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Results of Minimal Incision Distal Metatarsal Osteotomy for Moderate to Severe Hallux Valgus
J Korean Foot Ankle Soc. 2015;19:51-57
Published online June 15, 2015
© 2015 Korean Foot and Ankle Society

Jung-Wook Huh, Il-Soo Eun, Young-Chul Ko, Man-Jun Park, Sook-Hyun Park

Department of Orthopedic Surgery, Busan Medical Center, Busan, Korea
Correspondence to: Il-Soo Eun
Department of Orthopedic Surgery, Busan Medical Center, 359 Worldcup-daero,
Yeonje-gu, Busan 611-706, Korea
Tel: 82-51-507-3000, Fax: 82-51-507-3001, E-mail: dreun7@hanmail.net
Received April 6, 2015; Revised April 25, 2015; Accepted April 27, 2015.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Purpose: Minimal incision distal metatarsal osteotomy (MIDMO) is known to be an effective surgical procedure for mild to moderate hallux valgus. However, the result of MIDMO on moderate to severe hallux valgus is controversial; therefore, we investigated the radiological and clinical results of MIDMO on moderate to severe hallux valgus.
Materials and Methods: We reviewed 51 feet (48 patients) with moderate to severe hallux valgus. The mean age was 67.0 years and the mean follow-up period was 32.2 months. Radiological data of hallux valgus angle, first intermetatarsal angle, and distal metatarsal articular angle on plain radiographs were analyzed. Recurrence, union, lateral translation of distal fragment and angulation were also analyzed. The clinical data were obtained using American Orthopaedic Foot and Ankle Society (AOFAS) score of preoperation and last follow-up. Receiver operating characteristic (ROC) curve was used to determine a cut-off value.
Results: The mean hallux valgus angle measured at preoperation was 37.7o and 15.9o at last follow-up. The mean first intermetatarsal angle of preoperation and last follow-up were 15.2o and 8.3o. The mean distal metatarsal articular angle changed from 12.6o at preoperation to 7.8o at last follow-up. Preoperative hallux valgus angle (p=0.0051) and distal metatarsal articular angle (p=0.0078) were statistically significant factors affecting postoperative AOFAS score. Cut-off value of each was 37o and 13o, respectively. Lateral translation of distal fragment in 5 recurrent cases was 23.0% compared to 45.3% of 46 non-recurrent cases. The result was statistically significant and the cut-off value was 38%.
Conclusion: Sufficient lateral translation over 38% in MIDMO on moderate to severe hallux valgus patients with preoperative hallux valgus angle under 37° and distal metatarsal articular angle under 13° can lead to good clinical results without recurrence.
Keywords : Moderate to severe hallux valgus, Minimal incision, Distal metatarsal osteotomy


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