Minimally Invasive Distal Chevron Osteotomy for Symptomatic Bunionette: Clinical and Radiologic Results of a 31-Case Retrospective Study

Abstract

Background: Bunionette is a common forefoot deformity that usually leads to significant discomfort. Multiple surgical techniques have been described for correcting bunionette. The purpose of this study is to analyze the clinical and radiologic outcomes of a new surgical technique via minimally invasive distal Chevron osteotomy of the fifth metatarsal without fixation, trying to find an effective technique with fewer complications. Methods: We retrospectively analyzed the data of 28 patients (31 feet) who presented with symptomatic bunionette that was resistant to conservative treatment and who underwent surgery at our center from February 2018 to February 2020. A minimum follow-up of 20 months was obtained (mean follow-up 26 months, range 20–37). Clinical results were evaluated using the visual analog scale (VAS) and the American Orthopaedic Foot & Ankle Society (AOFAS) score; 5 different radiologic parameters were analyzed. Results: After surgery, the mean AOFAS score increased by 29 points ( P < .001) and the mean VAS scores decreased by 6 points ( P < .001). An adequate radiologic correction was observed with a decrease in the M4–M5 intermetatarsal angle from 10.3 to 4.8 degrees ( P < .001), metatarsophalangeal angle by a mean of 16.05 degrees ( P < .001), and lateral deviation angle of the fifth metatarsal from 8.5 to 0.97 degrees ( P < .001). Moreover, the length of the fifth metatarsal and the forefoot width was reduced ( P < .001). The only complication was an asymptomatic delay in bone healing, but a complete bone consolidation was achieved after therapy. Conclusion: The proposed surgical technique shows a good correction capacity with excellent clinical and radiologic results and low complication rates. Level of Evidence: Level IV, retrospective case series.