• Journal of Korean Foot and Ankle Society
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• v.5 no.2
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• pp.149-155
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• 2001

Purpose: To evaluate the clinical results of Mitchell osteotomy and proximal metatarsal dome osteotomy in hallux valgus deformity. Materials and Methods: From January 1993 to June 2000, 28 cases (17 patients) with hallux valgus deformity who underwent Mitchell osteotomy were categorized as group I, 26 cases (16 patients) who underwent proximal metatarsal dome osteotomy were categorized as group II. We analyzed clinical results according to preoperative and postoperative clinical functional analysis and objective comparison of correction angle between two groups. Results: The average hallux valgus correction in the Mitchell osteotomy group went from $36^{\circ}$ to $11^{\circ}$, and in the proximal metatarsal dome osteotomy group, the hallux valgus angle was reduced from $32^{\circ}$ to $6^{\circ}$. The intermetatarsal angle in the Mitchell osteotomy group was corrected from $13^{\circ}$ to $9^{\circ}$, and in the proximal metatarsal dome osteotomy group the intermetatarsal angle was reduced from $14^{\circ}$ to $7^{\circ}$. Although, proximal metatarsal dome osteotomy group have shown better correction angle and radiographic results in the correction of hallux valgus angle and intermetatarsal angle but, all patients in the Mitchell osteotomy and proximal metatarsal dome osteotomy groups had no statistically significant differences of clinical functional results between two groups. Conclusion: In our studies, the proximal metatarsal dome osteotomy applied to. hallux valgus deformity was found as a good radiographic results than Mitchell osteotomy, but there were no differences between the two operations in terms of functional satisfaction.

• Journal of Korean Foot and Ankle Society
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• v.18 no.2
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• pp.56-61
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• 2014

Purpose: This study was conducted among patients with moderate to severe hallux valgus who underwent distal chevron osteotomy and groups of patients with or without Akin osteotomy were compared for evaluation of the relationship between their radiological and clinical outcomes. Materials and Methods: From January 2009 to January 2012, among patients with moderate to severe hallux valgus who underwent distal chevron osteotomy at our institution, 28 cases with additional Akin osteotomy and 35 cases without Akin osteotomy available to follow up of more than one year were included in this study. For radiologic evaluation, hallux valgus angle, 1, 2 intermetatarsal angle, and hallux interphalangeal angle were measured before and after surgery. For clinical assessment, visual analogue scale score, American Orthopaedic Foot and Ankle Society score, subjective satisfaction of the patients, and passive range of motion of the first metatarsophalangeal joints were evaluated. Results: At the final follow up, correction of valgus hallux angle and 1, 2 intermetatarsal angle was obtained from radiation results of both groups and it was found that patients who underwent Akin osteotomy showed radiographically larger angle correction but less subjective satisfaction. Conclusion: Patients with moderate to severe hallux valgus who underwent distal chevron osteotomy showed not only functional but also radiographically satisfactory results, and patients who underwent additional Akin osteotomy showed decreased subjective satisfaction. Therefore, if an incongruent first metatarsophalangeal joint is not observed, distal chevron osteotomy without Akin osteotomy seems preferable.

• Journal of Korean Foot and Ankle Society
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• v.16 no.2
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• pp.123-127
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• 2012

Purpose: The purpose of this study was to evaluate the clinical and radiographic results of the parallel-shaped modified Scarf osteotomy which is performed the Scarf osteotomy parallel to the shaft of the 1st metatarsal bone for hallux valgus deformities. Materials and Methods: We retrospectively reviewed 43 patients who had been treated by the parallel-shaped modified Scarf osteotomy for hallux valgus deformities between January 2006 and March 2011. We evaluated the results after this Scarf osteotomy with respect American Orthopaedic Foot & Ankle Society (AOFAS) scores, radiologic results by comparing intermetatarsal angle between 1stand 2nd metatarsal bones and hallux valgus angle. Results: We checked out the pre-operational and post-operational radiologic evaluation of intermetatarsal angle and hallux valgus angle between 1st and 2nd metatarsal bones. The mean AOFAS scores improved from 63.5 to 88.5. At final follow up, The hallux valgus angle improved from $31.4^{\circ}$ (16-52) to $9.0^{\circ}$ (3-13) and the intermetatarsal angle improved from $18.6^{\circ}$ (12-30) to $9.3^{\circ}$ (6-12) postoperatively. There was no case of major complications included recurrence of valgus deformity, correction or fixation failure and stress fractures. Conclusion: Our results suggest the our parallel-shaped modified Scarf osteotomy produces improved AOFAS scores, and effective correction of hallux valgus deformities. Our Scarf technique of osteotomy which is performed in parallel to the metatarsal bone minimizes the need for skill while more reliable and obtaining good correction and avoids associated complications.

• Journal of Korean Foot and Ankle Society
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• v.14 no.1
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• pp.16-20
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• 2010

Purpose: This study analyzed the clinical and radiographic outcome of the severe hallux valgus corrected with proximal reverse chevron metatarsal osteotomy and Akin osteotomy. Materials and Methods: The study was based on 18 feet (15 patients) of severe hallux valgus (hallux valgus angle ${\geq}40^{\circ}$ or intermetatarsal angle ${\geq}18^{\circ}$) treated with proximal reverse chevron metatarsal osteotomy and followed for more than 1 year. Akin osteotmy was added in 72% of the patients. Clinically preoperative and postoperative AOFAS Hallux Metatarsophalangeal-interphalangeal score, VAS pain score and satisfaction after the surgery were analyzed. Radiologically hallux valgus angle, hallux valgus interphalangeal angle, the intermetatarsal angle and sesamoid position before and after the operation were analyzed. Results: AOFAS Hallux Metatarsophalangeal-interphalangeal score improved from 54.5 (25-78) to 87.7 (70-100) and VAS pain score decreased from 6.0 (3-8) to postoperative 1.2 (0-5). Ninety-six percents of the patients were satisfied with results. Radiologically hallux valgus angle was decreased from $43.3^{\circ}(31-58^{\circ})$ preoperatively to $6.8^{\circ}(-8-27^{\circ})$ postoperatively. The intermetatarsal angle was decreased from $18.4^{\circ}(11-24)^{\circ}$ preoperatively to $5.3^{\circ}(1-12^{\circ})$postoperatively. The sesamoid subluxation was improved from $2.8{\pm}0.4$ preoperatively to $0.4{\pm}0.6$ postoperatively. Conclusion: Proximal reverse chevron metatarsal osteotomy and lateral soft tissue release with additional Akin osteotomy is good treatment option for severe hallux valgus.

• Journal of Korean Foot and Ankle Society
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• v.12 no.1
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• pp.14-19
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• 2008

Purpose: We tried to understand the effects of the derotational closing wedge Akin osteotomy during the operation for the hallux valgus with pronation of great toe. Materials and Methods: Eighty five patients who had undergone Akin osteotomy among the eighty seven patients who had been treated with Scarf osteotomy with hallux valgus were included in this study. Derotational supination was added on the medial closing wedge Akin osteotomy at the base of proximal phalanx and it was secured with K-wire, headless screw or staple. We measured and analyzed pre- and post-operative hallux primus valgus angle and hallux pronational rotatory angle. Results: The hallux primus valgus angle improved an average of $14{\pm}2.98$ degrees to $-1{\pm}1.68$ degrees with the hallux pronational rotatory angle respectively from $24.8{\pm}7.64$ degrees to $4.7{\pm}4.22$ degrees. Conclusions: After the metatarsal osteotomy for the treatment of the hallux valgus with the pronation of great toe, derotational closing wedge Akin osteotomy can give us a belief that it can correct the hallux primus valgus angle and hallux pronational rotatory angle also and it can be a helpful method for minimizing the recurrence rate of the hallux valgus deformity.

• Journal of Korean Foot and Ankle Society
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• v.8 no.1
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• pp.64-70
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• 2004

Purpose: We compared the result of a proximal metatarsal closed wedge osteotomy and soft tissue procedure with a modified chevron osteotomy and soft tissue procedure in the treatment of hallux valgus. Materials and Methods: Between March 1999 and February 2003, we performed proximal metatarsal closed wedge osteotomy and soft tissue procedure on 17 feet (12 patients), and modified chevron osteotomy and soft tissue procedure on 12 feet (9 patients). Results: According to Mayo clinic forefoot scoring system (FFSS), group 1, with proximal metatarsal closed wedge osteotomy, shows 67.2 points postoperatively and group 2, with modified chevron osteotomy, shows 68.5 points postoperatively. In group 1, the average correction of hallux valgus angle and intermetatarsal angle was 20.8 degrees and 4.8 degrees, respectively. In group 2, the average correction of hallux valgus angle and intermetatarsal angle was 19.9 degrees and 4.7 degrees, respectively. The average shortening was 3.15 mm in group 1 and 1.38 mm in group 2. Conclusion: We obtained relatively good clinical and radiographic result in this study. The effect on shortening of the first metatarsal was greater in the proximal metatarsal closed wedge osteotomy than modified chevron osteotomy, but the metatarsal shortening did not related with metatarsalgia. So, both techniques seems optimal surgical treatment for hallux valgus deformity.

• Clinics in Orthopedic Surgery
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• v.10 no.4
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• pp.479-483
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• 2018

Background: We developed a modified proximal scarf osteotomy technique for moderate to severe hallux valgus in an attempt to obtain better correction of the deformity. In addition, we compared the clinical and radiographic results of this modified technique with those of the classic scarf osteotomy reported in other studies. Methods: Between December 2004 and July 2009, 44 cases of modified proximal scarf osteotomy was performed in 35 patients with moderate hallux valgus. The American Orthopedic Foot and Ankle Society (AOFAS) score, visual analogue scale (VAS) score, range of motion of the first metatarsophalangeal joint, and radiographic results were evaluated. Results: The mean hallux valgus angle and the mean first intermetatarsal angle improved from an average of $32.2^{\circ}$ and $14.3^{\circ}$, respectively, to an average of $12.5^{\circ}$ and $8.6^{\circ}$, respectively. The distal metatarsal articular angle improved from an average of $18.7^{\circ}$ to $12.4^{\circ}$. The preoperative mean AOFAS and VAS scores were 47 points and 7 points, respectively, which improved to 86 points and 1 point, respectively, at the final follow-up. Limited range of motion occurred in two cases postoperatively. The height of the first metatarsal-cuneiform joint, which was an average of 15.9 mm preoperatively, did not change. The first metatarsal-talus angle increased from an average of $4.1^{\circ}$ to $7.1^{\circ}$. Conclusions: The modified proximal scarf osteotomy for the treatment of moderate hallux valgus showed similar results with the classic scarf osteotomy with regard to changes in the first intermetatarsal angle and postoperative satisfaction. Therefore, we suggest the modified proximal scarf osteotomy be considered as well as other proximal osteotomy in the treatment of moderate to severe hallux valgus.

• Journal of Korean Foot and Ankle Society
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• v.21 no.2
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• pp.43-49
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• 2017

Hallux valgus is a deformity characterized by lateral deviation of the great toe and medial deviation of the first metatarsal. When planning an operative treatment, it is important to realize that the deformity is tridimensional and diverse. Operative techniques include medial eminence resection, distal soft tissue procedure, first metatarsal osteotomy (distal, diaphyseal, proximal, or multiple), proximal phalanx osteotomy, arthrodesis (first metatarsophalangeal or metatarsocuneiform joint), and so on. Among these techniques, osteotomy is the main procedure for correcting the hallux valgus. The objective of this article is to describe the characteristics and recent advancements made for corrective osteotomies in the hallux valgus. The pathophysiology of the hallux valgus is also described.

• Journal of Korean Foot and Ankle Society
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• v.6 no.1
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• pp.15-20
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• 2002

Authors studied 24 cases in 18 patients with the hallux valgus deformity treated by Reverdin osteotomy at Department of Orthopaedic Surgery, Wallace Memorial Baptist Hospital from January 1995 to December 1999. Reverdin osteotomy is one of the distal metatarsal osteotomies in the treatment of hallux valgus in adults. We performed Reverdin osteotomy on 24 cases (18 patients) for painful hallux valgus associated with an increased hallux valgus angle (> 35degrees) and first-second intermetatarsal angle(>13 degrees). The results were as follows. 1. The average first-second intermetatarsal angle was 16.8 degrees and average valgus angle was 37.3 degrees, preoperatively. they were corrected to 7.8 degrees and 12 degrees respectively. 2. The metatarsalgia of the great toe was subsided in all cases and they were satisfied with the result of their operations in respect to cosmetically and functionally. Avascular necrosis of capital fragment, nonunion, and dorsal angulation were not developed in any case. But one case had superficial wound infection and delayed union, presumably due to secondary infection.

• Journal of Korean Foot and Ankle Society
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• v.10 no.2
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• pp.156-162
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• 2006

Purpose: To evaluate the results and effectiveness of distal chevron osteotomy combined with lateral soft tissue release for the correction of hallux valgus deformity. Materials and Methods: 31 patients who underwent distal chevron osteotomy with lateral soft tissue release between July 2002 and June 2003, were analyzed in terms of hallux valgus angle, intermetatarsal angle, subluxation of sesamoid, AOFAS score and the occurrence of avascular necrosis of the first metatarsal head. Results: The mean amount of the correction of hallux valgus angle was $26.3^{\circ}$. The mean amount of the correction of intermetatarsal angle was $6.6^{\circ}$. The mean amount of the correction of sesamoid subluxation was 1.2 points. The mean improvement of AOFAS score was 25.8 points. Avascular necrosis of the first metatarsal head was not found in any cases. Conclusion: For correction of hallux valgus deformity, distal chevron osteotomy with lateral soft tissue release showed improvement of hallux valgus angle, sesamoid subluxation and AOFAS score with no evidence of avascular necrosis of the first metatarsal head.