F-Shaped Osteotomy Combined with Basal Opening Wedge Osteotomy for Severe Hallux Valgus.

Objective To evaluate the safety and effectiveness of osteotomy adjacent to the articular surface of the metatarsal head combined with basal opening wedge osteotomy for severe hallux valgus. Methods The double osteotomy procedure was carried out in 56 patients (72 feet) with severe hallux valgus deformity, with an average follow-up of 25 months from March 2010 to February 2019. Hallux valgus angle (HVA), distal metatarsal articular angle (DMAA), intermetatarsal angle (IMA), and distal articular set angle (DASA) were measured for all patients via weight-bearing anteroposterior (AP) X-ray images. In addition, the American Orthopedic Foot & Ankle Society (AOFAS) scale was used for evaluating the function of the hallux. Results The HVA, IMA, and DMAA reduced from 49.30 +/- 6.60, 19.33 +/- 4.70, and 29.85 +/- 10.96 to 13.19 +/- 6.10, 5.97 +/- 3.13, and 5.63 +/- 3.44, respectively (P < 0.01). DASA decreased from 4.33 +/- 2.34 to 4.08 +/- 1.91 and did not show a statistically significant difference (P = 0.48). Among the 72 feet, 69 feet healed normally, and 3 feet had bone resorption at the osteotomy edges. No cases of bone sclerosis, bone necrosis, bone nonunion, or ankylosis were observed. On average, the AOFAS score improved from 34.66 +/- 12.07 (preoperative) to 88.78 +/- 5.73 (postoperative). Conclusions The proposed double osteotomy procedure can maintain the match metatarsophalangeal joints without ischemic necrosis of bones, and is demonstrated to be safe, effective, and feasible for correcting severe hallux valgus.