Moderate to severe hallux valgus deformity: correction with proximal crescentic osteotomy and distal soft-tissue release

Between 1991 and 1995, 96 patients (114 feet) were treated with a proximal crescentic metatarsal osteotomy and distal soft-tissue procedure fur modera te to severe hallux valgus deformity [intermetatarsal (IM) angle > 15 degre es, or hallux valgus (HV) angle > 30 degrees]. At an average follow-up of 2 6 months, 8 men and 62 women (86 feet) with a mean age of 53.2 years were r etrospectively reviewed. The HV angle averaged 41.1 degrees preoperatively and 14.6 degrees postoperatively. The respective values for the IM angle we re 17.8 degrees and 7.8 degrees, Neither the average metatarsal shortening of 3 mm nor the dorsal angulation at the osteotomy site seen in 9% of cases evidenced any clinical significance at followup. Patient satisfaction was excellent or good in 91%, and the mean Mayo Clinic Forefoot Score (total 75 points) improved from 37.2 to 61.1 points. Complications included 8 cases of hallux varus and 5 cases of hardware failure. Based on this fit st study exclusively focusing on moderate to severe hallux valgus deformity, we con clude that proximal first metatarsal osteotomy in combination with a latera l soft-tissue procedure is effective in correcting moderate to severe sympt omatic: hallux valgus deformity with metatarsus primus varus (IM angle > 15 degrees or HV angle > 30 degrees).