Skip to main content
SpringerLink
Log in

Proximal opening wedge metatarsal osteotomy for correction of moderate to severe hallux valgus deformity using a locking plate

  • Original Paper
  • Published:
International Orthopaedics Aims and scope Submit manuscript

Abstract

Purpose

Hallux valgus is a complex deformity of the first metatarsophalangeal joint, with varus angulation of the first metatarsal, valgus deviation of the great toe and lateral displacement of the sesamoids and the extensor tendons. The aim of the surgery is to achieve correction of the varus deviation of the 1st metatarsal which is considered by some as the primary intrinsic predisposing factor to hallux valgus deformity.

Methods

We retrospectively reviewed 85 patients (107 feet) who underwent an opening wedge osteotomy of the 1st metatarsal for correction of moderate to severe hallux valgus and metatarsus primus varus. A medially applied anatomic pre-contoured locking plate was used for fixation of the osteotomy.

Results

The mean IMA was decreased from 15.8 (range 12–22) degrees to 7.8 (range 0–12) degrees. The mean pre-operative HVA was 39 (range 21–52) degrees and the mean postoperative HVA was 11.8 (6–19) degrees. The pre-operative AOFAS score was 52 (SD 3.1) and the postoperative score was 85 (SD 5.2).

Conclusion

The proximal opening wedge metatarsal osteotomy is a safe, effective and reproducible technique for correction of moderate to severe hallux valgus deformity. The use of a locking plate provides enough control at the fragments, enhancing healing of osteotomy and maintenance of the correction even with a violated proximal lateral cortex.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Nikolaou V, Korres D, Xypnitos F, Lazarettos J, Lallos S, Sapkas G, Efstathopoulos N (2009) Fixation of Mitchell’s osteotomy with bioabsorbable pins for the treatment of hallux valgus deformity. Int Orthop 33:701–706

    Article  PubMed  Google Scholar 

  2. Mann R, Coughlin M (1981) Hallux valgus—etiology, anatomy, treatment and surgical considerations. Clin Orthop Relat Res 157:31–41

    PubMed  Google Scholar 

  3. Reize P, Schanbacher J, Wulker N (2007) K-wire transfixation or distraction following the Keller-Brandes arthroplasty in hallux rigidus and hallux valgus? Int Orthop 31:325–331

    Article  PubMed  CAS  Google Scholar 

  4. Coughlin M, Mann R (2007) Surgery of the foot and ankle, 8th edn. CV Mosby, St Louis, pp 183–362

    Google Scholar 

  5. Chuchpaiwong B (2012) Comparing proximal and distal metatarsal osteotomy for moderate to severe hallux valgus. Int Orthop 36(11):2275–2278

    Article  Google Scholar 

  6. Jawish R, Assoum H, Saliba E (2010) Opening wedge osteotomy of the first cuneiform for the treatment of hallux valgus. Int Orthop 34:361–368

    Article  PubMed  Google Scholar 

  7. Mann R, Rudicel S, Graves S (1992) Repair of hallux valgus with a distal soft-tissue procedure and proximal metatarsal osteotomy. J Bone Joint Surg Am 74-A:124–129

    Google Scholar 

  8. Sammarco GJ, Brainard BJ, Sammarco VJ (1983) Bunion correction using proximal chevron osteotomy. Foot Ankle 14:8–14

    Article  Google Scholar 

  9. Park CH, Ahn JY, Kim YM, Lee WC (2013) Plate fixation for proximal chevron osteotomy has greater risk for hallux valgus recurrence than Kirschner wire fixation. Int Orthop 37(6):1085–1092

    Google Scholar 

  10. Barouk LS (2005) Scarf osteotomy for hallux valgus correction. Local anatomy, surgical technique, and combination with other forefoot procedures. Foot Ankle Clin 5:525–558

    Google Scholar 

  11. Fuhrmann R, Zollinger-Kies H, Kundert HP (2010) Mid-term results of scarf osteotomy in hallux valgus. Int Orthop 34:981–989

    Article  PubMed  Google Scholar 

  12. Nyska M, Trnka HJ, Parks B, Myerson M (2003) The Ludloff metatarsal osteotomy: guidelines for optimal correction based on a geometric analysis conducted on a sawbone model. Foot Ankle Int 24(1):34–39

    PubMed  Google Scholar 

  13. Mau C, Lauber HJ (1926) Die operative Behandlung des Hallux Valgus. Deutsche Zeit Orthop 197:361–377

    Google Scholar 

  14. Sammarco VJ (2007) Surgical strategies; Mau osteotomy for correction of moderate and severe hallux valgus deformity. Foot Ankle Int 28:857–864

    Article  PubMed  Google Scholar 

  15. Nigro JS, Geger GM, Catanzariti AR (1991) Closing base wedge osteotomy. J Foot Surg 30(5):494–505

    PubMed  CAS  Google Scholar 

  16. Trethowan J (1923) A system of surgery. PB Hoeber, New York, pp 1046–1049

    Google Scholar 

  17. Mothershed RA (2001) Osteotomies of the first metatarsal base. In: Banks AS, Downey MS, Martin DE, Miller SJ (eds) McGlamry’s comprehensive textbook of foot and ankle surgery. Lippincott Williams & Wilkins, Philadelphia

    Google Scholar 

  18. Budiman-Mak E, Conrad KJ, Roach K (1991) The foot function index: a measure of foot pain and disability. J Clin Epidemiol 4:561–570

    Article  Google Scholar 

  19. Kitaoka H, Alexander I, Adelaar R, Nunley J, Myerson M, Sanders M (1994) Clinical rating systems for the ankle-hindfoot, midfoot, hallux and lesser toes. Foot Ankle Int 15(12):349–353

    Article  PubMed  CAS  Google Scholar 

  20. Richter M, Zech S, Geerling J, Frink M, Knobloch K, Krettek C (2006) A new foot and ankle outcome score: questionnaire based, subjective, visual-analogue-scale, validated and computerized. Foot Ankle Surg 12:191–199

    Article  Google Scholar 

  21. Cooper M, Berlet G, Shurnas P, Lee T (2007) Proximal opening-wedge osteotomy of the first metatarsal for correction of hallux valgus. Surg Technol Int 16:215–219

    PubMed  Google Scholar 

  22. Amarnek D, Juda E, Oloff L, Jacobs A (1986) Opening base wedge osteotomy of the first metatarsal utilizing rigid external fixation. J Foot Surg 25:321–326

    PubMed  CAS  Google Scholar 

  23. Haddad R (1975) Hallux valgus and metatarsus primus varus treated by bunionectomy and proximal metatarsal osteotomy. South Med J 68(6):684–686

    Article  PubMed  Google Scholar 

  24. Sollito RJ, Hart TJ, Sergi AR (1991) Opening base wedge osteotomy with first metatarsophalangeal joint implantation arthroplasty—a retrospective study. J Foot Surg 30:165–169

    Google Scholar 

  25. Wanivenhaus AH, Feldner-Busztin H (1988) Basal osteotomy of the first metatarsal for the correction of metatarsus primus varus associated with hallux valgus. Foot Ankle 8:337–343

    Article  PubMed  CAS  Google Scholar 

  26. Shurnas P, Watson T, Crislip T (2009) Proximal first metatarsal opening wedge osteotomy with a low profile plate. Foot Ankle Int 30(9):865–872

    Article  PubMed  Google Scholar 

  27. Wukich D, Roussel A, Dial D (2009) Correction of metatarsus primus varus with an opening wedge plate: a review of 18 procedures. J Foot Ankle Surg 48(4):420–426

    Article  PubMed  Google Scholar 

  28. Kumar S, Konan S, Oddy M, Madhav R (2012) Basal medial opening wedge first metatarsal osteotomy stabilized with a low profile wedge plate. Acta Orthop Belg 78:362–368

    PubMed  Google Scholar 

  29. Randhawa S, Pepper D (2009) Radiographic evaluation of hallux valgus treated with opening wedge osteotomy. Foot Ankle Int 30:427–431

    Article  PubMed  Google Scholar 

  30. Saragas N (2009) Proximal opening-wedge osteotomy of the first metatarsal for hallux valgus using a low profile plate. Foot Ankle Int 30:976–980

    Article  PubMed  Google Scholar 

  31. Easley ME, Trnka HJ (2007) Current concepts review: hallux valgus part ii: operative treatment. Foot Ankle Int 28:748–758

    Article  PubMed  Google Scholar 

  32. Watson T, Shurnas P (2008) The proximal opening wedge osteotomy for the correction of hallux valgus deformity. Tech Foot Ankle Surg 7(1):17–24

    Article  Google Scholar 

  33. Smith W, Hyer C, DeCarbo W, Berlet G, Lee T (2009) Opening wedge osteotomies for correction of hallux valgus. A review of wedge plate fixation. Foot Ankle Spec 2(6):277–282

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Foot and Ankle Surgery, Metropolitan Hospital, Athens, Greece

    Athanasios Badekas

  2. 1st Orthopaedic and Trauma Department, 424 Military General Hospital, Thessaloniki, Greece

    Dimitrios Georgiannos, Vasilios Lampridis & Ilias Bisbinas

  3. Royal Bournemouth Hospital, Castle Lane East, Bournemouth, BH7 7DW, UK

    Dimitrios Georgiannos

Authors
  1. Athanasios Badekas
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Dimitrios Georgiannos
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Vasilios Lampridis
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ilias Bisbinas
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Dimitrios Georgiannos.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Badekas, A., Georgiannos, D., Lampridis, V. et al. Proximal opening wedge metatarsal osteotomy for correction of moderate to severe hallux valgus deformity using a locking plate. International Orthopaedics (SICOT) 37, 1765–1770 (2013). https://doi.org/10.1007/s00264-013-2019-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00264-013-2019-x

Keywords

Search

Navigation