Effectiveness of triple osteotomy in correcting severe hallux valgus with the first metatarsal pronation deformity_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

XING Yachang ¹ ,  WANG Xinwen ² , LI Yi ² , LIU Cheng ²

1. The Second Ward of Orthopedics Department, the Second People’s Hospital of Nanyang, Nanyang Henan, 473000, P. R. China;
2. Foot and Ankle Surgery Ward, Honghui Hospital, Xi’an Jiaotong University, Xi’an Shaanxi, 710054, P. R. China;

Corresponding?author：

WANG Xinwen, Email: wangxinwen139@163.com

Keywords：

Hallux valgus; the first metatarsal; pronation deformity; triple osteotomy

DOI：

10.7507/1002-1892.202504095

Video：

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Objective To explore the effectiveness of triple osteotomy in correcting severe hallux valgus with the first metatarsal pronation deformity. Methods A retrospective analysis was conducted on the clinical data of 29 patients (40 feet) with severe hallux valgus accompanied by the first metatarsal pronation deformity, who were admitted between January 2022 and December 2023 and met the selection criteria. There were 8 males (10 feet) and 21 females (30 feet), with an average age of 50.0 years (range, 44-62 years). The disease duration ranged from 5 to 9 years (mean, 6.5 years). All patients underwent triple osteotomy to correct the deformity. The American Orthopaedic Foot and Ankle Society (AOFAS) score and visual analogue scale (VAS) score were used to evaluate joint function and pain before and after operation. Based on pre- and post-operative X-ray films, hallux valgus angle (HVA), intermetatarsal angle (IMA), and distal metatarsal articular angle (DMAA) were measured to evaluate the correction of hallux valgus; the shape classification of the lateral edge of the first metatarsal and the pronation of first metatarsal angle (PFMA) were observed to assess the correction of the first metatarsal pronation deformity. Results A superficial infection occurred in 1 foot and the incison healed after dressing change; the remaining incisions healed by first intention. All patients were followed up 12-18 months (mean, 12.6 months). Three cases (4 feet) experienced limited movement of the metatarsophalangeal joint after operation, and the joint function recovered after strengthening functional exercises. During follow-up, no recurrence of deformity or secondary metatarsal pain occurred. Compared with preoperative scores, the AOFAS score increased and the VAS score decreased at last follow-up, and the differences were significant (P<0.05). Radiographic examination showed that the osteotomy achieved bony healing, with the healing time of 2.5-6.2 months (mean, 4.1 months). The hallux valgus deformity was corrected, and the IMA, HVA, and DMAA were significantly smaller at last follow-up when compared with those before operation (P<0.05). The first metatarsal pronation deformity was also corrected; there was no R-type (R-type for pronation deformity) on the lateral edge of the first metatarsal at last follow-up, and the PFMA decreased compared with preoperative levels (P<0.05) and was corrected to the normal range. Conclusion Triple osteotomy can achieve good effectiveness for correcting severe hallux valgus with the first metatarsal pronation deformity. The functional training of the first metatarsophalangeal joint needs to be strengthened.

Citation： XING Yachang, WANG Xinwen, LI Yi, LIU Cheng. Effectiveness of triple osteotomy in correcting severe hallux valgus with the first metatarsal pronation deformity. Chinese Journal of Reparative and Reconstructive Surgery, 2025, 39(7): 843-847. doi: 10.7507/1002-1892.202504095 Copy

1.	王欣文, 汶倩, 劉誠, 等. 雙平面截骨術治療合并跖骨遠端關節面角增大的重度踇外翻. 中國修復重建外科雜志, 2020, 34(1): 41-45.
2.	Zhao R, Wang G, Li F, et al. Developing machine learning-based predictive models for hallux valgus recurrence based on measurements from radiographs. Foot Ankle Int, 2024, 45(9): 1000-1008.
3.	溫建民. 踇外翻診斷與治療方法選擇的探討. 中國骨傷, 2018, 31(3): 199-202.
4.	Clarke TAC, Platt SR. Treatment of hallux valgus by Scarf osteotomy—rates and reasons for recurrence and rates of avascular necrosis: A systematic review. Foot Ankle Surg, 2021, 27(6): 622-628.
5.	Smith SE, Landorf KB, Butterworth PA, et al. Scarf versus Chevron osteotomy for the correction of 1-2 intermetatarsal angle in hallux valgus: a systematic review and meta-analysis. J Foot Ankle Surg, 2012, 51(4): 437-444.
6.	Kim Y, Kim JS, Young KW, et al. A New measure of tibial sesamoid position in hallux valgus in relation to the coronal rotation of the first metatarsal in CT scans. Foot Ankle Int, 2015, 36(8): 944-952.
7.	Yamaguchi S, Sasho T, Endo J, et al. Shape of the lateral edge of the first metatarsal head changes depending on the rotation and inclination of the first metatarsal: a study using digitally reconstructed radiographs. J Orthop Sci, 2015, 20(5): 868-874.
8.	Dawei Qu, Zhang J. Quantitative analysis of the rotation of the first metatarsal in valgus. Electronic Journal of Foot and Ankle Surgery, 2016(4): 30-35.
9.	Park CH, Jang JH, Lee SH, et al. A comparison of proximal and distal Chevron osteotomy for the correction of moderate hallux valgus deformity. Bone Joint J, 2013, 95-B(5): 649-656.
10.	Kitaoka HB, Alexander IJ, Adelaar RS, et al. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int, 1997, 18(3): 187-188.
11.	Myles PS, Troedel S, Boquest M, et al. The pain visual analog scale: is it linear or nonlinear? Anesth Analg, 1999, 89(6): 1517-1520.
12.	Klein C, Kinz W, Zembsch A, et al. The hallux valgus angle of the margo medialis pedis as an alternative to the measurement of the metatarsophalangeal hallux valgus angle. BMC Musculoskelet Disord, 2014, 15: 133. doi: 10.1186/1471-2474-15-133.
13.	Wagner P, Ortiz C, Wagner E. Rotational osteotomy for hallux valgus. A new technique for primary and revision cases. Tech Foot Ankle Surg, 2017, 16(1): 3-10.
14.	Srivastava S, Chockalingam N, El Fakhri T. Radiographic measurements of hallux angles: a review of current techniques. Foot (Edinb), 2010, 20(1): 27-31.
15.	Lalevée M, Barbachan Mansur NS, Lee HY, et al. Distal metatarsal articular angle in hallux valgus deformity. Fact or fiction? A 3-dimensional weightbearing CT assessment. Foot Ankle Int, 2022, 43(4): 495-503.
16.	Choi JY, Suh JS, Cho JH, et al. Outcome of proximal triple derotational metatarsal osteotomy for three-dimensional correction of hallux valgus deformity. Int Orthop, 2021, 45(12): 3101-3110.
17.	Palmanovich E, Ohana N, Tavdi A, et al. A modified minimally invasive osteotomy for hallux valgus enables reduction of malpositioned sesamoid bones. Arch Orthop Trauma Surg, 2023, 143(10): 6105-6112.
18.	Steadman J, Barg A, Saltzman CL. First metatarsal rotation in hallux valgus deformity. Foot Ankle Int, 2021, 42(4): 510-522.
19.	呂振木, 孫超, 張奉琪, 等. 合并DMAA增大的踇外翻治療. 足踝外科電子雜志, 2015, 2(1): 7-9.
20.	Wagner P, Wagner E. Republication of “Proximal Rotational Metatarsal Osteotomy for Hallux Valgus (PROMO): Short-term prospective case series with a novel technique and topic review”. Foot Ankle Orthop, 2023, 8(3): 24730114231195049. doi: 10.1177/24730114231195049.
21.	Al-Nammari SS, Christofi T, Clark C. Double first metatarsal and akin osteotomy for severe hallux valgus. Foot Ankle Int, 2015, 36(10): 1215-1222.
22.	Braito M, Dammerer D, Hofer-Picout P, et al. Proximal opening wedge osteotomy with distal chevron osteotomy of the first metatarsal for the treatment of moderate to severe hallux valgus. Foot Ankle Int, 2019, 40(1): 89-97.
23.	Booth S, Bhosale A, Mustafa A, et al. Triple osteotomy for the correction of severe hallux valgusdeformity: Patient reported outcomes and radiological evaluation. Foot (Edinb), 2016, 28: 30-35.

1. 王欣文, 汶倩, 劉誠, 等. 雙平面截骨術治療合并跖骨遠端關節面角增大的重度踇外翻. 中國修復重建外科雜志, 2020, 34(1): 41-45.
2. Zhao R, Wang G, Li F, et al. Developing machine learning-based predictive models for hallux valgus recurrence based on measurements from radiographs. Foot Ankle Int, 2024, 45(9): 1000-1008.
3. 溫建民. 踇外翻診斷與治療方法選擇的探討. 中國骨傷, 2018, 31(3): 199-202.
4. Clarke TAC, Platt SR. Treatment of hallux valgus by Scarf osteotomy—rates and reasons for recurrence and rates of avascular necrosis: A systematic review. Foot Ankle Surg, 2021, 27(6): 622-628.
5. Smith SE, Landorf KB, Butterworth PA, et al. Scarf versus Chevron osteotomy for the correction of 1-2 intermetatarsal angle in hallux valgus: a systematic review and meta-analysis. J Foot Ankle Surg, 2012, 51(4): 437-444.
6. Kim Y, Kim JS, Young KW, et al. A New measure of tibial sesamoid position in hallux valgus in relation to the coronal rotation of the first metatarsal in CT scans. Foot Ankle Int, 2015, 36(8): 944-952.
7. Yamaguchi S, Sasho T, Endo J, et al. Shape of the lateral edge of the first metatarsal head changes depending on the rotation and inclination of the first metatarsal: a study using digitally reconstructed radiographs. J Orthop Sci, 2015, 20(5): 868-874.
8. Dawei Qu, Zhang J. Quantitative analysis of the rotation of the first metatarsal in valgus. Electronic Journal of Foot and Ankle Surgery, 2016(4): 30-35.
9. Park CH, Jang JH, Lee SH, et al. A comparison of proximal and distal Chevron osteotomy for the correction of moderate hallux valgus deformity. Bone Joint J, 2013, 95-B(5): 649-656.
10. Kitaoka HB, Alexander IJ, Adelaar RS, et al. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int, 1997, 18(3): 187-188.
11. Myles PS, Troedel S, Boquest M, et al. The pain visual analog scale: is it linear or nonlinear? Anesth Analg, 1999, 89(6): 1517-1520.
12. Klein C, Kinz W, Zembsch A, et al. The hallux valgus angle of the margo medialis pedis as an alternative to the measurement of the metatarsophalangeal hallux valgus angle. BMC Musculoskelet Disord, 2014, 15: 133. doi: 10.1186/1471-2474-15-133.
13. Wagner P, Ortiz C, Wagner E. Rotational osteotomy for hallux valgus. A new technique for primary and revision cases. Tech Foot Ankle Surg, 2017, 16(1): 3-10.
14. Srivastava S, Chockalingam N, El Fakhri T. Radiographic measurements of hallux angles: a review of current techniques. Foot (Edinb), 2010, 20(1): 27-31.
15. Lalevée M, Barbachan Mansur NS, Lee HY, et al. Distal metatarsal articular angle in hallux valgus deformity. Fact or fiction? A 3-dimensional weightbearing CT assessment. Foot Ankle Int, 2022, 43(4): 495-503.
16. Choi JY, Suh JS, Cho JH, et al. Outcome of proximal triple derotational metatarsal osteotomy for three-dimensional correction of hallux valgus deformity. Int Orthop, 2021, 45(12): 3101-3110.
17. Palmanovich E, Ohana N, Tavdi A, et al. A modified minimally invasive osteotomy for hallux valgus enables reduction of malpositioned sesamoid bones. Arch Orthop Trauma Surg, 2023, 143(10): 6105-6112.
18. Steadman J, Barg A, Saltzman CL. First metatarsal rotation in hallux valgus deformity. Foot Ankle Int, 2021, 42(4): 510-522.
19. 呂振木, 孫超, 張奉琪, 等. 合并DMAA增大的踇外翻治療. 足踝外科電子雜志, 2015, 2(1): 7-9.
20. Wagner P, Wagner E. Republication of “Proximal Rotational Metatarsal Osteotomy for Hallux Valgus (PROMO): Short-term prospective case series with a novel technique and topic review”. Foot Ankle Orthop, 2023, 8(3): 24730114231195049. doi: 10.1177/24730114231195049.
21. Al-Nammari SS, Christofi T, Clark C. Double first metatarsal and akin osteotomy for severe hallux valgus. Foot Ankle Int, 2015, 36(10): 1215-1222.
22. Braito M, Dammerer D, Hofer-Picout P, et al. Proximal opening wedge osteotomy with distal chevron osteotomy of the first metatarsal for the treatment of moderate to severe hallux valgus. Foot Ankle Int, 2019, 40(1): 89-97.
23. Booth S, Bhosale A, Mustafa A, et al. Triple osteotomy for the correction of severe hallux valgusdeformity: Patient reported outcomes and radiological evaluation. Foot (Edinb), 2016, 28: 30-35.

Chinese Journal of Reparative and Reconstructive Surgery

Effectiveness of triple osteotomy in correcting severe hallux valgus with the first metatarsal pronation deformity

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