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Chirurgia Del Piede 2000 March;24(1):53-62

Copyright © 2000 EDIZIONI MINERVA MEDICA

language: Italian

Distal osteotomy of the first metatarsal bone for the surgical treatment of hallux valgus

Milano L., Marconetto M., Pisani P. C.

Distal first metatarsal osteotomies allow the structural deviations typical of hallux valgus to be corrected in all three spatial planes; they can be easily associated with soft tissues procedures or phalangeal osteotomies. Even if different designs are used, all distal osteotomies show similar biomechanical characteristics; the most important one is the possibility of altering the position of the metatarsal head in all three spatial planes. It is possible to dislocate the head laterally, thus reducing the intermetatarsal angle (IMA); it is also possible, by modifying the plane of osteotomy appropriately, to move the head in plantar or dorsal direction, lenghten or shorten the metatarsal bone or rotate the head to correct metatarsal pronation. In addition they are the only osteotomies able to correct distal metatarsal articular angle (DMAA) effectively and to act in the presence of congruous joint. Indications are slight or moderate hallux valgus with IMA not in excess of 20° in preferably young patients and in joints without degeneratives changes. Complications are reported in a smaller percentage if indications and execution are correct. The most severe complication is cephalic necrosis but its incidence is minimal if osteotomy is performed with a correct technique. Austin osteotomy, Reverdin osteotomy (with Green, Todd and Laird modifications) and percutaneous techniques are described.