Management of Severe Hallux Valgus Using Combined Proximal Closing Osteotomy with a Distal Soft Tissue Reconstruction

Background: many surgical procedures were described for correction of hallux valgus and the type of operation is based upon; foot length, width and redressibility of the transverse arch, hallux valgus evaluation of possibility of its passive redression and radiographic examination of foot. Aim of the work: To evaluate the results of hallux valgus surgery combining the distal soft tissue reconstruction (DSTR) or modified McBride procedure and proximal closing wedge osteotomy of the first metatarsal base. Patients and methods: This prospective study, was performed in King Abdul-Aziz Hospital, Taif, Saudi Arabia. The study was approved by the local committee of human research, and all patients gave written informed consent to participation. Ten patients (8 women and 2 men) with mean age of 28 years (18-40 years) were included in the study with 16 surgeries. The mean postoperative follow-up was 36 months (28 – 48). The operative technique performed in these patients was a combination of DSTR with closing osteotomy of the first metatarsal base.Results: The mean pre-operative intermetatarsal 1-2 angle (IMA) revealed by radiographs was surgically corrected from 20.3 degrees at the baseline to the mean degree of 7.9. The mean pre-surgical hallux valgus angle (HVA) was 44.9 degrees proved by radiographs was surgically improved to 11.7 degrees, and 3 years after operation it reached 12.3 degrees (mean). Ninety percent of patients were satisfied with their surgical results and cosmetic improvements were achieved in 93.7 % (15/16 feet in 9 patients). Conclusion: The combination of wedge osteotomy of the first metatarsal base and the distal soft tissue reconstruction (DSTR) or modified McBride procedure is suit able in the treatment of young patients having severe forms of hallux valgus and minimum arthritic changes in metatarsophalangeal joint with increased IMA.