Introduction: Hallux valgus (HV) deformity is a condition with gradually increasing prevalence, often accompanied by cosmetic deformity. The change in pain and functional levels of patients after surgery directly affects the clinical outcomes in moderate hallux valgus deformities.

Aim: The aim of this study was to compare the clinical outcomes of proximal opening-wedge osteotomy and distal chevron osteotomy in the treatment of moderate hallux valgus deformity.

Materials and Methods: 37 patients aged between 55 and 65, who were diagnosed with moderate hallux valgus deformity between March 2015 and December 2017 in Ankara Yıldırım Beyazit University Yenimahalle Training and Research Hospital were enrolled in this study. Patients who underwent proximal opening-wedge osteotomy (POWO) were assigned to Group 1 (n=19) and patients who underwent distal chevron osteotomy (DCO) were assigned to Group 2 (n=18). There was no difference between the groups in terms of age, duration of follow-up, demographic and radiological parameters. Visual Analogue Scale (VAS) and American Orthopedic Foot and Ankle Score (AOFAS) systems were used to compare the preoperative period with months 3, 6 and 12.

Results: There was a significant difference between the two groups in terms of VAS and AOFAS scores at months 3 and 6 in favor of Group 2 (p<0.001). According to the follow-up at month 12, the change in VAS (p=0.518) and AOFAS (p=0.119) measurements was not statistically significant for any of the groups. Both groups exhibited a statistically significant increase in the scores at months 3 and 6 as compared to the preoperative period.

Conclusion: Proximal opening-wedge osteotomy was found to be more effective than distal chevron osteotomy in terms of short-term pain and functional scores in the treatment of moderate hallux valgus deformity. On the other hand, it was seen in follow-ups that both methods alleviated pain and provided similar improvement from the functional aspect.

Keywords: Hallux valgus, distal osteotomy, proximal osteotomy.

1. Mann RA, Coughlin MJ: Hallux valgus--etiology, anatomy, treatment and surgical considerations. Clin Orthop Relat Res 1981(157):31-41.
2. Coughlin MJ, Jones CP: Hallux valgus: demographics, etiology, and radiographic assessment. Foot Ankle Int 2007, 28(7):759-777.
3. Thordarson DB, Rudicel SA, Ebramzadeh E, Gill LH: Outcome study of hallux valgus surgery--an AOFAS multi-center study. Foot Ankle Int 2001, 22(12):956-959.
4. Ferrari J, Higgins JP, Williams RL: Interventions for treating hallux valgus (abductovalgus) and bunions. Cochrane Database Syst Rev 2000(2):CD000964.
5. Garrow AP, Papageorgiou A, Silman AJ, Thomas E, Jayson MI, Macfarlane GJ: The grading of hallux valgus. The Manchester Scale. J Am Podiatr Med Assoc 2001, 91(2):74-78.
6. Srivastava S, Chockalingam N, El Fakhri T: Radiographic angles in hallux valgus: comparison between manual and computer-assisted measurements. J Foot Ankle Surg 2010, 49(6):523-528.
7. Srivastava S, Chockalingam N, El Fakhri T: Radiographic measurements of hallux angles: a review of current techniques. Foot (Edinb) 2010, 20(1):27-31.
8. LaPorta GA, Nasser EM, Mulhern JL, Malay DS: The Mechanical Axis of the First Ray: A Radiographic Assessment in Hallux Abducto Valgus Evaluation. J Foot Ankle Surg 2016, 55(1):28-34.
9. Radwan YA, Mansour AM: Percutaneous distal metatarsal osteotomy versus distal chevron osteotomy for correction of mild-to-moderate hallux valgus deformity. Arch Orthop Trauma Surg 2012, 132(11):1539-1546.
10. Coughlin MJ: Hallux valgus. J Bone Joint Surg Am 1996, 78(6):932-966.
11. Easley ME, Trnka HJ: Current concepts review: hallux valgus part II: operative treatment. Foot Ankle Int 2007, 28(6):748-758.
12. Pinney S, Song K, Chou L: Surgical treatment of mild hallux valgus deformity: the state of practice among academic foot and ankle surgeons. Foot Ankle Int 2006, 27(11):970-973.
13. Trnka HJ, Zembsch A, Easley ME, Salzer M, Ritschl P, Myerson MS: The chevron osteotomy for correction of hallux valgus. Comparison of findings after two and five years of follow-up. J Bone Joint Surg Am 2000, 82-A(10):1373-1378.
14. Trnka HJ: Osteotomies for hallux valgus correction. Foot Ankle Clin 2005, 10(1):15-33.
15. Klosok JK, Pring DJ, Jessop JH, Maffulli N: Chevron or Wilson metatarsal osteotomy for hallux valgus. A prospective randomised trial. J Bone Joint Surg Br 1993, 75(5):825-829.
16. Meier PJ, Kenzora JE: The risks and benefits of distal first metatarsal osteotomies. Foot Ankle 1985, 6(1):7-17.
17. Murawski DE, Beskin JL: Increased displacement maximizes the utility of the distal chevron osteotomy for hallux valgus deformity correction. Foot Ankle Int 2008, 29(2):155-163.
18. Oravakangas R, Leppilahti J, Laine V, Niinimaki T: Proximal Opening Wedge Osteotomy Provides Satisfactory Midterm Results With a Low Complication Rate. J Foot Ankle Surg 2016, 55(3):456-460.
19. Baumhauer JF, Nawoczenski DA, DiGiovanni BF, Wilding GE: Reliability and validity of the American Orthopaedic Foot and Ankle Society Clinical Rating Scale: a pilot study for the hallux and lesser toes. Foot Ankle Int 2006, 27(12):1014-1019.
20. Stukenborg-Colsman C, Claassen L, Ettinger S, Yao D, Lerch M, Plaass C: [Distal osteotomy for the treatment of hallux valgus (Chevron osteotomy)]. Orthopade 2017, 46(5):402-407.
21. Klugarova J, Hood V, Bath-Hextall F, Klugar M, Mareckova J, Kelnarova Z: Effectiveness of surgery for adults with hallux valgus deformity: a systematic review. JBI Database System Rev Implement Rep 2017, 15(6):1671-1710.
22. Malagelada F, Sahirad C, Dalmau-Pastor M, Vega J, Bhumbra R, Manzanares-Cespedes MC, Laffenetre O: Minimally invasive surgery for hallux valgus: a systematic review of current surgical techniques. Int Orthop
23. Brogan K, Lindisfarne E, Akehurst H, Farook U, Shrier W, Palmer S: Minimally Invasive and Open Distal Chevron Osteotomy for Mild to Moderate Hallux Valgus. Foot Ankle Int 2016, 37(11):1197-1204.
24. Kaufmann G, Sinz S, Giesinger JM, Braito M, Biedermann R, Dammerer D: Loss of Correction After Chevron Osteotomy for Hallux Valgus as a Function of Preoperative Deformity. Foot Ankle Int 2018:1071100718807699.
25. Braito M, Dammerer D, Hofer-Picout P, Kaufmann G: Proximal Opening Wedge Osteotomy With Distal Chevron Osteotomy of the First Metatarsal for the Treatment of Moderate to Severe Hallux Valgus. Foot Ankle Int 2018:1071100718799079.

Mustafa Akkaya

Department of Orthopedics and Traumatology, Ankara Yildirim Beyazit University, 06100 Ankara, Turkey

Tel: +90 312 587 20 29, Email: This email address is being protected from spambots. You need JavaScript enabled to view it.