MODIFIED CHEVRON OSTEOTOMY FOR TREATMENT OF HALLUX VALGUS

Abstract

Background & Objective: Hallux valgus is the most common forefoot deformity in adults, especially in

females. Almost 150 different procedures have been described for the treatment of Hallux valgus deformity.

Modified distal metatarsal Chevron osteotomy with distal soft tissue release is one of the most effective

procedures for the correction of mild to moderate Hallux valgus deformity.

Methods: This is a prospective observational study conducted at Department of Orthopedic Surgery

Services hospital Lahore from Jan 2018 to Jan 2019 after taking permission from the hospital ethical review

board. A total number of 20 patients of age between 25-65 years were included in the study. Informed written

consent was obtained from each patient. Each patient underwent X- rays in dorsoplantar and lateral views in

weight-bearing position including axial sesamoid view of the foot. Hallux valgus angle (HV), inter-

metatarsal angle (IMA) were measured on x rays while clinically each patient was assessed for American

orthopedic foot and ankle society score (AOFAS) pre-operatively. In all these patients, we performed the

Modified chevron osteotomy with lateral soft tissue release and medial eminence excision with capsular

repair. Post-operative follow-up was done at two weeks, six weeks, 3 months and at one year for the

radiological assessment of HV angle and IMA along with AOFAS score on clinical examination.

Results: Total no of patients enrolled in our study were 20 with 16 females and 4 males. Four patients had

mild Hallux valgus while 16 patient had moderate Hallux valgus. Pre-operative mean AOFAS score was 56.50 ±

3.54. Six patients had B/L Hallux valgus deformity. Thus a total no. of 23 feet in 20 patient underwent Modified

Chevron osteotomy with distal soft tissue release. Before surgery the mean HV angle was 31.52°±6.44° while

mean IMA was 18°±1.10°. The AOFOS score improve from 56.50±3.54 pre-operatively to 85.95±6.15 after

06 weeks post-operatively. It further improved to 94±1.25 after 01 year at the final follow up. The mean HV

angle was improved from 31.52°±6.44° pre-operatively to 6.4°±1° after 06 weeks and 6.42°±1° after 01 year

post operatively. The mean IMA improved from 18±1.10 pre-operatively to 5.4±1.30 after 06 weeks post-

operatively and 5.6°±1.1° at the end of 01 year. The osteotomy union time was 10-16 weeks after the surgery.

There was no recurrence of the deformity, Infection, stiffness of the joint and avascular necrosis of metatarsal

head noted post-operatively at the end of one year. The mean first metatarsal shortening was 3.6±1.2mm at

the final follow up. The patient satisfaction was also good (90.5%).

Conclusion: Modified chevron osteotomy with distal soft tissue release is a good procedure for correction of

mild to moderate Hallux valgus. It allows a significant lateral displacement of distal fragment (4.5mm). This

osteotomy improves the foot biomechanics, has got durable functional and cosmetic result.