Proximal Intermetatarsal Divergence in Distal Chevron Osteotomy for Hallux Valgus: An Overlooked Finding


AKPINAR E., BÜYÜK A. F. , ÇETİNKAYA E., Gursu S., Ucpunar H., ALBAYRAK A.

JOURNAL OF FOOT & ANKLE SURGERY, vol.55, no.3, pp.504-508, 2016 (SCI-Expanded) identifier identifier identifier

  • Publication Type: Article / Article
  • Volume: 55 Issue: 3
  • Publication Date: 2016
  • Doi Number: 10.1053/j.jfas.2016.01.043
  • Journal Name: JOURNAL OF FOOT & ANKLE SURGERY
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus
  • Page Numbers: pp.504-508
  • Erzincan Binali Yildirim University Affiliated: No

Abstract

The goal of distal chevron osteotomy for hallux valgus is to restore proper first-toe joint alignment by performing lateral translation of the distal first metatarsal fragment (the metatarsal head). We hypothesized that in some patients this procedure might also result in involuntary medial translation of the proximal first metatarsal fragment, which we called proximal intermetatarsal divergence. The aim of the present study was to compare the pre- and postoperative radiographs of patients with hallux valgus to determine whether we could identify proximal intermetatarsal divergence. We retrospectively compared the pre- and postoperative radiographs of 29 feet in 28 patients treated with distal chevron osteotomy. Two different methods were used to measure the intermetatarsal angles: the anatomic intermetatarsal angle (aIMA) and the mechanical intermetatarsal angle (mIMA). The maximum intermetatarsal distance (MID) was also measured. We defined proximal intermetatarsal divergence as a postoperative increase in the aIMA or MID, coupled with a decrease in the mIMA. For data analysis, we divided the patients into low-angle (mild deformity) and high-angle (severe deformity) groups, according to their preoperative mIMA. The mean +/- standard deviation patient age was 41 +/- 14 years. In the low-angle group, the mean mIMA decreased (from 10.91 degrees to 7.00 degrees), the mean aIMA increased (from 11.80 degrees to 13.55 degrees), and the mean MID increased (from 17.97 mm to 20.60 mm; p = .001, for all). In the high-angle group, the mean mIMA decreased (from 14.30 degrees to 6.90 degrees; p = .001), the mean aIMA decreased (from 14.77 degrees to 13.54 degrees; p = .06), and the mean MID decreased (from 20.74 mm to 20.37 mm; p = .64). The results of our study suggest that proximal intermetatarsal divergence might occur after distal chevron osteotomy for hallux valgus, primarily in patients with a low preoperative mIMA. (C) 2016 by the American College of Foot and Ankle Surgeons. All rights reserved.