SLR - August 2009 - Adrienne Loretz
Reference:
Coughlin, M.J., Jones, Carroll P. (2007). Hallux valgus and first ray mobility: A prospective study. The Journal of Bone and Joint Surgery (American), 89, 1887-1898.
Scientific Literature Review
Reviewed by: Adrienne Loretz, DPM
Residency Program: OCPM-UHHS Richmond Medical Center
Podiatric Relevance:
This study provides informative data regarding the effect of operative treatment of hallux valgus deformity with the use of a proximal crescentic osteotomy and distal soft-tissue repair of the first metatarsophalangeal joint.
Methods:
149 patients in whom moderate to severe hallux valgus deformities were treated with surgical repair between September 1999-May 2002 were enrolled in the study. After initial screening, forty-nine patients excluded due to a diagnosis of mild, recurrent, congruent,or inflammatory arthritis, or juvenile hallux valgus. Two patients died and five were unavailable for the final evaluation leaving 103 adult patients for the final cohort. The initial evaluation consisted of a routine examination focusing on the patients’ pain. A pain score was determined using a 10-point visual analog scale and the American Orthopaedic Foot and Ankle Society (AOFAS) scale. These scores were also calculated at the final follow up visit. A physical examination directed at the first metatarsophalangeal joint and ankle joint range of motion was also performed. The surgical procedure entailed a distal soft-tissue realignment with a proximal crescentic osteotomy. In some cases, a proximal phalangeal closing-wedge osteotomy was performed at the discretion of the surgeon.
Results:
All 103 patients were treated with a distal soft tissue reconstruction and a proximal crescentic osteotomy of the first metatarsal. These patients returned for a final evaluation at a minimum of two years (mean duration of 27 months). The mean pain score improved from 6.5 points preoperatively to 1.1 points following surgery. The mean American Orthopaedic Foot and Ankle Society score improved from 57 points preoperatively to 91 points postoperatively. Twenty-three feet demonstrated increased mobility of the first ray prior to surgery and only two feet did so post-operatively. Plantar gapping noted on lateral radiographs preoperatively was resolved in nine feet post-operatively. Complications included recurrence in six feet.
Conclusions:
The authors conclude that the surgical management of moderate to severe hallux valgus deformities should include a proximal cresentic osteotomy of the first metatarsal with distal soft-tissue realignment to correct the deformity and decrease pain. They determined that first ray mobility was reduced to a normal level without performing an arthrodesis of the metatarsocuneiform joint.