Hj. Trnka et al., Basal closing wedge osteotomy for correction of hallux valgus and metatarsus primus varus: 10- to 22-year follow-up, FOOT ANKL I, 20(3), 1999, pp. 171-177
Between 1974 and 1985, 59 patients (83 feet) underwent basal closing wedge
osteotomy in combination with a bunionectomy and a lateral soft tissue rele
ase for correction of hallux valgus and metatarsus primus varus at this ins
titution. Of the original 59 patients, 42 patients (60 feet) with at least
10 years of follow-up (average, 194 months; range, 144-266 months) were ava
ilable for this study, Results were analyzed by review of the medical recor
ds and plain radiographs, a standardized clinical questionnaire, and physic
al examination. Of the 60 feet, patients rated outcomes as excellent or goo
d in 51 feet (85%) and rated cosmesis as excellent or good in 44 feet (73%)
, Radiographically at final follow-up, hallux valgus and intermetatarsal an
gles averaged 19.9 degrees (range, 0-40 degrees) and 6.7 degrees (range, 0-
18 degrees), respectively, The sesamoid position was corrected from an aver
age preoperative grade of 2.6 to a grade of 0.9 at final follow-up, The ave
rage shortening of the first metatarsal was 5 mm, The disadvantages of the
closing wedge osteotomy are that it is technically demanding and it entails
the risk of shortening, dorsal malalignment, and metatarsalgia, In the cur
rent study, long-term complications included hallux varus deformity (16 fee
t), dorsal malalignment (15 feet), and metatarsalgia (14 feet). Despite goo
d correction of the intermetatarsal angle and sesamoid position, the clinic
al results and the incidence of complications after basal closing wedge ost
eotomy were not as favorable as those reported for other procedures in the
literature, Therefore, alternative procedures, such as the basal crescentic
osteotomy or the basal chevron osteotomy, should be used.