Austin Procedure and Modified Austin Procedures

The Austin procedure is primarily a transpositional V osteotomy of the head of the first metatarsal for the management of hallux valgus. The procedure was first reported in the podiatric literature and attributed to Dr. Austin by Miller and Croce. The procedure was presented initially by Dr. Dale Austin in his 1981 publication. The procedure as described is a horizontally directed V osteotomy performed in the metaphyseal bone of the first metatarsal, with the arms of the V at an angle of 60°. Transposition of the head of the metatarsal laterally from one-fourth to one-half the width of the metatarsal shaft addresses the increase in intermetatarsal angle (Fig. 12-1). Redirection by rotation of the metatarsal head is performed to address abnormal transverse plane alignment of the articular surface of the metatarsal head. The osteotomy is fixated by impaction via manual pressure and the protruding portion of the metatarsal shaft is then resected. The osteotomy is combined with soft tissue balancing medially and laterally with tenotomy of the adductor hallucis. This procedure has also been referred to in the literature as the Austin osteotomy, chevron procedure, or Chevron osteotomy. Subsequent modifications have been described to address components of deformity associated with hallux valgus and first metatarsophalangeal joint deformity. These modifications include a bicorrectional technique for treatment of an associated abnormal proximal articular set angle (PASA) or transverse plane deformity of the head of the first metatarsal, to incorporate shortening or lengthening of the metatarsal, as well as plantar flexion and dorsiflexion of the metatarsal head and the correction of metatarsus primus elevatus. The bicorrectional technique as described by Gerbert et al. requires the performance of a second bone cut that extends 80 percent through the metatarsal to remove a medial wedge of bone head (Fig. 12-2A). Duke and Kaplan reported that by angulating the osteotomy from distal-medial to proximal-lateral shortening of the bone will result, and that plantar flexion will accompany an osteotomy that is directed from dorsomedial to plantar-lateral. Combining the techniques described it is possible to effect triplane correction to varying degrees with the osteotomy (Fig. 12-3A and B). Youngswick performed a second osteotomy paralleling the dorsal arm of the V osteotomy to enable plantar flexion for the management of a metatarsus primus elevatus associated with a hallux limitus (see Fig. 12-2B). Vogler modified the Austin osteotomy to incorporate an extended dorsal arm of the osteotomy, the socalled offset V osteoplasty (see Fig. 12-2C). The angle of the V reduces from 60° to 40°. The advantages to this modification, according to Vogler, are greater stability of the osteotomy and the ease with which screw fixation in an interfragmentary mode can be applied. Again, modification of the osteotomy allows multiplanar correction. A similar osteotomy has been described by Kalish et al. Modification of the Kalish osteotomy to address an abnormal proximal articular set angle has also been described. Selection of patients for this procedure includes those complaining of pain associated with a hallux valgus deformity with inability to function comfortably in normal or conventional shoe wear. There should be