Analysis of Independent Predictors of Poor Outcomes of Chevron Osteotomy for Hallux Valgus: Focus on Generalized Ligamentous Laxity and Foot Width Changes

Abstract

Category: Bunion, Midfoot/Forefoot Introduction/Purpose: The identification of factors associated with poor outcomes in patients who have undergone chevron metatarsal osteotomy is helpful for predicting postoperative outcomes. The purpose of this study was to evaluate the impact of generalized ligamentous laxity and various clinical risk factors on the radiological and clinical outcomes of chevron osteotomy for hallux valgus. Methods: A total of 135 patients (137 feet) who underwent chevron metatarsal osteotomy for hallux valgus deformity were included in this study. The mean follow-up duration was 5.6 years (range, 2–10.4 years). Generalized ligamentous laxity was assessed in all patients. After assessing the clinical outcome after chevron osteotomy for hallux valgus using the American Orthopedic Foot and Ankle Society scores - Hallux Metatarsophalangeal-Interphalangeal scale (AOFAS score), the clinical and radiological risk factors that affect postoperative outcomes were analyzed with bivariate and logistic regression analyses. Results: The average AOFAS score improved on surgical treatment from 51.4 ± 13.5 preoperatively to 86.0 ± 12.1 at the last follow-up (P < 0.001). Patients with generalized ligamentous laxity showed no significant difference in radiological and clinical parameters compared to non-laxity patients. According to bivariate and multivariate logistic regression analyses, second plantar callosity on the metatarsophalangeal joint before surgery and the ratio of foot width difference after surgery were significantly associated with clinical outcome after surgery. Conclusion: In the surgical treatment of hallux valgus, more careful surgical technique is required for patients with second plantar callus on the metatarsophalangeal joint before surgery, and efforts are needed to reduce foot width through surgical treatment.