Lviv clinical bulletin 2015, 1(9): 50-52

Optimization of Surgical Treatment of Severe Hallux Valgus by Modified Osteosynthesis Method

A. Yatskevych

Danylo Halytsky Lviv National Medical University

Introduction. Attention to the problem of Valgus deviation of the first toe (VDFT) does not weaken for about 200 years, due to its considerable population distribution (18,0-20,0%), as well as the lack of treatment efficacy, the recurring nature of deformation

Aim. To optimize the treatment of VDFT, improving the methods of osteosynthesis after the corrective osteotomy of the I pectoral bone.

Materials and methods. The results of treatment of 42 patients with severe forms of VDFT were analyzed. The average age of patients was 52 years. The clinical, orthopedic, and roentgenologic examination according to standard methods was conducted. The angle of the VDFT was more than 35°, the first inter-axial angle was more than 18°, the first finger was pierced, and in the I-membranous-phalangeal joint – subluxated, the displacement of the lateral sesameiform bone reached 100.0%. All the patients were treated with proximal corrective osteotomy of the I pectoral bone with an osteosynthesis using screw according to the technique we upgraded.

Results. Postoperative wounds in all cases were healed by the initial tension. The consolidation of osteotomy based on the results of the X-ray examination took place in the period of five to six weeks. According to the assessment of the AOFAS scale, in three cases (7.1%) satisfactory results were noted. Of these, in one patient (2.4%), although there was a good correction of the shape of the foot, contracture in the I plexus- phalangeal joint arose because of the patient’s late removing of the syringe. In two patients (4.8%) the correction was partially lost (up to 10 °) with a satisfactory foot function and no pain. This correlated with the phenomena of osteoporosis of the bones of the foot in these patients. In 39 operated patients (42.4%) there were good and excellent results. In particular, in 17 patients (40.5%) – the average score was 82.4 and in 22 (52.4%) – 95.7.

The results of the treatment were consistent with the results obtained in patients operated with the use of plates with angular stability, which today are considered as “golden standard” of osteosynthesis in foot surgery, but compared with them, the proposed method is less traumatic, technically simpler, significantly lower (on average in 10 times cost of implants.

Conclusions. Fixing the fragments of the I pectoral bone after osteotomy due to VDFT with a long screw according to our modified method provided early activation, comfortable treatment and a good cosmetic and functional result. The applied method of fixation is effective, technically simple, minimally invasive, economically viable, and allows to improve the results of treatment of patients with VDFT.


  1. Prozorovsky DV, Romanenko KK, Horidova LD, Ershov DV. The Choice of the Fixation Method during the Proximal Osteotomy of the First Metatarsal Bone. Trauma. 2012;13(3):111-115. (Ukrainian).
  2. Kardanov AA, Makinyan LG, Lukin MP. Surgical Treatment of the Deformations of the First Ray of the Foot: History and Modern Aspects. Moskow: Medpractice-M, 2008. 103 p. (Russian).
  3. Korzh NA, Prozorovsky DV, Romanenko KK. Modern X-ray-Anatomical Parameters in the Diagnosis of Transverse-Planar Deformation of the Anterior Part of the Foot. Trauma. 2009;10(4):445-450. (Ukrainian).
  4. Musalatov KhA, Uellens-Ananyeva T, Petrov NV. On the Issue of the Pathogenesis and Peculiarities of the Surgical Treatment of Valgus Deformation of the First Toe of the Foot. Medical Care. 2004;1:12-14. (Russian).
  5. Prozorovsky DV. Evaluation of the Results of the Surgical Treatment of the Forefoot Deformities. Ukrainian Morphological Almanac. 2010;8(3):114-116. (Ukrainian).
  6. Muller ME, Algover M, Schneider R, Willinger H. Guidance on the Internal Osteosynthesis: transl. from Germ. Moskow: AdMarginem, 1996. 750 p. (Russian).
  7. Cherkes-Zade DI, Kamenev YF. Foot Surgery. Moskow: Medicine, 2002. 328 p. (Russian).
  8. Shapiro KI. Statistics of the Injuries and Diseases of Feet. Injuries and Diseases of the Foot. Leningrad, 1979. p. 150-153. (Russian).
  9. Yarygin NV, Shaklychev OK, Khudalov TT. The X-ray Characteristics of the Anterior Part of the Foot in Case of Transverse Flatfoot. Surgeon. 2011;9:36-42. (Russian).
  10. Hyer CF, Glover JP, Berlet GC, Philbin TM, Lee TH. A comparison of the crescentic and Mau osteotomies for correction of hallux valgus. J Foot Ankle Surg. 2008;47(2):103-111.
  11. Acevedo JI. Fixation of metatarsal osteotomies in the treatment of hallux valgus. Foot Ankle Clin. 2000;5(3):451-468.
  12. Barouk LS. Forefoot reconstruction. Paris: Springer, 2005. 388 р.
  13. Hofstaetter SG, Glisson RR, Alitz CJ, Trnka HJ, Easley ME. Biomechanical comparison of screws and plates for hallux valgus opening-wedge and Ludloff osteotomies. Clin Biomech (Bristol, Avon). 2008;23(1):101-108.
  14. Campbell WC, Canale ST, James H et al. Campbell’s operative orthopaedics. 11th Philadelphia, PA: Mosby/Elsevier, 2008.
  15. Vanore JV, Christensen JC, Kravitz SR, Schuberth JM, Thomas JL, Weil LS et al. Diagnosis and treatment of first metatarsophalangeal joint disorders. Section hallux valgus. J Foot Ankle Surg. 2003;42(3):112-123.
  16. Hetherington VJ. Textbook of Hallux Valgus and forefoot surgery. Cleveland, OH: Churchill Livingstone, 1994. 599 р.
  17. Lin JS, Bustillo J. Surgical treatment of hallux valgus: a review. Curr Opin Orthoped. 2007;18(2):112-117.
  18. Mann RA, Mann JA. Proximal crescent osteotomy. In: Operative Techniques in Orthopaedic Surgery. Wiesel SW, editor. Philadelphia: Lippencott Williams & Wilkins, 2011. р. 11-25.
  19. Mann RA, Rudicel S, Graves SC. Repair of hallux valgus with a distal soft-tissue procedure and proximal metatarsal osteotomy. A long-term follow-up. J Bone Joint Surg Am. 1992;74(1):124-129.
  20. Campbell JT, Schon LC, Parks BG, Wang Y, Berger BI. Mechanical comparison of biplanar proximal closing wedge osteotomy with plantar plate fixation versus crescentic osteotomy with screw fixation for the correction of metatarsus primus varus. Foot Ankle Int. 1998;19(5):293-299.
  21. Jones C, Coughlin M, Petersen W, Herbot M, Paletta J. Mechanical comparison of two types of fixation for proximal first metatarsal crescentic osteotomy. Foot Ankle Int. 2005;26(5):371-374.
  22. Zettl R, Trnka HJ, Easley M, Salzer M, Ritschl P. Moderate to severe hallux valgus deformity: correction with proximal crescentic osteotomy and distal softtissue release. Arch Orthop Trauma Surg. 2000;120(7-8):397-402.
  23. Chow FY, Lui TH, Kwok KW, Chow YY. Plate fixation for crescentic metatarsal osteotomy in the treatment of hallux valgus: an eight-year followup study. Foot Ankle Int. 2008;29(1):29-33.
  24. Robinson AH, Limbers JP. Modern concepts in the treatment of hallux valgus. J Bone Joint Surg. 2005;87(8):1038-1045.
  25. Rodrigues RC, Masiero D, Mizusaki JM, Imoto AM, Peccin MS, Cohen M et al. Translation, cultural adaptation and validation of the «American orthopaedic foot and ankle societys (AOFAS) ankle – hindfoot scale. Acta Ortop Bras. 2008;16(2):107-111.
  26. Veri JP, Pirani SP, Claridge R. Crescentic proximal metatarsal osteotomy for moderate to severe hallux valgus: a mean 12.2 year follow-up study. Foot Ankle Int. 2001;22(10):817-822.