Abstract
Classic treatment algorithms limit the use of distal chevron osteotomy (DCO) to cases
with an intermetatarsal angle (IMA) <14°. As the IMA increases, it is accepted that
the contact between the metatarsal head and shaft will be insufficient. We have investigated
the reliability of IMA to predict contact area percentage after DCO. Preoperative
radiographs of patients with hallux valgus were subdivided as mild, moderate, and
severe using traditional algorithms. After excluding the mild cases, we randomly selected
100 patients (50 moderate and 50 severe) and calculated the estimated bony contact
(EBC) with our method and investigated the percentage of patients who could have >50%
contact area if we perform a DCO. Thirty of 50 (60%) and 17 of 50 (34%) patients had
>50% EBC in moderate and severe groups, respectively. We performed DCO for 24 patients
(14 moderate and 10 severe cases). The 100-point American Orthopaedic Foot and Ankle
Society (AOFAS) hallux-metatarso-phalangeal-interphalangeal scale was used to assess
the clinical outcome. For the moderate group, we calculated mean IMA 16° (standard
deviation [SD] ± 1.4°) and mean EBC 66.9% (SD ± 10.8%). For the severe group, we calculated
mean IMA 20.9° (SD ± 0.7°) and mean EBC 63.1% (SD ± 10.4%). Paired t tests showed significant improvement comparing preoperative and postoperative AOFAS
scores, IMA, hallux valgus angle, and sesamoid position for all operated patients
(p < .001). We did not see any recurrence of hallux valgus or hallux varus and had only
1 minor complication that we managed conservatively. IMA may not always be a reliable
parameter to predict the stability of DCO. Because the stability depends on the contact
surfaces of osteotomy fragments, metatarsal head diameter and remaining bone contact
should be the primary concerns. Two patients with the same IMA can have a different
contact surface varying on a broad spectrum.
Level of Clinical Evidence
Keywords
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Article info
Publication history
Published online: July 23, 2019
Footnotes
Financial Disclosure: None reported.
Conflict of Interest: None reported.
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Copyright
© 2018 by the American College of Foot and Ankle Surgeons. All rights reserved.
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- ErratumThe Journal of Foot and Ankle SurgeryVol. 58Issue 6
- PreviewIn regard to the article: “Should We Use Intermetatarsal Angle as Primary Determinant to Define the Limits of Distal Chevron Osteotomy?” by Görkem Kıyak, Tanil Esemenli; published in The Journal of Foot & Ankle Surgery, September–October, Volume 58, Issue 5, pp 880–885, the legend for Figure 4 should be as follows:
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