarsal osteotomy (DCMO). Methods: We retrospectively reviewed the radiographs and clinical findings of the patients with painful callosities under the second metatarsal head, complicated by hallux valgus, who underwent isolated PCMO, scarf osteotomy, or DCMO from February 2005 to January 2015. Each osteotomy was performed with 20 degrees of plantar ward obliquity. Along with lateral translation and rotation of the distal fragment to correct the deformity, lowering of the first metatarsal head was made by virtue of the oblique metatarsal osteotomy. Results: Significant postoperative change in the second metatarsal height was observed on axial radiographs in all groups; this value was greatest in the PCMO group (vs scarf: P = .013; vs DCMO: P = .008) but did not significantly differ between the scarf and DCMO groups ( P = .785). The power for second metatarsal height correction was significantly greater in the PCMO group (vs scarf: P = .0005; vs DCMO: P = .0005) but did not significantly differ between the scarf and DCMO groups ( P = .832). Conclusions: Among the 3 osteotomy techniques commonly used to correct hallux valgus deformity, we observed that PCMO yielded the most effective height change of the second metatarsal head. Level of Evidence: Level III, retrospective comparative series.

Modified Chevron Osteotomy for Hallux Valgus

1994 ◽  
Vol 15 (12) ◽  
pp. 642-645 ◽  
Author(s):  
Richard E. Donnelly ◽  
Charles L. Saltzman ◽  
Todd A. Kile ◽  
Kenneth A. Johnson
Keyword(s):  
Hallux Valgus ◽  
Screw Fixation ◽  
Valgus Deformity ◽  
Chevron Osteotomy ◽  
Hallux Valgus Deformity ◽  
Long Term Follow Up ◽  
Reliable Procedure ◽  
Shoe Wear

The chevron osteotomy for hallux valgus was modified by addition of screw fixation and change of the osteotomy angle. Thirty-six patients underwent this modified osteotomy. All had mild to moderate symptomatic hallux valgus deformities. No other forefoot procedures were performed. Standing radiographs were taken before surgery, at 1 month after surgery, and, for the 15 patients who returned for long-term follow-up, at 1 year or more after surgery. Overall, 35/42 procedures were rated as satisfactory without reservations and 7 were rated as satisfactory with mild reservations. All patients stated that they had some improvement in their preoperative symptoms, which included pain, cosmetic concerns, and shoe wear difficulties. Radiographically, none of the capital fragments displaced and there were no malunions, nonunions, nor evidence of avascular necrosis. The average metatarsophalangeal-1 angle improved 8° and the average intermetatarsal 1–2 angle improved 4°. This modification is relatively simple, increases stability, and allows early weightbearing. In our experience, the modified chevron osteotomy has been a very reliable procedure for mild to moderate symptomatic hallux valgus deformity.

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