Hallux valgus: Chevron Osteotomy
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Patients with symptomatic Hallux Valgus will have pain predominantly from the medial eminence (though of course not all patients are symptomatic). Pain is classically when in shoe-wear (or more specifically tighter fitting shoe-wear). Surgery in the majority of cases is indicated for pain.
With regards to radiographic criteria a mild Hallux Valgus could be said to be a Hallux Valgus angle (the degree of lateral angulation of the hallux relative to the first ray ) of less than 2o degrees and an inter-metatarsal (IM) angle of less than 11 degrees. A moderate deformity displays a Hallux Valgus angle of 20 to 40 degrees and an Inter-metatarsal angle of 11-18 degrees. A severe deformity a Hallux Valgus angle in excess of 4o degrees and inter-metatarsal angle over 18 degrees.
The Chevron osteotomy is a distal diaphyseal osteotomy which is used for correcting smaller Hallux Valgus deformities and is most successfully used to correct IM angles of less than 15 degrees.
There is debate about the risk of avascular necrosis if the operation is combined with a formal open lateral release. A more limited transarticular lateral soft tissue release can be performed through the medial joint approach and this is usually required to mobilise the osteotomy adequately.
Author:Mark Herron FRCS.
Institution: The Wellington Hospital, London, UK.