SLR - August 2014 - Fellner
Reference: Wong DW, Wu DY, Man HS, Leung AK. The Use of a Syndesmosis Procedure for the Treatment of Hallux Valgus: Good Clinical and Radiological Results Two Years Post-operatively. Bone Joint J. 2014 Apr; 96-B(4):502-7.
Scientific Literature Review
Reviewed By: Dieter J. Fellner, DPM
Residency Program: Montefiore Medical Center, Bronx NY
Podiatric Relevance: Many operative procedures are described in the literature for the surgical management of hallux valgus. The osteotomy is generally regarded as the procedure of choice, of varying complexity and technical difficulty. The first metatarsal osteotomy creates a deformity in a bone when attempting to correct a malposition of the first metatarsal. It is associated also with several potential complications. The syndesmosis procedure is a bone sparing alternative directed at the key component of hallux valgus, the metatarsus primus varus.
Methods: This was a retrospective assessment of 27 patients (54 feet) using the American Orthopedic Foot & Ankle Society (AOFAS) score, radiographs, and measurement of plantar pressures conducted pre- and post-operatively. The mean age of patients was 46 years (18-70), mean follow-up was 26.4 months. (24 – 33.4 months).
Results: The mean AOFAS score improved from 62.8 to 94.4 points. Significant improvements were found on all radiological parameters; mean HV angle and 1st metatarsal angle was reduced from 33.20 to 19. 10 and from 150 to 7.20. Mean medial sesamoid position improved from 6.3 to 3.6. Mean maximum force to and force-time integral under the hallux significantly increased by 71.1 percent. Maximum force under the hallux was delayed by 11 to 96.8 percent stance indicating restoration of function to the hallux. Three patients suffered a stress fracture to the second metatarsal.
Conclusions: The syndesmosis procedure appears to be an effective procedure for hallux valgus in all age groups, and does not involve cutting of bone. The metatarsus primus varus is primarily addressed and a novel use of a fibro-osseous bridge is created between the first and second metatarsal to permanently maintain the correction in the sagittal and transverse planes. The hallux valgus is corrected and function to the segment is restored. Further studies need to be conducted with a validated outcome measure instrument such as the Manchester-Oxford Foot Questionnaire. Future work should also address long term follow up and determination of the exact nature of the soft-tissue formed by the suture and periosteal elevation between the two metatarsals.