Distal Chevron Osteotomy without Fixation for Correction of Hallux Valgus: A Ten Year Retrospective Study

Abstract

Reuven Lexier and Camalene Chrysostoum

Introduction: More than eighty surgical methods have been proposed to correct Hallux Valgus Deformity. This study evaluates the efficacy of Distal Chevron Osteotomy by means of assessing pre-operative and post-operative radiographic parameters and clinical results.

Methods: The authors performed a ten-year retrospective study, on patients treated with Chevron Osteotomy alone without internal fixation, by the senior author, at the Toronto Western Hospital, between the years 2000-2009. The association of Hallux Valgus with demographics, other pre-operative foot pathology, etiology, intra-op pathology, complications (late and early) and radiographic parameters (pre-operative and post-operative IMA and HVA’s) were studied.

Results: Two hundred and eight-five Chevron osteotomies were performed, on one hundred and seventy-eight patients with Hallux Valgus. In the study group 89% were female, the average age was 44 years ± 14 (range 16 to 77), 60% were bilateral. Radiographic measurements of the Hallux Valgus angle (HVA) and Intermetatarsal angle (IMA) demonstrated a statistically significant difference in pre-operative and post-operative measurements (p <0.05) t-test. The mean correction in the HVA for the left foot was 14.94 degrees compared with 14.98 degrees for the right foot. A mean correction of 1.99 degrees in the IMA for the left foot and 2.05 degrees for the right foot was obtained. The recurrence rate for Hallux Valgus was 0.70% (2 feet). In 12.36% of the study group, unexpected intra-operative findings such as EHL tendon contracture, bursae, intra-osseous ganglion cysts, and osteoporosis or capital osteophytes resulted in adding to, or modifying, the standard operative procedure.

Conclusion: Despite minor and largely reversible post-operative complications, this study demonstrates that with distal Chevron osteotomy excellent radiographic and cosmetic correction of the deformity was achieved with a high level (99.30%) of patient satisfaction. Patients should be advised pre-operatively about their risk for developing Keloids 5.61%, transfer metatarsalgia 4.56% and recurrence 0.70% when treated by Chevron osteotomy.

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