Treatment of Hallux Valgus with a Chevron Osteotomy Combined with a Lateral Release

Purpose: Current literature recommends proximal first metatarsal osteotomy for large hallux valgus deformities. Combined distal osteotomy with lateral release can be done and may provide a similar degree of correction. The concern with this technique is disruption of the blood supply to the first metatarsal head. We hypothesized that a chevron osteotomy in conjunction with a lateral release is effective in correcting some larger hallux valgus deformities without causing disruption of the blood supply to the first metatarsal head. Methods: We reviewed the imaging studies of fortysix cases that underwent a distal chevron osteotomy with lateral release for correction of larger hallux valgus deformities with incongruent joints. The AP radiographs of the operated foot were measured preoperatively and postoperatively. We documented the degree of correction of the first metatarsophalangeal (MTP) angle, degree of correction of the intermetatarsal (IM) angle, and improvement in joint congruity. Results: The mean MTP angles were 30° preoperatively and 16° postoperatively. The mean IM angles were 15° preoperatively and 7° postoperatively. In all cases the first MTP joint was incongruent preoperatively and congruent postoperatively. In the short term follow-up, none of the radiographs showed evidence of avascular necrosis of the first metatarsal head. Conclusion: A chevron osteotomy with lateral release can be used to effectively treat large hallux valgus deformities with minimal risk of first metatarsal head avascular necrosis