Skip to main content
SpringerLink
Log in

Outcome of proximal triple derotational metatarsal osteotomy for three-dimensional correction of hallux valgus deformity

  • Original Paper
  • Published:
International Orthopaedics Aims and scope Submit manuscript

Abstract

Purpose

To correct hallux valgus deformities in patients with a greater pronation of the first metatarsal, we designed a novel proximal triple derotational metatarsal osteotomy (PTDMO), which could be used to achieve three-dimensional correction of hallux valgus deformities at the proximal metatarsal level.

Methods

We prospectively evaluated the radiographic and clinical outcomes of 13 consecutive cases underwent PTDMO between November 2018 and May 2020. The minimum follow-up for inclusion was 12 months. The hallux valgus angle (HVA), first-to-second intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA), relative length of the second metatarsal, and medial sesamoid position on the weight bearing foot anteroposterior radiographs, and the degree of the first metatarsal pronation on forefoot axial radiographs were measured pre-operatively, at six weeks post-operatively, and at the final follow-up. The American Orthopaedic Foot and Ankle Society (AOFAS) score and Foot Ankle Outcome Scores (FAOS) were measured.

Results

In the comparison of pre-operative and final follow-up parameters, HVA, IMA, and DMAA were significantly improved post-operatively (all, P < 0.001). The relative length of the second metatarsal did not differ significantly post-operatively (P = 0.724). The medial sesamoid was significantly reduced (P = 0.01), and the first metatarsal pronation decreased by 10.16° (P = 0.034). Regarding clinical parameters, the AOFAS score and FAOS in all categories significantly improved post-operatively (all, P < 0.001).

Conclusion

PTDMO resulted in satisfactory radiographic and clinical outcomes with respect to deformity correction and pain relief, with significant post-operative reduced pronation of the first metatarsal.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

Data availability

All data generated or analyzed during this study are included in this published article.

References

  1. Choi JY, Yoon HH, Suh YM, Suh JS (2017) Surgical correction of hallux valgus complicated with adult-type pes plano-valgus. J Orthop Surg 25(1):1–6

    Google Scholar 

  2. Zhang Y, Awrejcewicz J, Szymanowska O et al (2018) Effects of severe hallux valgus on metatarsal stress and the metatarsophalangeal loading during balanced standing: a finite element analysis. Comput Biol Med 1(97):1–7

    Article  Google Scholar 

  3. Eustace S, O’Byrne J, Stack J, Stephen MM (1993) Radiographic features that enable assessment of first metatarsal rotation: the role of pronation in hallux valgus. Skeletal Radiol 22(3):153–156

    Article  CAS  Google Scholar 

  4. Hicks JH (1953) The mechanics of the foot Part I: the joints. J Anat 87:345–357

    CAS  PubMed  PubMed Central  Google Scholar 

  5. Maldin RA (1972) Axial rotation of the first metatarsal as a factor in hallux valgus. J Am Podiatry Assoc 62:85–93

    Article  CAS  Google Scholar 

  6. Saltzman CL, Brandser EA, Anderson CM, Berbaum KS, Brown TD (1996) Coronal plane rotation of the first metatarsal. Foot Ankle Int 17(3):157–161

    Article  CAS  Google Scholar 

  7. Steadman J, Barg A, Saltzman CL (2021) First metatarsal rotation in hallux valgus deformity. Foot Ankle Int 42(4):510–522

    Article  Google Scholar 

  8. Wagner E, Wagner P (2020) Metatarsal pronation in hallux valgus deformity: a review. J Am Acad Orthop Surg Glob Res Rev 4(6):e20.00091

    PubMed  PubMed Central  Google Scholar 

  9. Campbell B, Miller MC, William L, Conti SF (2018) Pilot study of a 3-dimensional method for analysis of pronation of the first metatarsal of hallux valgus patients. Foot Ankle Int 39:1449–1456

    Article  Google Scholar 

  10. Cruz EP, Wagner FV, Henning C, Sanhudo JAV, Pagnussato F, Galia CR (2017) Comparison between simple radiographic and computed tomographic three-dimensional reconstruction for evaluation of the distal metatarsal angle. J Foot Ankle Surg 56(3):505–509

    Article  Google Scholar 

  11. Okada R, Mitsuo K, Yasuda T, Jotoku T, Kitano N, Shima H (2007) The shape of the lateral edge of the first metatarsal head as a risk for recurrence of hallux valgus. J Bone Joint Surg Am 89(10):972:163-2172

    Google Scholar 

  12. Shibuya N, Kyprios EM, Panchani PN, Martin LR, Thorud JC, Jupiter DC (2018) Factors associated with early loss of hallux valgus correction. J Foot Ankle Surg 57:236–240

    Article  Google Scholar 

  13. Booth S, Bhosale A, Mustafa A, Shenoy R, Pillai A (2016) Triple osteotomy for the correction of severe hallux valgus deformity: patient reported outcomes and radiological evaluation. Foot 28:30–35

    Article  Google Scholar 

  14. Fernández RD (2017) Percutaneous triple and double osteotomies for the treatment of hallux valgus. Foot Ankle Int 38(2):159–166

    Article  Google Scholar 

  15. Hardy RH, Clapham JC (1951) Observations on hallux valgus; based on a controlled series. J Bone Joint Surg Br 33-B(3):376–391

    Article  CAS  Google Scholar 

  16. Suzuki J, Tanaka Y, Takaoka T, Kadono K, Takakura Y (2004) Axial radiographic evaluation in hallux valgus: evaluation of the transverse arch in the forefoot. J Orthop Sci 9(5):446–451

    Article  Google Scholar 

  17. Ibrahim T, Beiri A, Azzabi M, Best AJ, Taylor GJ, Menon DK (2007) Reliability and validity of the subjective component of the American Orthopaedic Foot and Ankle Society clinical rating scales. J Foot Ankle Surg 46(2):65–75

    Article  Google Scholar 

  18. Kitaoka HB, Alexander IJ, Adelaar RS, Nunley JA, Myerson MS, Sanders M (1994) Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int 15(7):349–353

    Article  CAS  Google Scholar 

  19. Roos EM, Brandsson S, Karlsson J (2001) Validation of the foot and ankle outcome score for ankle ligament reconstruction. Foot Ankle Int 22(10):788–794

    Article  CAS  Google Scholar 

  20. Eustace S, Byrne JO, Beausang O, Codd M, Stack J, Stephens MM (1994) Hallux valgus, first metatarsal pronation and collapse of the medial longitudinal arch-a radiological correlation. Skeletal Radiol 23(3):191–194

    Article  CAS  Google Scholar 

  21. Mortier JP, Bernard JL, Maestro M (2018) Axial rotation of the first metatarsal head in a normal population and hallux valgus patients. Orthop Traumatol Surg Res 3(3):1–8

    Google Scholar 

  22. Wagner P, Wagner E (2012) Proximal rotational metatarsal osteotomy for hallux valgus (PROMO): short-term prospective case series with a novel technique and topic review. Foot Ankle Orthop 98(6):677–683

    Google Scholar 

  23. Wagner P, Wagner E (2019) The use of a triplanar metatarsal rotational osteotomy to correct hallux valgus deformities. JBJS Essent Surg Tech 9(4):e43.1-e43.2

    Google Scholar 

  24. Zein AB, Elhalawany AS, Nagy M et al (2021) Three-dimensional correction of hallux valgus deformity: a novel technique. Tech Orthop [Online ahead of print]

  25. Wagner E, Ortiz C, Gould JS et al (2013) Proximal oblique sliding closing wedge osteotomy for hallux valgus. Foot Ankle Int 34(11):1493–1500

    Article  Google Scholar 

  26. Wagner E, Ortiz C, Keller A (2007) Proximal oblique slide closing wedge metatarsal osteotomy with plate fixation for severe hallux valgus deformities. Tech Foot Ankle Surg 6(4):270–274

    Article  Google Scholar 

  27. Cruz EP, Wagner FV, Henning C, Sanhudo JAV, Pagnussato F, Galia CR (2019) Does hallux vagus exhibit a deformity inherent to the first metatarsal bone? J Foot Ankle Surg 58(6):1210–1214

    Article  Google Scholar 

  28. Scheele CB, Christel ST, Fröhlich I et al (2020) A cone beam CT based 3D-assessment of bony forefoot geometry after modified Lapidus arthrodesis. Foot Ankle Surg 26(8):883–889

    Article  Google Scholar 

Download references

Acknowledgements

In remembrance of Woon Hyuk Lee (1982–2020), Jun Young Choi is grateful for his help with analyzing data and English editing.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Inje University Ilsan Paik Hospital, 170 Juhwa-ro, Ilsanseo-gu, Goyang-si, Gyeonggi-do, South Korea

    Jun Young Choi, Jin Soo Suh, Jin Ho Cho & Seung Jun Park

Authors
  1. Jun Young Choi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jin Soo Suh
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jin Ho Cho
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Seung Jun Park
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

JY Choi wrote the article with organizing the data, participated in the design of the study, and performed the statistical analysis. JS Suh conceived the study, and participated in its design and coordination and helped to draft the manuscript. JH Cho participated in the writing the article in English. SJ Park sorted the involved patients with a review of medial record.

Corresponding author

Correspondence to Jun Young Choi.

Ethics declarations

Ethics approval

This study was approved by the appropriate institutional ethics review committee and performed according to the tenets of the Declaration of Helsinki.

Consent to participate

Written informed consent was obtained from all enrolled patients.

Consent to publication

Authors agree to publication. This manuscript has not been published in any journals.

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Level of evidence: IV, case series

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Choi, J.Y., Suh, J.S., Cho, J.H. et al. Outcome of proximal triple derotational metatarsal osteotomy for three-dimensional correction of hallux valgus deformity. International Orthopaedics (SICOT) 45, 3101–3110 (2021). https://doi.org/10.1007/s00264-021-05170-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00264-021-05170-7

Keywords

Search

Navigation