Oblique Displacement Osteotomy for Hallux Valgus.

The standard operations for the correction of hallux valgus in the middle-aged are not entirely satisfactory when applied to the same condition presenting in adolescence. Most of these procedures, although they correct the deformity, interfere to some extent with the efficiency of the foot. This is of little importance in the older patient, who is unlikely to put heavy strain on the site of the operation, but it can be a disability in younger people, who may be involved in considerable physical exertion. Dissatisfaction with the results of treatment of hallux valgus in the adolescent has led to the introduction of a variety of corrective operations. These were fully reviewed by Cholmeley (1958), who came to the conclusion that the Hohmann operation (1948) gave the best results. About the same time Mitchell, Fleming, Allen, Glenney and Sanford (1958) published the results of Mitchell’s corrective operation. Before these operations were described surgeons had believed that correction of the primus metatarsus varus was the secret of success, and several osteotomies were suggested to accomplish this: for instance, Ellis (1951) described how this could be achieved by stapling the basal epiphysis of the first metatarsal. In the Hohmann and Mitchell operations the primus varus is accepted and the valgus is corrected by an osteotomy of the neck of the metatarsal with displacement of the metatarsal head laterally. Both the operations have the disadvantage of producing a small distal fragment, requiring careful shaping of the osteotomy surfaces and often internal fixation to obtain stability. Oblique osteotomies to produce the same displacement have been described previously by a number of authors (Ludloff 1918 ; Mizuno, Suma and Yanuzaki 1956), but they have been rendered unnecessarily complicated, either by the obliquity of the osteotomy, or by the removal of bone wedges. The operation to be described is presented because it is simple and is less likely to result in complications. It can also be carried out as rapidly as the standard procedures used in older patients.