Distal chevron osteotomy with lateral release for moderate to severe hallux valgus patients aged sixty years and over

Abstract

Purpose To analyze the outcome of distal chevron metatarsal osteotomy (DCMO) with lateral release for moderate to severe hallux valgus patients aged 60 years or more. Methods Consecutive 77 DCMOs in 54 patients were evaluated. Average age at operation was 65.1 +/- 4.3 (range 60-79) years; the mean follow-up period was 20.5 +/- 14.2 (range 12-93) months. Hallux valgus angle (HVA), first to second inter-metatarsal angle (IMA), and lateral sesamoid grades were measured. Considering the weak bone quality of the patients, fixation failures such as pin migration, callus formation, delayed union, and first metatarsal bone shortening were reviewed. Osteoarthritis (OA) of the first metatarsophalangeal joint (MTPJ), limitation of 1st MTPJ motion (LOM), and transfer metatarsalgia were also reviewed. Results HVA, IMA, and sesamoid grades were improved at three months and final follow-up. The mean HVA was 36.9 degrees +/- 7.0 degrees preoperatively and 6.8 degrees +/- 7.1 degrees at final follow-up. The mean correction angle of HVA was 31.3 degrees +/- 8.5 degrees at three months and 30.1 degrees +/- 8.9 degrees at final follow-up. The mean IMA was 16.3 degrees +/- 3.0 degrees pre-operatively and 7.7 degrees +/- 2.7 degrees at final follow-up. Hallux varus deformity was observed in three feet. Instability of osteotomy site was observed in one foot. Mean metatarsal shortening length was 1.26 +/- 2.1 mm at three month follow-up. There were no cases of transfer metatarsalgia after operation. OA was observed in four feet post-operatively. LOM was observed in ten feet (13.0%). There were no instances of re-fracture or avascular necrosis (AVN). Conclusion Despite concerns about aggravation of OA and fixation failure, distal chevron osteotomy with lateral release was safe on patients aged 60 years and over.