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
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- Modern concepts in the treatment of hallux valgus.J Bone Joint Surg Br. 2005; 87: 1038-1045
- Mann's Surgery of the Foot and Ankle.Mosby, Maryland Heights, MO2007: 184-362
- Equivalent correction in scarf and chevron osteotomy in moderate and severe hallux valgus: a randomized controlled trial.Foot Ankle Int. 2008; 29: 1209-1215
- Distal chevron osteotomy with distal soft tissue procedure for moderate to severe hallux valgus deformity.Foot Ankle Int. 2010; 31: 683-688
- Large displacement distal chevron osteotomy for the correction of hallux valgus deformity.J Foot Ankle Surg. 2002; 41: 213-220
- A method of predicting the degree of functional correction of the metatarsus primus varus with a distal lateral displacement osteotomy in hallux valgus.Foot Ankle. 1985; 5: 322-326
- Correction of metatarsus primus varus with the Chevron metatarsal osteotomy: an analysis of corrective factors.Chn Orthop Relat Res. 1989; 243: 180-183
- An anatomical basis for the degree of displacement of the distal chevron osteotomy in the treatment of hallux valgus.Foot Ankle. 1997; 18: 213-215
- Reconstructive Foot and Ankle Surgery: Management of Complications.3rd ed. Saunders, Philadelphia2018
- Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes.Foot Ankle Int. 1994; 15: 349-353
- Reliability and validity of the subjective component of the American Orthopaedic Foot and Ankle Society clinical rating scales.J Foot Ankle Surg. 2007; 46: 65-74
- Radiographic measurements in patients with hallux valgus before and after proximal crescentic osteotomy.J Bone Joint Surg Am. 2009; 91: 1369-1376
- First metatarsal base osteotomies for hallux abducto valgus deformities.Clin Podiatr Med Surg. 2014; 31: 247-263
- First metatarsal head osteotomies for the correction of hallux abducto valgus.Clin Podiatr Med Surg. 2014; 31: 221-231
- A new osteotomy for hallux valgus: a horizontally directed "V" displacement osteotomy of the metatarsal head for hallux valgus and primus varus.Clin Orthop. 1981; 157: 25-30
- Angular correction and complications of proximal first metatarsal osteotomies for hallux valgus deformity.Int Orthop. 2013; 37: 1771-1780
- Proximal metatarsal osteotomy for hallux valgus: comparison of outcome for moderate and severe deformities.Foot Ankle Int. 2008; 29: 664-670
- Medial eminence thickness with and without hallux valgus.Foot Ankle Int. 2002; 23: 48-50
- Surgical treatment of mild hallux valgus deformity: the state of practice among academic foot and ankle surgeons.Foot Ankle Int. 2006; 27: 970-973
- The effect of hallux abducto valgus surgery on the sesamoid apparatus position.J Am Podiatr Med Assoc. 1999; 89: 551-559
- Sesamoid position in hallux valgus in relation to the coronal rotation of the first metatarsal.Foot Ankle Clin. 2018; 23: 219-230
- Is the rotational deformity important in our decision-making process for correction of hallux valgus deformity?.Foot Ankle Clin. 2018; 23: 205-217
- [Evaluation of the Scarf osteotomy in hallux valgus related to distal metatarsal articular angle: a prospective study of 79 operated cases].Rev Chir Orthop Reparatrice Appar Mot. 1999; 85: 381-386
- Geometric analysis of indications for minimally invasive distal metatarsal osteotomy in treatment of hallux valgus.J Orthop Surg Res. 2015; 10: 163
- Hallux valgus angle as main predictor for correction of hallux valgus.BMC Musculoskelet Disord. 2008; 9: 70
- Evidence of treatment algorithms for hallux valgus.JSM Foot Ankle. 2016; 1: 1003
Published online: July 23, 2019
Financial Disclosure: None reported.
Conflict of Interest: None reported.
© 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: