Fixation of metatarsal osteotomies in the treatment of hallux valgus.

Osteotomies as a treatment for hallux valgus require careful preoperative planning and meticulous attention to surgical technique. The procedure selected should be tailored to fit the deformity. For a patient with mild hallux valgus, the chevron osteotomy is the most intrinsically stable of the distal osteotomies and has the least potential for complications. Interest in the Ludloff osteotomy has had a resurgence because of its improved stability compared with more traditional osteotomies for correction of metatarsus primus varus. This osteotomy, however, is less forgiving and more dependent on technique than other procedures. The proximal chevron osteotomy, with plantar-to-dorsal screw placement, is easier to perform than the Ludloff and provides excellent stability. Regardless of the osteotomy used, screw fixation has been shown to be mechanically superior to all other modes of fixation (K-wire, staples, or no fixation). Postoperatively, a hard-soled postoperative shoe that permits weight-bearing on the heel and lateral foot is recommended; however, for the more unstable osteotomies and for those performed in patients with poor bone quality, a period of non-weight-bearing should be considered. Future studies with cyclic loading may help modify these current postoperative restrictions.