M. Severyns, JL. Rouvillain, P. Carret
(Fort de France)
Introduction. In the last decade the interest of minimaly invasive surgery (MIS) has been growing. Theoretically, this kind of procedure could decrease time to recovery and rehabilitation, with a reduction of morbidity. The present study assessed a 35-months clinical and radiological outcomes and complications of percutaneous surgery for mild to moderate hallux valgus using Reverdin-Isham and Akin osteotomies without osteosynthesis.
Materials and methods. This is a retrospective series of 48 patients (57 cases) with medium to moderate hallux valgus, who undergone the same percutaneous surgery, between 2003 and 2011. The collection of preoperative data and at last follow-up concerned dorsal, plantar flexion, M1P1, M1M2, DMAA angles, Kitaoka functional score, subjective and objective satisfaction.
Results. Kitaoka functional score rose from a preoperative median of 60/100 to 90/100 postoperatively (p<0.05); 90% of patients were satisfied or very satisfied with their result at end of follow-up. Hallux valgus and distal metatarsal articular angle (DMAA) were significantly reduced (respectively 30 and 14° to 15 and 8°, p<0.05). There was a significantly increased of MTP1 joint stiffness (p<0.05).
Discussion. Percutaneous correction by Reverdin-Isham and Akin osteotomies seems to be effective in isolated medium-to-moderate hallux valgus. Stiffness observed is comparable to other open procedures, but need to be compared to MIS with internal fixation. Transfer metatarsalgia can be induced by first metatarsal shortening after this procedure.