Distal Metatarsal Chevron Osteotomy with Trans-Articular Lateral Soft Tissue Release in Moderate to Severe Hallux Valgus

Purpose: To assess the clinical and radiographic results of distal metatarsal chevron osteotomy (DMCO) and transarticular release of lateral soft tissue for moderate to severe hallux valgus deformities. Materials and Methods: 20 cases were studied. Hallux valgus angle (HVA) and first-second intermetatarsal angle (1, 2 IMA) were measured preoperatively and at 1 year after surgery. The clinical evaluation was performed with the American Orthopaedic Foot and Ankle Society (AOFAS) hallux-metatarso-phalangeal-interphalangeal scale. Results: The average lateral shift of the distal segment was 6.9 ㎜ (range: 5 to 8 ㎜). The average preoperative HVAs and 1, 2 IMAs were 31.2° (range: 29 to 36°) and 15.0° (range: 13 to 18°) respectively, which improved 1 year after surgery to 8.4° (ange: 1 to 17°) and 6.6° (range: 3 to 11°), respectively. The average AOFAS score improved from 47.0 points (range: 32 to 65 points) to 91.0 points (range: 72 to 100 points). Four patients were dissatisfied with the profiles of their feet, two patients had significant limitations in dorsiflexion of the first metatarsophalangeal joints, and one patient had neuralgic pain after removal of a K-wire. Conclusion: The overall outcomes were good with DMCO and transarticular release of the lateral soft-tissue. However, these procedures alone, in some advanced deformities, would result in subjectively unsatisfactory medial foot contours.