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

• Published in: The Journal of foot and ankle surgery Vol. 64; no. 4; pp. 338 - 348
• Main Authors: Pérez-Fernández, Albert, Fierres, Sara Rivera, Llobet, Magdalena Edo, Miguel, Elena Cañas, González, Óscar Pablos, Fernández, Miguel Ángel Pérez, Huaraca, Carlos Urbina, Carnaval, Thiago, Videla, Sebastián, Ferrer, José Luís Agulló
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.07.2025
• Subjects: Adult; Aged; Aged, 80 and over; Bone Plates; Bunion recurrence; Bunion surgery complications; Female; Forefoot Deformities; Hallux Valgus - diagnostic imaging; Hallux Valgus - surgery; Humans; Intramedullary plate fixation; Joint preservation techniques; Male; Metatarsal Bones - diagnostic imaging; Metatarsal Bones - surgery; Middle Aged; Osteotomy - instrumentation; Osteotomy - methods; Recurrence; Reoperation; Retrospective Studies; Treatment Outcome; Joint preservation techniques; Forefoot Deformities; Intramedullary plate fixation; Bunion surgery complications; Bunion recurrence; 4
• ISSN: 1067-2516; 1542-2224; 1542-2224
• DOI: 10.1053/j.jfas.2024.12.007

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.