Comparison of triplanar Chevron osteotomy with Chevron osteotomy in the treatment of hallux valgus for preventing transfer metatarsalgia

Abstract

Abstract Background: Hallux valgus (HV) is often accompanied by metatarsalgia. The purpose of this study was to compare the radiological and clinical outcomes of the new triplanar Chevron osteotomy (TCO) and Chevron osteotomy (CO) in the treatment of hallux valgus (HV), especially on plantar callosities and metatarsalgia. Methods: In this retrospective analysis, 90 patients (45 patients per group) with mild to moderate HV and plantar callosities were treated with TCO and CO from July 2020 to January 2022. In both procedures, the apex was located in the centre of the head of the first metatarsal bone, and the CO was oriented towards the fourth MTPJ at a 60° angle. Plantar-oblique Chevron osteotomy (POCO) was defined as Chevron osteotomy and a 20° plantar tilt; TCO was defined as POCO-based metatarsal osteotomy with a 10° tilt towards the metatarsal head. Primary outcome measures included X-ray measurements of the preoperative and postoperative HVA, IMA, DMAA, FML, SMHH and clinical measurements including VAS and AOFAS scores and changes in callosity grade and area and in the number of people with metatarsalgia. Secondary outcomes included complications, recurrence rates, and cosmetic appearance. Results: The HVA, IMA, and DMAA measurements were significantly decreased after surgery (P <0.001) in all patients. In the TCO group, the mean FML and SMHH increased significantly postoperatively (P<0.001). The AOFAS and VAS scores improved postoperatively in both groups (P < 0.001). All patients experienced satisfactory pain relief and acceptable cosmesis. The plantar callosity areas were smaller postoperatively in both the TCO and CO groups, but the change in the area (Δarea) of the TCO group was significantly different from that of the CO group (P < 0.001). The number of postoperative metatarsalgia patients and the plantar callosity grades in the TCO group were both significantly lower than those in the CO group after osteotomy (P<0.05 for both). Conclusions: TCO prevents dorsal shift of the metatarsal head and preserves and even increases the FML, thereby preventing future metatarsalgia in patients. Therefore, compared with CO, TCO has better orthopaedic outcomes and is an effective method for treating mild to moderate HV and preventing transfer metatarsalgia.