Osteotomy of the First Metatarsal Base on the Treatment of Moderate to Severe Hallux Valgus Results after Mean Follow-up Time of Eight Years

OBJECTIVE To assess the result of the treatment of moderate to severe hallux valgus with osteotomy of the first metatarsal base associated to distal release of soft parts and medial capsuloplasty. METHODS 13 patients were assessed (15 feet) submitted to surgical treatment of hallux valgus moderate to severe. The mean follow-up time was 102 months; there were 12 female and 1 male patients, with mean age at the time of surgery of 49 years. The patients enrolled were interviewed according to the questionnaire developed by our service, clinically examined according to the AOFAS scale and submitted to X-ray tests for comparing the results with baseline images. RESULTS The mean score of the AOFAS scale obtained at the final assessment was 82 points. Nine of the 15 feet (60%) showed some late complications, with four (27%) varus deformities, three (20%) recurrences; two patients (13%) presenting with pain complaints with no associated deformity. In the hallux metatarsophalangeal joint, movement loss was 41° (57%); dorsiflexion movement was mostly affected, with a mean loss of 37° (60%). The range of motion on the contralateral intact side served as control group. Arthrosis progression was seen on the final X-ray evaluation. In all cases, shortening and lifting of the first metatarsal were noticed; however, we couldn't correlate the shortening and lifting with metatarsalgia, plant callosity or lower scoring on the AOFAS scale at the final evaluation. CONCLUSIONS The osteotomy technique by the basis and with distal realignment of soft parts employed in the treatment of moderate to severe hallux valgus showed a high rate of late complications. Due to the high number of complications, we believe that adopting this technique for correcting hallux valgus deformities should be carefully considered.