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Journal of Bone and Joint Surgery - British Volume, Vol 86-B, Issue 7, 1016-1020.
doi: 10.1302/0301-620X.86B7.15108  
Copyright © 2004 by British Editorial Society of Bone and Joint Surgery
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Chevron osteotomy in hallux valgus

TEN-YEAR RESULTS OF 112 CASES

W. Schneider, MD, Senior Resident, Orthopaedic Surgeon; N. Aigner, MD, Resident, Orthopaedic Surgeon; O. Pinggera, MD, Resident, Orthopaedic Surgeon; and K. Knahr, MD, Orthopaedic Surgeon, Professor, Head of Department

Second General Orthopedic Department, Orthopedic Hospital Vienna – Speising, Speisingerstrasse 109, A-1130 Vienna, Austria.

Correspondence should be sent to Dr W. Schneider.

The Chevron osteotomy was described in 1976. There have, however, been only short- to mid-term follow-up reviews, often with small numbers of patients.

We looked at 112 feet (73 patients) with a minimum follow-up of ten years following Chevron osteotomy with a distal soft-tissue procedure. Clinical evaluation was calculated using the hallux score of the American Orthopedic Foot and Ankle Society (AOFAS). For 47 feet (30 patients), the results were compared with those from an interim follow-up of 5.6 years.

The AOFAS-score improved from a pre-operative mean of 46.5 points to a mean of 88.8 points after a mean of 12.7 years. The first metatarsophalangeal (MTP) angle showed a mean pre-operative value of 27.6° and was improved to 14.0°. The first intermetatarsal (IM) angle improved from a pre-operative mean value of 13.8° to 8.7°. The mean pre-operative grade of sesamoid subluxation was 1.7 on a scale from 0 to 3 and improved to 1.2. Measured on a scale from 0 to 3, arthritis of the first MTP joint progressed from a mean of 0.8 to 1.7. Comparing the results in patients younger and older than 50 years, the Chevron osteotomy performed equally in both age groups. Analysing the subgroup of 47 feet with a post-operative follow-up of both 5.6 and 12.7 years, the AOFAS pain and the overall score showed a further improvement between both follow-up evaluations. The MTP angle, first IM angle and sesamoid position remained unchanged. The progression of arthritis of the first MTP joint between 5.6 and 12.7 years post-operatively was statistically significant. Only one patient required a revision procedure due to painful recurrence of the deformity.

Excellent clinical results following Chevron osteotomy not only proved to be consistent, but showed further improvement over a longer follow-up period. The mean radiographic angles were constant without recurrence of the deformity. So far, the statistically significant progression of first MTP joint arthritis has not affected the clinical result, but this needs further observation.




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John Lourie
J Bone Joint Surg Br Online, 29 Mar 2005 [Full text]

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Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General