Abstract

Background: Hallux Valgus (HV) is the most common forefoot deformity whose incidence is bilateral in 84 to 97.3% of cases. This raises the question on whether these cases should be operated sequentially or simultaneously. We wish to examine the pertinence of simultaneous bilateral HV correction in the treatment of moderate to severe isolated bilateral symptomatic hallux valgus deformity using a distal metatarsal osteotomy.
Methods: Between May 2015 and April 2018, we performed 341 hallux valgus corrections using the ReveL procedure, a distal biplanar metatarsal osteotomy technique, completed by the Akin osteotomy in necessary cases. Of these, 31 cases with simultaneous correction of an isolated bilateral HV deformity were selected for this study. The AOFAS and the EQ-5D scores were used to evaluate the clinical outcome. HV, IMA and DMAA angles as well as sesamoid deviation were compared in pre- and postoperative standard standing X-rays. Gait analysis was performed at longest follow-up and maximum force (Max-F, N), peak pressure (Peak-P, kPa), contact area (Con-A, cm2), contact time (Con-T, s) and the force-time integral (FTI, %) values were compared to the ones of a sex and age matched group of healthy subjects.
Results: After a mean follow-up of 37 months, we observed a significant rise in AOFAS score by an average of 35 points. We observed an average reduction of the following radiological parameters: HV angle by 19.37°, IMA by 8.21°, DMAA by 17.67° and sesamoid deviation by 3.4mm. There was no significant difference between the gait analysis of the operated patients and the one of the control groups and the postoperative forefoot plantar pressure was restored and similar to healthy subjects.
Conclusion: Simultaneous distal metatarsal osteotomies in bilateral cases of moderate-to-severe HV can significantly improve the patient’s clinical and radiological outcome with a high level of satisfaction.

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