First metatarsal osteotomy with an intramedullary locking plate is a good alternative for the reintervention of recurrent hallux valgus

Abstract

This study describes the results of first metatarsal (M1) distal osteotomy with an intramedullary locking plate in persistent/recurrent painful hallux valgus (HV) deformity (without advanced degenerative changes) after primary surgery. Outcomes included postoperative incidences of HV angle (HVA)<16°, intermetatarsal angle (IMA)<9°, proximal articular set angle (PASA)<10°, and the American Orthopedic Foot and Ankle Society (AOFAS) score. Data normality was assessed with the Shapiro-Wilk test, and preoperative vs. postoperative comparisons, as well as postoperative angles vs. preestablished thresholds, were performed with the Wilcoxon signed rank test or the paired Student's t-test, as applicable. Firth's penalized logistic regression analyzed the association between severe complications and undergoing surgery before 2017. Thirty-two patients were included, with a median (range) age of 62.5 (40.0 – 84.0) years; 31 (96.9 %) were females. The minimum follow-up was 24 months. Postoperative incidences (95 %CI) of HVA<16°, IMA<9°, and PASA<10° were, respectively, 75.0 % (57.9 – 86.8 %), 93.8 % (79.9 – 98.3 %), and 56.0 % (33.6 – 66.4 %). Median postoperative HVA, IMA, PASA, and AOFAS score values improved significantly (p < 0.001 for all). Postoperative HVA and IMA were significantly better than preestablished thresholds (p = 0.008 and p < 0.001, respectively), but the PASA was not (p = 0.507). Seven (21.9 %) patients experienced Clavien-Dindo ≥IIIa complications, all in the early implementation period (first 5 years), corresponding to the first 20 surgeries performed (p = 0.046). In conclusion, distal M1 osteotomy plus stabilization with an intramedullary plate offers a viable joint-preserving alternative for recurrent moderate to severe HV deformities in patients without severe arthritic changes or hypermobility of the first TMT joint.