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CC BY-NC-ND 4.0 · Rev Bras Ortop (Sao Paulo) 2021; 56(04): 504-512
DOI: 10.1055/s-0040-1721367
Artigo Original
Pé e Tornozelo

Percutaneous Hallux Valgus: An Algorithm for the Surgical Treatment[*]

Article in several languages: português | English
Igor Marijuschkin 
1  Hospital São Lucas, Santos, SP, Brasil
,
Matheus Levy Souza 
2  Hospital Mater Dei, Belo Horizonte, MG, Brasil
,
José Luiz Garcia Diaz 
1  Hospital São Lucas, Santos, SP, Brasil
,
Paulo Carvalho 
3  Hospital Ortopédico de Santana, Parede, Portugal
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Abstract

Objective To present the clinical and radiographic results of hallux valgus surgical correction using four percutaneous techniques, chosen according to a predefined radiographic classification.

Methods We prospectively evaluated 112 feet in 72 patients with hallux valgus operated over the course of 1 year. Percutaneous distal soft tissue release (DSTR) and the Akin procedure (DSTR-Akin) were performed in mild cases. In mild to moderate hallux valgus with distal metatarsal joint angle > 10°, we added the Reverdin-Isham (RI) osteotomy. In moderate cases with joint incongruity, we performed the percutaneous chevron (PCH). Finally, a Ludloff-like percutaneous proximal osteotomy fixed (PPOF) with a screw was proposed in severe cases with an intermetatarsal angle (IMA) > 17°. According to these criteria, 26 DSTRs-Akin, 36 PCHs, 35 RIs, and 15 PPOFs were performed. The mean follow-up was of 17.2 months (range: 12 to 36 months). The mean age at operation was 58.8 years (range: 17 to 83 years), and 89% of the patients were female.

Results The mean preoperative hallux valgus angle (HVA) and the IMA decreased from 21° to 10.2° and from 11.2° to 10.3° respectively in the DSTR-Akin. In the RI, the mean HVA decreased from 26.6° to 13.7°, and the IMA, from 11.2° to 10.3°; in the PCH, the mean HVA decreased from 31° to 14.5°, and the IMA decreased 14.9° to 10.7°; as for the PPOF, the mean HVA decreased from 39.2° to 17.7°, and the IMA, from 11.8° to 6.8°. The average ankle and hindfoot score of the American Orthopaedic Foot and Ankle Society (AOFAS) increased from 49.2 to 88.6. The rate of complications was of 11%.

Conclusion Our treatment protocol does not differ much from the classic ones, with similar results as well. We have as advantages less aggression to soft tissues and better cosmetic results. Level of Evidence: level IV, prospective case series.

Keywords

hallux valgus - metatarsal bones - minimally invasive surgical procedures

* Work developed at Hospital São Lucas, Santos, SP, Brazil.


Financial Support

There was no financial support from public, commercial, or non-profit sources.




Publication History

Received: 28 April 2020

Accepted: 16 September 2020

Publication Date:
30 August 2021 (online)

© 2021. Sociedade Brasileira de Ortopedia e Traumatologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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