Chevron osteotomy with minimally invasive surgery (MIS) of the first metatarsal.
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Published:
Feb 12, 2017
Keywords:
Hallux valgus. Minimally invasive surgery. Chevron osteotomy.
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Abstract
BackgroundThe aim of this study was to analyze the radiological results of a roof (“Chevron”) osteotomy with MIS (Minimally invasive surgery) technique of the first metatarsal in a uniform population of patients with moderate hallux valgus.MethodsSurgical treatment of hallux valgus was performed between October 2013 and November 2014, by a roof ("Chevron") osteotomy with MIS technique of the first metatarsal in 24 feet of 21 patients. All patients had a diagnosis of moderate hallux valgus.ResultsThe mean preoperative intermetatarsal angle between M1-M2 was 12.46° (range: 11-15°, SD 1.03). Postoperatively, the mean intermetatarsal angle was 8.13° (range: 5-10°; SD 1.16), with an angular correction of 4.33° in average. The mean preoperative hallux valgus angle was 33.96° (range: 20-40°; SD 4.93) and postoperatively, the metatarsal-phalangeal angle was 8.16° in average, (range: 3-15°, SD 2.86), thus improving in 25.86° in average.ConclusionsRadiological results obtained from the minimally invasive technique (Chevron osteotomy), confirm a safe and effective procedure for the treatment of moderate hallux valgus, with mid-term satisfactory angular correction. This method faithfully mimics the open Chevron surgical technique retaining all its known virtues. To our knowledge, no equivalent study was found in the literature.
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del Vecchio, J. J., Ghioldi, M. E., & Raimondi, N. (2017). Chevron osteotomy with minimally invasive surgery (MIS) of the first metatarsal. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 82(1), 19-27. https://doi.org/10.15417/633
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Clinical Research
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References
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2. Coughlin MJ: Juvenile hallux valgus. In Coughlin, MJ; Mann, RA (eds.): Surgery of the foot and ankle, 7th edition, Mosby Yearbook, St. Louis, pp. 270-319, 1999.
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5. Myerson M: Foot and Ankle disorders, hallux valgus. WB Sanders Co. Philadelphia, pp. 213-289, 1999.
6. Mitchell LA, Baxter DE. A Chevron-Akin double osteotomy for correction of hallux valgus.Foot Ankle. 1991 Aug;12(1):7-14.
7. Austin DW, Leventen EO. A new osteotomy for hallux valgus: a horizontally directed "V" displacement osteotomy of the metatarsal head for hallux valgus and primus varus. Clin Orthop Relat Res. 1981 Jun;(157):25-30.
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9. Donnelly RE, Saltzman CL, Kile TA, Johnson KA. Modified chevron osteotomy for hallux valgus. Foot Ankle Int. 1994 Dec;15(12):642-5.
10. Schneider W, Aigner N, Pinggera O, Knahr K. Chevron osteotomy in hallux valgus. Ten-year results of 112 cases. J Bone Joint Surg Br. 2004 Sep;86(7):1016-20.
11. Bai LB, Lee KB, Seo CY, Song EK, Yoon TR. Distal chevron osteotomy with distal soft tissue procedure for moderate to severe hallux valgus deformity. Foot Ankle Int. 2010 Aug;31(8):683-8.
12. Potenza V, Caterini R, Farsetti P, Forconi F, Savarese E, Nicoletti S, Ippolito E. Chevron osteotomy with lateral release and adductor tenotomy for hallux valgus. Foot Ankle Int. 2009 Jun;30(6):512-6.
13. Magnan B, Pezzè L, Rossi N, Bartolozzi P. Percutaneous distal metatarsal osteotomy for correction of hallux valgus. J Bone Joint Surg Am. 2005 Jun;87(6):1191-1199.
14. Bauer T, de Lavigne C, Biau D, De Prado M, Isham S, Laffenétre O. Percutaneous hallux valgus surgery: a prospective multicenter study of 189 cases. Orthop Clin North Am. 2009 Oct;40(4):505-14.
15. Radwan YA, Mansour AM. Percutaneous distal metatarsal osteotomy versus distal chevron osteotomy for correction of mild-to-moderate hallux valgus deformity. Arch Orthop Trauma Surg. 2012 Nov;132(11):1539-46.
16. Bösch P, Wanke S, Legenstein R. Hallux valgus correction by the method of Bösch: a new technique with a seven-to-ten-year follow-up. Foot Ankle Clin. 2000 Sep;5(3):485-98, v-vi. Review.
17. Gicquel T, Fraisse B, Marleix S, Chapuis M, Violas P. Percutaneous hallux valgus surgery in children: short-term outcomes of 33 cases. Orthop Traumatol Surg Res. 2013 Jun;99(4):433-9.
18. Vernois J. The treatment of the hallux valgus with a percutaneous chevron osteotomy. J Bone Joint Surg Br 2011;93(Suppl IV):482.
19. Redfern D, Perera AM. Minimally invasive osteotomies. Foot Ankle Clin. 2014 Jun;19(2):181-9.
20. Redfern D, Gill I, Harris M. Early experience with a minimally invasive modified chevron and akin osteotomy for correction of hallux valgus. J Bone Joint Surg Br 2011;93(Suppl IV):482.
21. Brogan K, Voller T, Gee C, Borbely T, Palmer S. Third-generation minimally invasive correction of hallux valgus: technique and early outcomes. Int Orthop. 2014 Oct;38(10):2115-21.
22. Fuhrmann RA, Layher F, Wetzel WD. Radiographic changes in forefoot geometry with weightbearing. Foot Ankle Int. 2003 Apr;24(4):326-31.
23. Coughlin MJ, Saltzman CL, Nunley JA 2nd. Angular measurements in the evaluation of hallux valgus deformities: a report of the ad hoc committee of the American Orthopaedic Foot & Ankle Society on angular measurements. Foot Ankle Int. 2002 Jan;23(1):68-74.
24. Mann, RA; Coughlin, MJ: Adult hallux valgus. In Mann, RA; Coughlin, MJ (eds): Surgery of the foot and ankle, 7 th edition, C.V. Mosby, St. Louis, pp 159 – 269, 1999.
25. Miller JW. Distal first metatarsal displacement osteotomy. Its place in the schema of bunion surgery. J Bone Joint Surg Am. 1974 Jul;56(5):923-31.
26. Schneider W, Csepan R, Knahr K. Reproducibility of the radiographic metatarsophalangeal angle in hallux surgery. J Bone Joint Surg Am. 2003 Mar;85-A(3):494-9.
27. Chi TD, Davitt J, Younger A, Holt S, Sangeorzan BJ. Intra and inter-observer reliability of the distal metatarsal articular angle in adult hallux valgus. Foot Ankle Int. 2002;23:722-726.
28. Piggott, H.: The natural history of hallux valgus in adolescence and early adult life. J. Bone and Joint Surg. 1960; 42-B(4):749-760.
29. Coughlin, M. J., and Thompson, F. M.: The high price of high-fashion footwear. In Instructional Course Lectures, The American Academy of Orthopaedic Surgeons. Vol. 44, pp. 371-377. Rosemont, Illinois, The American Academy of Orthopaedic Surgeons, 1995.
30. Johnson, JE; Clanton, TO; Baxter, DE; Gottlieb, MS: Comparison of chevron osteotomy and modified McBride bunionectomy for correction of mild to moderate hallux valgus deformity. Foot Ankle. 12:61 – 68, 1991.
31. Green, MA; Dorris, MF; Baessler, TP; Mandel, LM; Nachlas,
MJ: Avascular necrosis following distal chevron osteotomy of the first metatarsal. J Foot Ankle Surg. 32:617 – 622, 1993.
32. Peterson, DA; Zilberfarb, JL; Greene, MA; Colgrove, RC: Avascular necrosis of the first metatarsal head: incidence in distal osteotomy combined with lateral soft tissue release. Foot Ankle Int. 15:59 – 63, 1994.
33. Leventen, EO: The chevron procedure. Orthopedics. 13:973– 976, 1990.
34. Meier, PJ; Kenzora, JE: The risks and benefits of distal first metatarsal osteotomies. Foot Ankle. 6:7 – 17, 1985.
35. Peterson, DA; Zilberfarb, JL; Greene, MA; Colgrove, RC: Avascular necrosis of the first metatarsal head: incidence in distal osteotomy combined with lateral soft tissue release. Foot Ankle Int. 15:59 – 63, 1994.
36. Resch, S; Stenstr¨om, A; Gustafson, T: Circulatory disturbance of the first metatarsal head after chevron osteotomy as shown by bone scintigraphy. Foot Ankle. 13:137 – 142, 1992.
37. Kadakia AR, Smerek JP, Myerson MS. Radiographic results after percutaneous distal metatarsal osteotomy for correction of hallux valgus deformity. Foot Ankle Int. 2007 Mar;28(3):355-60.
38. Huang PJ, Lin YC, Fu YC, et al. Radiographic evaluation of minimally invasive distal metatarsal osteotomy for hallux valgus. Foot Ankle Int 2011;32(5):S503–7.
39. Pochatko DJ, Schlehr FJ, Murphey MD, Hamilton JJ. Distal chevron osteotomy with lateral release for treatment of hallux valgus deformity. Foot Ankle Int. 1994 Sep;15(9):457-61.
40. Potenza V, Caterini R, Farsetti P, Forconi F, Savarese E, Nicoletti S, Ippolito E. Chevron osteotomy with lateral release and adductor tenotomy for hallux valgus. Foot Ankle Int. 2009 Jun;30(6):512-6.
41. J. Vernois, D. Redfern, Percutaneous Chevron; the union of classic stable fixed approach and percutaneous technique, Fuß & Sprunggelenk (2013), http://dx.doi.org/10.1016/j.fuspru.2013.03.001.
42. Brogan K, Voller T, Gee C, Borbely T, Palmer S. Third-generation minimally invasive correction of hallux valgus: technique and early outcomes. Int Orthop. 2014 Oct;38(10):2115-21.
2. Coughlin MJ: Juvenile hallux valgus. In Coughlin, MJ; Mann, RA (eds.): Surgery of the foot and ankle, 7th edition, Mosby Yearbook, St. Louis, pp. 270-319, 1999.
3. Du Vries H: Surgery of the Foot. C.V. Mosby Co. St. Louis, pp. 346-442, 1959.
4. Mann RA; Coughlin, MJ: Adult Hallux Valgus. In Mann, RA; Coughlin, MJ (eds.): Surgery of the Foot and Ankle, 7th edition, C.V.
Mosby, St. Louis, pp 159-269, 1999.
5. Myerson M: Foot and Ankle disorders, hallux valgus. WB Sanders Co. Philadelphia, pp. 213-289, 1999.
6. Mitchell LA, Baxter DE. A Chevron-Akin double osteotomy for correction of hallux valgus.Foot Ankle. 1991 Aug;12(1):7-14.
7. Austin DW, Leventen EO. A new osteotomy for hallux valgus: a horizontally directed "V" displacement osteotomy of the metatarsal head for hallux valgus and primus varus. Clin Orthop Relat Res. 1981 Jun;(157):25-30.
8. Coughlin, M. J.: Chevron procedure. Contemp. Orthop. 1991; 23:45-49.9.
9. Donnelly RE, Saltzman CL, Kile TA, Johnson KA. Modified chevron osteotomy for hallux valgus. Foot Ankle Int. 1994 Dec;15(12):642-5.
10. Schneider W, Aigner N, Pinggera O, Knahr K. Chevron osteotomy in hallux valgus. Ten-year results of 112 cases. J Bone Joint Surg Br. 2004 Sep;86(7):1016-20.
11. Bai LB, Lee KB, Seo CY, Song EK, Yoon TR. Distal chevron osteotomy with distal soft tissue procedure for moderate to severe hallux valgus deformity. Foot Ankle Int. 2010 Aug;31(8):683-8.
12. Potenza V, Caterini R, Farsetti P, Forconi F, Savarese E, Nicoletti S, Ippolito E. Chevron osteotomy with lateral release and adductor tenotomy for hallux valgus. Foot Ankle Int. 2009 Jun;30(6):512-6.
13. Magnan B, Pezzè L, Rossi N, Bartolozzi P. Percutaneous distal metatarsal osteotomy for correction of hallux valgus. J Bone Joint Surg Am. 2005 Jun;87(6):1191-1199.
14. Bauer T, de Lavigne C, Biau D, De Prado M, Isham S, Laffenétre O. Percutaneous hallux valgus surgery: a prospective multicenter study of 189 cases. Orthop Clin North Am. 2009 Oct;40(4):505-14.
15. Radwan YA, Mansour AM. Percutaneous distal metatarsal osteotomy versus distal chevron osteotomy for correction of mild-to-moderate hallux valgus deformity. Arch Orthop Trauma Surg. 2012 Nov;132(11):1539-46.
16. Bösch P, Wanke S, Legenstein R. Hallux valgus correction by the method of Bösch: a new technique with a seven-to-ten-year follow-up. Foot Ankle Clin. 2000 Sep;5(3):485-98, v-vi. Review.
17. Gicquel T, Fraisse B, Marleix S, Chapuis M, Violas P. Percutaneous hallux valgus surgery in children: short-term outcomes of 33 cases. Orthop Traumatol Surg Res. 2013 Jun;99(4):433-9.
18. Vernois J. The treatment of the hallux valgus with a percutaneous chevron osteotomy. J Bone Joint Surg Br 2011;93(Suppl IV):482.
19. Redfern D, Perera AM. Minimally invasive osteotomies. Foot Ankle Clin. 2014 Jun;19(2):181-9.
20. Redfern D, Gill I, Harris M. Early experience with a minimally invasive modified chevron and akin osteotomy for correction of hallux valgus. J Bone Joint Surg Br 2011;93(Suppl IV):482.
21. Brogan K, Voller T, Gee C, Borbely T, Palmer S. Third-generation minimally invasive correction of hallux valgus: technique and early outcomes. Int Orthop. 2014 Oct;38(10):2115-21.
22. Fuhrmann RA, Layher F, Wetzel WD. Radiographic changes in forefoot geometry with weightbearing. Foot Ankle Int. 2003 Apr;24(4):326-31.
23. Coughlin MJ, Saltzman CL, Nunley JA 2nd. Angular measurements in the evaluation of hallux valgus deformities: a report of the ad hoc committee of the American Orthopaedic Foot & Ankle Society on angular measurements. Foot Ankle Int. 2002 Jan;23(1):68-74.
24. Mann, RA; Coughlin, MJ: Adult hallux valgus. In Mann, RA; Coughlin, MJ (eds): Surgery of the foot and ankle, 7 th edition, C.V. Mosby, St. Louis, pp 159 – 269, 1999.
25. Miller JW. Distal first metatarsal displacement osteotomy. Its place in the schema of bunion surgery. J Bone Joint Surg Am. 1974 Jul;56(5):923-31.
26. Schneider W, Csepan R, Knahr K. Reproducibility of the radiographic metatarsophalangeal angle in hallux surgery. J Bone Joint Surg Am. 2003 Mar;85-A(3):494-9.
27. Chi TD, Davitt J, Younger A, Holt S, Sangeorzan BJ. Intra and inter-observer reliability of the distal metatarsal articular angle in adult hallux valgus. Foot Ankle Int. 2002;23:722-726.
28. Piggott, H.: The natural history of hallux valgus in adolescence and early adult life. J. Bone and Joint Surg. 1960; 42-B(4):749-760.
29. Coughlin, M. J., and Thompson, F. M.: The high price of high-fashion footwear. In Instructional Course Lectures, The American Academy of Orthopaedic Surgeons. Vol. 44, pp. 371-377. Rosemont, Illinois, The American Academy of Orthopaedic Surgeons, 1995.
30. Johnson, JE; Clanton, TO; Baxter, DE; Gottlieb, MS: Comparison of chevron osteotomy and modified McBride bunionectomy for correction of mild to moderate hallux valgus deformity. Foot Ankle. 12:61 – 68, 1991.
31. Green, MA; Dorris, MF; Baessler, TP; Mandel, LM; Nachlas,
MJ: Avascular necrosis following distal chevron osteotomy of the first metatarsal. J Foot Ankle Surg. 32:617 – 622, 1993.
32. Peterson, DA; Zilberfarb, JL; Greene, MA; Colgrove, RC: Avascular necrosis of the first metatarsal head: incidence in distal osteotomy combined with lateral soft tissue release. Foot Ankle Int. 15:59 – 63, 1994.
33. Leventen, EO: The chevron procedure. Orthopedics. 13:973– 976, 1990.
34. Meier, PJ; Kenzora, JE: The risks and benefits of distal first metatarsal osteotomies. Foot Ankle. 6:7 – 17, 1985.
35. Peterson, DA; Zilberfarb, JL; Greene, MA; Colgrove, RC: Avascular necrosis of the first metatarsal head: incidence in distal osteotomy combined with lateral soft tissue release. Foot Ankle Int. 15:59 – 63, 1994.
36. Resch, S; Stenstr¨om, A; Gustafson, T: Circulatory disturbance of the first metatarsal head after chevron osteotomy as shown by bone scintigraphy. Foot Ankle. 13:137 – 142, 1992.
37. Kadakia AR, Smerek JP, Myerson MS. Radiographic results after percutaneous distal metatarsal osteotomy for correction of hallux valgus deformity. Foot Ankle Int. 2007 Mar;28(3):355-60.
38. Huang PJ, Lin YC, Fu YC, et al. Radiographic evaluation of minimally invasive distal metatarsal osteotomy for hallux valgus. Foot Ankle Int 2011;32(5):S503–7.
39. Pochatko DJ, Schlehr FJ, Murphey MD, Hamilton JJ. Distal chevron osteotomy with lateral release for treatment of hallux valgus deformity. Foot Ankle Int. 1994 Sep;15(9):457-61.
40. Potenza V, Caterini R, Farsetti P, Forconi F, Savarese E, Nicoletti S, Ippolito E. Chevron osteotomy with lateral release and adductor tenotomy for hallux valgus. Foot Ankle Int. 2009 Jun;30(6):512-6.
41. J. Vernois, D. Redfern, Percutaneous Chevron; the union of classic stable fixed approach and percutaneous technique, Fuß & Sprunggelenk (2013), http://dx.doi.org/10.1016/j.fuspru.2013.03.001.
42. Brogan K, Voller T, Gee C, Borbely T, Palmer S. Third-generation minimally invasive correction of hallux valgus: technique and early outcomes. Int Orthop. 2014 Oct;38(10):2115-21.