Crescentic distal metatarsal osteotomy for the treatment of hallux valgus: a prospective, randomized, controlled study of two different fixation methods

Objectives: This study was designed to draw attention to a distal metatarsal osteotomy technique, which has been some¬what overlooked for the treatment of hallux valgus, and to compare the clinical and radiographic results of two different fixation methods. Methods: The study included 16 feet of 13 patients (11 wom¬en, 2 men) who were treated with crescentic distal metatar- sal osteotomy for mild-to-moderate hallux valgus (<35°). The patients were randomized to two fixation methods with two cross K-wires (group 1; 7 patients, 8 feet) and a compressive screw (group 2; 6 patients, 8 feet). The results were evaluated using the AOFAS (American Orthopaedic Foot and Ankle Society) clinical rating scale for hallux, and a visual analog scale for pain. Radiographic measurements included the hallux valgus angle (HVA), first/second intermetatarsal angle (IMA), and distal metatarsal articular angle (DMAA), before and 12 months after surgery. Results: There were no significant differences between the two groups with regard to pre- and postoperative AOFAS scores and pain scores, which showed significant improvements in both groups at the end of one-year follow-up (p<0.001). The HVA and IMA significantly decreased from 32° to 19° and from 12° to 6° in group 1, and from 30° to 17° and from 12° to 8° in group 2, respectively (p<0.001). A similar improve¬ment was also seen in the DMAA (p<0.001). Postoperative radiographic improvements were similar in both groups. One patient in group 1 underwent revision surgery with the same technique due to recurrence, and one patient in group 2 had delayed union. Conclusion: Crescentic distal metatarsal osteotomy may be an appropriate technique in the treatment of mild-to-moderate hallux valgus.