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IntroductionTo evaluate the clinical and radiological results after fixation of the first metatarsal head (MTH) with one or two screws as part of the third-generation minimally invasive Chevron–Akin osteotomy (MICA) for hallux valgus deformities.Materials and methodsBetween August 2020 and November 2021, 55 MICA procedures (50 patients, male:female = 7:43), 22 with two (MICA2), 33 with one screw (MICA1) were performed for mild to severe hallux valgus deformities. Exclusion criteria were a concomitant pes adductus (Sgarlato angle > 20°) or hindfoot/midfoot deformities requiring treatment. In 27 cases, additional procedures on the forefoot (small toe corrections or metatarsal osteotomies II–V) were necessary. Pre- and post-operatively, hallux valgus angle (HVA) and intermetatarsal I/II angle (IMA) were measured. Clinically, subjective satisfaction, range of motion (ROM) of the first metatarsophalangeal joint (MTPJ), and pain level (NRS score) were evaluated. The minimum follow-up was 12 months.ResultsDisplacement of MTH was 70–90% on average, all osteotomies showed full consolidation at latest follow-up. In one case of either group, a slight subsidence of MTH was documented. The radiological and clinical parameters showed no differences between the groups. The pain level improved by an average of three points. The mobility of the MTPJ showed a slight reduction in nine cases after three months (4 MICA2, 5 MICA1) which persisted in three cases. Fifty-two of 55 patients (95%) would opt again for the operation.ConclusionsFixation of the first MTH with a single bicortical screw in MICA with moderate lateralization of MTH shows stable anchoring and good clinical results. The routine use of a second metatarsal screw can be omitted.

Researchers have modified PLA materials to enhance their mechanical properties and meet the clinical requirements. However, the strength and stiffness of PLA are still significantly lower than those of metals. Building on the established chevron clinical procedure and considering the mechanical characteristics of PLA screws, we devised a modified chevron osteotomy (MCO) based on a load-reducing structure with the aim of reducing the load on the screws. Subsequently, in vitro quasi-static in situ compression and dynamic fatigue tests were conducted for both procedures. DIC, micro-CT, and SEM were used to elucidate the unloading effects and structural damage of different bone cutting and implant locations on the PLA bone screws, providing biomechanical data for clinical applications. In-vitro simulation studies indicated that the unloading structure of the MCO procedure reduced the load borne by the PLA screws. Within the load range of the first metatarsal during walking, the MCO procedure exhibited a compressive strength 2.5 times that of the traditional chevron osteotomy groups and even exceeded the titanium alloy screw groups by 25%, ensuring PLA screw fixation strength and stability that are not inferior to metallic materials. A stable load-reducing structure in osteotomy procedures is the key to PLA materials becoming viable alternatives to metal orthopedic fixation devices.

Purpose To date, the surgical treatment of severe hallux valgus deformity remains challenging despite the various methods presented. This study aimed to compare the effectiveness of minimally invasive distal chevron Akin osteotomies (d-MICA) and minimally invasive proximal chevron Akin osteotomies (p-MICA) in correcting severe hallux valgus deformities. Methods This prospective follow-up study included patients randomly assigned to undergo p-MICA or d-MICA for hallux valgus deformities with a preoperative hallux valgus angle (HVA) ≥ 40° and/or a first to second intermetatarsal angle (IMA) ≥ 16°. After a minimum follow-up period of two years, we compared various clinico-radiographic parameters of patients whose HVA exceeded 15° at the final follow-up. Results In the p-MICA and d-MICA groups, seven of 40 cases (17.5%) and 16 of 41 cases (39.0%), respectively, exhibited HVA > 15° at the final follow-up (P = 0.048). The preoperative parameters showed no significant differences. However, at the first weight-bearing assessment, the HVA, IMA, and relative second metatarsal length were significantly smaller, and the distal metatarsal articular angle (DMAA) was greater in the p-MICA group (all P < 0.05) compared with the d-MICA group. Postoperatively, both groups exhibited significant decreases in HVA and IMA at the final follow-up (P < 0.001 for all parameters). The p-MICA group showed no significant changes in DMAA and the relative length of the second metatarsal (P = 0.253 and 0.185, respectively). However, the d-MICA group showed a significant decrease in DMAA (P < 0.001) and an increase in the relative length of the second metatarsal at the final follow-up (P = 0.01). Conclusions p-MICA and d-MICA procedures demonstrated effective correction potential for severe hallux valgus deformities; however, the d-MICA procedure exhibited a notably higher incidence of unsatisfactory correction at the final follow-up than p-MICA. Therefore, d-MICA may be less predictable in achieving successful outcomes than p-MICA in treating severe hallux valgus deformities.

BackgroundHallux valgus is a frequent condition of the forefoot, resulting in cosmetic deformity and pain. Chevron osteotomy (CO) is widely employed for the treatment of hallux valgus. Chevron–Akin double osteotomy (CAO) was previously described and superiority over an isolated Chevron procedure was assumed. The objective of this study was to compare the short-to-middle term outcomes of CO and CAO.Patients and methodsThis study included 72 patients with established diagnosis of mild-to-moderate hallux valgus, treated by either isolated CO or CAO. The CO group included 46 patients (mean 51.5 years) with a mean hallux valgus angle of 27°, while the CAO group included 26 subjects (mean 53.1 years) and a mean hallux valgus angle of 32° preoperatively. All patients were reviewed by physical examination, and standardized questionnaire, and pre- and postoperative standing X-rays were performed. Matched group analysis was carried out to analyze statistical differences of both techniques.ResultsThe patients were assessed and group matched at a mean of 1.37 years for the CO group and 1.04 years for the CAO group, postoperatively. Mean improvement of HVA (hallux valgus angle) was 10.6° in the CO group and the CAO group improved by 17.5°. DMAA (distal metatarsal articular angle) improved in the CO group by 5.4° and in the CAO by 13.7°. Mean AOFAS score improved by 27.9 (CO) and 21.5 (CAO). Patient satisfaction was high in both groups, with a tendency towards higher values within the CAO group.ConclusionsThese findings indicate that Chevron–Akin double osteotomy is a save and practicable procedure for the treatment of mild-to-moderate hallux valgus. Superiority of combined Chevron–Akin procedure over an isolated Chevron osteotomy might be limited to distinct clinical settings, but should not be generally assumed.

Background This systematic review and meta-analysis aimed to investigate the differences in hallux valgus angle (HVA), intermetatarsal angle (IMA), American Orthopedic Foot and Ankle Society (AOFAS) scores, and complication rates between chevron osteotomy and scarf osteotomy for correcting hallux valgus. Methods Two investigators independently searched for randomized controlled trials (RCTs) published from 2007 to 2018 on PubMed, Web of Science, and Cochrane Library databases. Next, chevron and scarf osteotomies were compared for their postoperative outcomes using HVA, IMA, and AOFAS scores and their complication rates. Meta-analysis was performed using Review Manager (version 5.3). Results Six RCTs—comprising 507 feet, of which 261 and 246 underwent chevron and scarf osteotomies, respectively—were included. The meta-analysis revealed that chevron osteotomy led to significantly smaller postoperative HVAs than scarf osteotomy (weighted mean difference [WMD] = -1.94, 95% CI = − 2.65 to − 1.29, P  < .00001). However, the differences in postoperative IMA (WMD = − 0.44, 95% CI = − 1.10 to 0.22, P  = .19), postoperative AOFAS scores (WMD = 0.75; 95% CI = − 5.32 to 6.82; P  = .81), and complication rates (risk ratio = 1.22, 95% CI = 0.65–2.27, P  = .53) between feet that underwent chevron and scarf osteotomies were nonsignificant. Conclusions Compared with scarf osteotomy, chevron osteotomy had significantly more favorable postoperative outcomes in terms of HVA correction, but not in terms of IMA, AOFAS scores, or complication rates. Level of evidence Level I, systemic review and meta-analysis.

Background Severe hallux valgus deformity with hallux valgus angle (HVA) greater than 40° presents significant challenges in surgical management. The metatarsal mid-shaft chevron osteotomy (MSCO) with spear plate fixation represents a novel approach for addressing these complex deformities. This study aimed to evaluate its clinical and radiographic outcomes in patients with severe hallux valgus. Methods This retrospective case series evaluated 54 patients (64 feet) who underwent MSCO with spear plate fixation for severe hallux valgus between January 2023 and March 2024. Inclusion criteria included symptomatic hallux valgus with preoperative HVA greater than 40°, skeletal maturity, and minimum 12-month follow-up. Clinical outcomes were assessed using visual analog scale pain scores (VAS) and American Orthopedic Foot and Ankle Society hallux metatarsophalangeal-interphalangeal (AOFAS-MTP-IP) scale. Radiographic parameters included HVA, intermetatarsal angle (IMA), and tibial sesamoid position. Osteotomy healing was defined as observed bridging of callus from the two segments. Results The cohort included 46 females and 8 males with mean age of 50.0 years. Mean osteotomy healing time was 3.1 months. HVA improved significantly from 44.1° preoperatively to 7.5° at final follow-up ( p  < 0.01). IMA decreased from 17.7° to 2.8° ( p  < 0.01). Tibial sesamoid position showed significant improvement ( p  = 0.02). VAS pain scores decreased from 5.4 to 0.8 ( p  < 0.01), and AOFAS-MTP-IP scores improved from 28.0 to 81.6 points ( p  < 0.01). Five complications (7.8%) occurred: one osteoarthritis, one hallux varus, and three hallux valgus recurrences. Conclusions MSCO with spear plate fixation demonstrates excellent clinical and radiographic outcomes for severe hallux valgus deformity, with significant improvements in deformity correction, pain relief, and functional scores, accompanied by low complication rates and reliable bone healing. Level of evidence Level IV, case series.

Purpose This study aimed to compare modified minimally invasive chevron osteotomy (MIC group) and traditional incision chevron osteotomy (TIC group) for correction of mild to moderate hallux valgus deformity. Methods This retrospective study enrolled 42 patients (60 feet) with mild to moderate hallux valgus deformities who were treated with modified MIC osteotomy or TIC osteotomy between January 2020 and June 2021. The patients were divided into the MIC and TIC groups according to whether the treatment received was minimally invasive. The MIC group included 20 patients (28 feet), comprising 1 male and 19 female patients; aged 37.15 ± 14.60 years, with mild hallux valgus deformity in 12 cases (14 feet) and moderate hallux valgus deformity in 8 cases (14 feet). In the TIC group comprising 22 patients (32 feet), including 1 male and 21 female patients, aged 40.95 ± 11.60 years, mild and moderate hallux valgus deformities were observed in 10 (18 feet) and 12 cases (14 feet), respectively. Preoperatively and at the last follow-up, the American Orthopedic Foot and Ankle Society (AOFAS) hallux, lesser toe score, and visual analog scale (VAS) pain were used to evaluate clinical efficacy. The hallux valgus angle (HVA), 1–2 metatarsal angle (1-2IMA), and distal metatarsal articular angle (DMAA) were measured and compared on the weight-bearing X-ray film of the foot preoperatively and postoperatively. At the last follow-up, recurrence of hallux valgus deformity, hallux adduction deformity, metatarsal head necrosis, metastatic plantar pain, and other complications were recorded. Results All 42 patients were followed up, and the follow-up time of the MIC group was 24.70 ± 6.63 months; The follow-up time of the TIC group was 22.82 ± 6.12 months, and there was no significant difference in follow-up time between the two groups ( P  > 0.05). One patient in the MIC group experienced pain in the dorsal side of the front foot postoperatively; one patient in the TIC group had a superficial infection of the incision postoperatively. There were no significant differences in age, gender, side classification, course of the disease, degree of hallux valgus deformity, and postoperative complications between the two groups ( P  > 0.05). The AOFAS scores, VAS, HVA, 1-2IMA, and DMAA in the MIC group improved from 54.61 ± 7.60, 4.50 ± 0.79, 28.38° ± 5.02°, 12.88° ± 1.50°, 12.03° ± 1.88°preoperatively to 89.93 ± 4.96, 2.04 ± 1.10, 10.27° ± 1.68°, 7.49° ± 0.95° and 7.83° ± 1.33° at the last follow-up, the difference was statistically significant ( P  < 0.05); the AOFAS score, VAS, HVA, 1-2IMA, and DMAA of the TIC group improved from 57.31 ± 7.59, 4.34 ± 0.70, 28.45° ± 4.47°, 12.88° ± 1.50°, 12.16° ± 1.81° preoperatively to 87.97 ± 5.96, 2.00 ± 1.11, 10.99° ± 2.25°, 7.49° ± 0.95°, and 8.25° ± 1.12° at the last follow-up, the difference was statistically significant ( P  < 0.05), but there was no significant difference in AOFAS score, VAS, HVA, 1-2IMA, and DMAA between the two groups ( P  > 0.05). The incision length of the MIC group was 2.06 ± 0.20 cm, and the incision length of the TIC group was 5.04 ± 0.54 cm, which was statistically significant ( P  < 0.05). Conclusion Whether it is modified minimally invasive chevron osteotomy or traditional incision chevron osteotomy, mild and moderate hallux valgus deformity is effectively treated, and the clinical efficacy and imaging results after surgery are significantly improved. Compared with traditional incision chevron osteotomy, the modified minimally invasive chevron osteotomy has a smaller incision and less trauma for mild to moderate hallux valgus.

Introduction Distal chevron osteotomy is commonly used for the operative treatment of hallux valgus (HV). However, there are several operative procedures that can be used to treat HV. The aim of this meta-analysis was to compare the efficacy of distal chevron osteotomy with different operative procedures. Materials and methods A systematic search was conducted using the MEDLINE and EMBASE databases to identify randomized clinical trials (RCTs). The variables were radiological (hallux metatarsal phalangeal angle [HVA] and intermetatarsal angle [IMA]) and clinical (American Orthopaedic Foot & Ankle Society Score [AOFAS]). Heterogeneity was assessed with chi 2 and I 2 statistics. A random effects model was used for significant heterogeneity. Publication bias was evaluated with funnel plots. Results Ten studies involving 985 patients were evaluated in the meta-analysis. Distal chevron osteotomy was associated with a mean IMA correction 2.18° greater than the scarf procedure (MD − 2.18; 95% CI − 3.67, − 0.69; p  = 0.004; I 2  = 0%). In addition, the proximal chevron was associated with a mean IMA correction 1.08° greater than the distal chevron (MD − 1.08; 95% CI − 1.86, − 0.29; p  = 0.007; I 2  = 0%). The AOFAS assessment showed an overall advantage of 3.2 points in favor of the Lingdren group compared with distal chevron osteotomy (MD 3.20; 95% CI 0.37, 6.04; p  = 0.03; I 2  = 0%). Conclusions Our findings indicate that distal chevron osteotomy provides a greater HVA correction than scarf osteotomy, and proximal chevron provides a larger IMA correction than distal chevron osteotomy. Lingdren osteotomy provides a greater AOFAS correction than distal chevron osteotomy. Level of evidence Level I, meta-analysis.

Background: The stress of foot bone can effectively evaluate the functional damage caused by foot deformity and the results of operation. In this study, the finite element method was used to investigate the degree of displacement of distal chevron osteotomy on metatarsal stress and metatarsophalangeal joint load; Methods: Four finite element models of displacement were established by using the CT images of a patient with moderate hallux valgus (hallux valgus angle and intermetatarsal angle were 26.74° and 14.09°, respectively), and the validity of the model was verified. Each finite element model consisted of bones and various cartilage structures, ligaments, and plantar fascia, as well as encapsulated soft tissue. Except for soft tissue, the material properties of other parts were isotropic linear elastic material, and the encapsulated soft tissue was set as nonlinear hyperelastic material. The mesh was tetrahedral mesh. Link elements were used in ligament and plantar fascia. A ground reaction force with a half-body weight was applied at the bottom of the floor to simulate the ground reaction when standing. The upper surfaces of the encapsulated soft tissue, distal tibia, and distal fibula were fixed. The stress distribution of metatarsals and the stress of cartilage of the first metatarsophalangeal joint were compared and analyzed; Results: Compared with the hallux valgus without osteotomy, the stress of the first metatarsals and second metatarsals of 2–4 mm decreased, and the stress of the interarticular cartilage of the first metatarsophalangeal joint with 4 mm was reduced. In the case of 6 mm, the stress value between the first metatarsal and the first metatarsophalangeal joint increased, and 4 mm was the most suitable distance; Conclusions: Compared with the hallux valgus without osteotomy, the stress of the first metatarsals and second metatarsals of 2–4 mm decreased, and the stress of the interarticular cartilage of the first metatarsophalangeal joint with 4 mm was reduced. In the case of 6 mm, the stress value between the first metatarsal and the first metatarsophalangeal joint increased, and 4 mm was the most suitable distance. For the degree of displacement of the distal chevron osteotomy, the postoperative stability and the stress distribution of metatarsal bone should be considered. Factors such as hallux valgus angle, intermetatarsal angle, patient’s age, body weight, and metatarsal width should be considered comprehensively. The factors affecting osteotomy need to be further explored. The degree of displacement of osteotomy can be evaluated by FE method before the operation, and the most suitable distance can be obtained.

Background: Hallux valgus is a common forefoot disorder with hundreds of proposed management techniques. Distal chevron osteotomy with a modified McBride procedure has been traditionally recommended for mild hallux valgus because of its simple and less invasive nature with fewer complications, faster recovery, and reliable outcomes. In recent years, the indications for this procedure have expanded to include hallux valgus with severe deformities. This study aims to compare the radiographic outcomes of the surgical treatment for moderate versus severe hallux valgus patients from the perspective of sesamoid bone reduction. Materials and Methods: A retrospective review of medical records identified 99 feet from 94 patients that were treated with distal chevron osteotomy with a modified McBride procedure. These feet were divided by the preoperative hallux valgus angle and intermetatarsal angle into the moderate and severe groups. Results: Postoperative radiographic parameters significantly improved in both groups after treatment, indicating adequate deformity correction. Improvement in the sesamoid position was better in the moderate group compared to that in the severe group. The recurrence rate in the severe group was higher than that in the moderate group without statistical significance. Conclusions: Based on the radiographic results of the postoperative position following sesamoid reduction, the distal chevron osteotomy with a modified McBride procedure is effective for treating moderate hallux valgus deformities. However, this treatment strategy may be associated with a higher recurrence rate in cases of severe hallux valgus deformity. A complete reduction in the sesamoids should be emphasized during the management of severe hallux valgus deformity.