Aims. The mainstay of surgical correction of hallux valgus is first
metatarsal osteotomy, either proximally or distally. We present
a technique of combining a distal chevron osteotomy with a proximal
opening wedge osteotomy, for the correction of moderate to severe
hallux valgus. Patients and Methods. We reviewed 45 patients (49 feet) who had undergone double osteotomy.
Outcome was assessed using the American Orthopaedic Foot and Ankle
Society (AOFAS) and the Short Form (SF) -36 Health Survey scores.
Radiological measurements were undertaken to assess the correction. The mean age of the patients was 60.8 years (44.2 to 75.3). The
mean follow-up was 35.4 months (24 to 51). Results. The mean AOFAS score improved from 54.7 to 92.3 (p <
0.001)
and the mean SF-36 score from 59 to 86 (p <
0.001). The mean
hallux valgus and intermetatarsal angles were improved from 41.6. o. to
12.8. o. (p <
0.001) and from 22.1. o. to 7.1. o. ,
respectively (p <
0.001). The mean distal metatarsal articular
angle improved from 23. o. to 9.7. o. The mean
sesamoid position, as described by Hardy and Clapham, improved from
6.8 to 3.5. The mean length of the first metatarsal was unchanged.
The overall rate of complications was 4.1% (two patients). Conclusion. These results suggest that a double osteotomy of the first metatarsal
is a reliable, safe technique which, when compared with other metatarsal
osteotomies, provides strong angular correction and excellent outcomes
with a low rate of complications. Cite this article: Bone Joint J 2016;98-B:1202–7