J Korean Foot Ankle Soc.  2021 Sep;25(3):141-144. 10.14193/jkfas.2021.25.3.141.

Minimally Invasive Proximal Transverse Metatarsal Osteotomy Followed by Intramedullary Plate Fixation for Hallux Valgus Deformity: A Case Report

• Kim JH
• Suh JS
• Choi JY

• KMID: 2520105
• DOI: http://doi.org/10.14193/jkfas.2021.25.3.141

Abstract

More than 120 surgical methods for the correction of hallux valgus deformities have been reported. For the correction of moderate to severe hallux valgus deformities with aesthetic demands, minimally invasive surgery at the proximal area can be considered. This paper reports a case of moderate hallux valgus deformity treated by a minimally invasive proximal transverse metatarsal osteotomy followed by intramedullary plate fixation.

Keyword

Forefoot; Hallux valgus; Minimally invasive surgical procedure; Proximal metatarsal osteotomy

Figure

• 

  Figure. 1 Radiographs of preoperative (A), immediate postoperative (B), 6-month follow-up (C), and at the last follow-up after hardware removal (D) have taken from a 58-year-old female patient with moderate hallux valgus deformity. Intramedullary plate fixation was performed along with the proximal transverse metatarsal osteotomy.

• 

  Figure. 2 A 15-mm incision was made on the medial aspect at 2 cm distal from the tarsometatarsal joint (A). A guide wire along the imaginary osteotomy line was inserted perpendicular to metatarsal shaft (B). Along the wire, osteotomy was done with oscillating saw. With holding the proximal fragment with towel clip, deformity correction was performed by lateral translation and axial rotation (supination) of the distal fragment (C). Then low profile locking plate (D) was inserted intramedullary and fixed to secure the osteotomy site.

• 

  Figure. 3 Postoperative (B) axial sesamoid view shows successful correction of pronation deformity compared to preoperative radiograph (A).

Reference

1. Malagelada F, Sahirad C, Dalmau-Pastor M, Vega J, Bhumbra R, Manzanares-Céspedes MC, et al. 2019; Minimally invasive surgery for hallux valgus: a systematic review of current surgical techniques. Int Orthop. 43:625–37. doi: 10.1007/s00264-018-4138-x. DOI: 10.1007/s00264-018-4138-x. PMID: 30218181.

2. Díaz Fernández R. 2019; Use of a percutaneous osteotomy with plate fixation in hallux valgus correction. Foot Ankle Surg. 25:106–12. doi: 10.1016/j.fas.2017.09.002. DOI: 10.1016/j.fas.2017.09.002. PMID: 29409298.

3. Kadakia AR, Smerek JP, Myerson MS. 2007; Radiographic results after percutaneous distal metatarsal osteotomy for correction of hallux valgus deformity. Foot Ankle Int. 28:355–60. doi: 10.3113/FAI.2007.0355. DOI: 10.3113/FAI.2007.0355. PMID: 17371659.

4. Choi JY, Ahn HC, Kim SH, Lee SY, Suh JS. 2019; Minimally invasive surgery for young female patients with mild-to-moderate juvenile hallux valgus deformity. Foot Ankle Surg. 25:316–22. doi: 10.1016/j.fas.2017.12.006. DOI: 10.1016/j.fas.2017.12.006. PMID: 29409176.

5. Giannini S, Cavallo M, Faldini C, Luciani D, Vannini F. 2013; The SERI distal metatarsal osteotomy and Scarf osteotomy provide similar correction of hallux valgus. Clin Orthop Relat Res. 471:2305–11. doi: 10.1007/s11999-013-2912-z. DOI: 10.1007/s11999-013-2912-z. PMID: 23494184. PMCID: PMC3676577.

6. Singh MS, Khurana A, Kapoor D, Katekar S, Kumar A, Vishwakarma G. 2020; Minimally invasive vs open distal metatarsal osteotomy for hallux valgus - a systematic review and meta-analysis. J Clin Orthop Trauma. 11:348–56. doi: 10.1016/j.jcot.2020.04.016. DOI: 10.1016/j.jcot.2020.04.016. PMID: 32405192. PMCID: PMC7211908.

7. Cho ST, Suh JS, Choi JY. 2019; Minimally invasive surgery for hallux valgus deformity using intramedullary low profile plate fixation: a case report. J Korean Foot Ankle Soc. 23:135–8. doi: 10.14193/jkfas.2019.23.3.135. DOI: 10.14193/jkfas.2019.23.3.135.

8. Wagner E, Wagner P. 2020; Metatarsal pronation in hallux valgus deformity: a review. J Am Acad Orthop Surg Glob Res Rev. 4:e20.00091. doi: 10.5435/JAAOSGlobal-D-20-00091. DOI: 10.5435/JAAOSGlobal-D-20-00091. PMID: 32656482. PMCID: PMC7322783.

9. Wagner E, Ortiz C, Gould JS, Naranje S, Wagner P, Mococain P, et al. 2013; Proximal oblique sliding closing wedge osteotomy for hallux valgus. Foot Ankle Int. 34:1493–500. doi: 10.1177/1071100713497933. DOI: 10.1177/1071100713497933. PMID: 23863313.

10. Wagner P, Wagner E. Proximal rotational metatarsal osteotomy for hallux valgus (PROMO): short-term prospective case series with a novel technique and topic review.  Foot Ankle Orthop. (July 1, 2018;). doi: 10.1177/2473011418790071. DOI: 10.1177/2473011418790071.