Operative treatment of hallux valgus – the effect of three osteotomy types on the first metatarsal, hallux valgus and metatarsal distal articulation angles
Background: Modern approach to hallux valgus deformations enables not only the stage treatment considering the magnitude of the deformity but also the objective evaluation of the results.We investigated the influence of the three most commonly used osteotomies on three most common demonstrative factors, especially proximal osteotomy on the distal metatasal articulation angle.
Methods: Three groups were created regarding the magnitude of the deformation. X rays of 15 corrections in each group were reviewed (45 cases, 34 women, 2 men). Each group was treated with only one of the three osteotomies: distal chevron osteotomy (Ch), distal chevron osteotomy with medial edge (ChM) and proximal osteotomy (POT). The effect on the three most comonly used demonstrative factors were noted: first intermetatarsal angle (IM), hallux valgus angle (HV), distal metatarsal articulation angle (DMAA). The age and the demonstrative factors were compared pre- and postoperative, in and between the groups.
Results: The correct, graded selection of the patients for the treatment was confirmed and false negative results excluded. Preoperative values of HV and DMAA are significantely different between three groups (p < 0.001) while IM are not (p = 0.118). Postoperative values of the HV and IM are significantely lower in all three groups (p < 0.001). DMAA is statisticaly different (positive) postoperatively in the ChM group (p < 0.001) but not in the Ch and POT groups (P = 0.398; p = 0.456).
Conclusions: Modern approach on hallux valgus deformations enables stage treatment and objective evaluation of the results what is demonstrated by the effect of the osteotomies on the demonstrative factors. Further investigations of the factors not yet considered or even unknown are also possible as shown on the example of the difference between the expected and measured effect of POT on DMAA.
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