A new "tension side" locking plate for Hallux Valgus: A prospective multicentre case series

Proximal oblique metatarsal osteotomy for hallux valgus using a plantar locking plate

BACKGROUND

The purpose of this retrospective study was to evaluate the clinical and radiological results of hallux valgus surgery using a plantar locking plate.

METHODS

Proximal oblique metatarsal osteotomy combined with distal soft tissue treatment was performed in 59 adult patients (68 feet) with hallux valgus, using an anatomically pre-contoured plantar locking plate for fixation of the osteotomy. The median age was 64.0 years and the median follow-up period was 16.5 months.

RESULTS

The mean JSSF scale improved significantly from 56.0 points preoperatively to 95.8 points postoperatively. The mean intermetatarsal angle and hallux valgus angle decreased from 16.4° and 41.8° preoperatively to 4.2° and 10.8° postoperatively, respectively. The mean inclination angle was 19.9° preoperatively and 20.5° postoperatively. Removal of hardware was needed in 2 feet (2.9%).

CONCLUSIONS

Proximal oblique metatarsal osteotomy is an effective method for relief of pain and improvement of function in correction of hallux valgus deformity. Use of a plantar locking plate provides sufficient maintenance of the correction, and complications associated with the hardware are rare.

[Proximal corrective osteotomy : Correction of hallux valgus deformity]

Severe symptomatic hallux valgus deformities are usually not treatable with conservative methods in the long-term. Surgical treatment currently aims for mechanical restitution of the first ray with preserved mobility of the first metatarsophalangeal (MTP 1) joint and with low risk of recurrence after surgery. Keeping these aims in mind the surgical methods consist of osteotomy at the proximal part of the first metatarsal bone with a high potential for correction of the deformity. Surgical interventions at the midshaft level of the first metatarsal are only useful if the anatomical shape of the metatarsal shows a wide shaft, which allows a large shift in the osteotomy. In all other cases of severe hallux valgus deformity two different surgical principles are currently used and recommended: 1. proximal or basal osteotomy of the first metatarsal bone in all cases with a preserved MTP 1 and tarsometatarsal (TMT-1) joint without signs of instability. 2. Arthrodesis of the TMT-1 joint in all cases of instability or degenerative changes with an intact MTP 1 joint, the so-called Lapidus arthrodesis. This article gives an overview over the most important and widely used surgical techniques for correction of severe hallux valgus deformities. Emphasis is placed on the different osteosynthesis techniques and the recommended postoperative regimens. The advantages and disadvantages of the most frequently employed osteotomy techniques are discussed based on the current literature and the authors own experience.