Open wedge vs. crescentic osteotomy comparable in healing for severe hallux valgus

Study Type: Therapy
OE Level of Evidence: 2
Journal Level of Evidence: N/A
45 patients with severe hallux valgus deformity were randomized to undergo either open wedge osteotomy or crescentic osteotomy for the purpose of comparing radiological and clinical outcomes of both methods after 12 months post-surgery. Results demonstrated that both surgical interventions were associated with significant improvements in hallux valgus angle, intermetatarsal angle, pain and function at 4 and 12 months. Between-group comparisons for Please login to view the rest of this report. Please login to view the rest of this report.
Funding: Not Reported
Conflicts: None disclosed
Why was this study needed now?
Numerous surgical techniques have been developed to treat hallux valgus deformities, as this malformation is often associated with abnormal gait, ulcers on the foot, and other secondary complications. There is a paucity of evidence directly comparing various techniques, including open wedge osteotomy and crescentic osteotomy for clinical outcomes such as foot function, pain, and radiological measures, thus warranting the present study.
What was the principal research question?
For patients with severe hallux valgus deformity, did either open wedge osteotomy or crescentic osteotomy result in superior clinical and radiological outcomes when assessed up to 12 months postoperatively?
Population: 45 patients aged 15 to 70 years with severe hallux valgus (hallux valgus angle >35 degrees and intermetatarsal angle >15 degrees) were included between January 2009 and January 2011. Distal lateral release and bunionectomy were performed for all patients prior to allocated osteotomy. Patients in both study groups followed identical postoperative therapy consisting of partial weight bearing, use of a static walker, and joint mobility exercises (mean age= 52 [19-70], 4M/41W).
Intervention: Open Wedge Osteotomy group: transverse proximal osteotomy of the metatarsal bone made 1.5 cm distal to the tarsometatarsal joint and fixation with the L-shaped non-locking Hemax plate was performed (n=22).
Comparison: Crescentic Osteotomy group: proximal crescentic osteotomy was performed 15 mm distal to the tarsometatarsal joint (proximal concavity) and stabilization with a 3-mm cannulated AO titanium screw was performed under tourniquet control (n= 23).
Outcomes: Outcomes of interest included the American Orthopaedic Foot and Ankle Society (AOFAS) score, a visual analogue scale (VAS) for pain, and anteroposterior weight-bearing radiographs analyzing hallux valgus angle (HV), intermetatarsal angle (IM), and radiological healing/length.
Methods: RCT: prospective
Time: Clinical and radiological evaluations were made preoperatively, and 4 and 12 months postoperatively.
What were the important findings?
What should I remember most?
How will this affect the care of my patients?
The authors responsible for this critical appraisal and ACE Report indicate no potential conflicts of interest relating to the content in the original publication.