[Initial experience with the closed method of subcapital osteotomy of the 1st metatarsus in hallux valgus].

The authors summarize initial findings with Bösh's modification of Hohmann's subcapital osteotomy made by means of a cutter from a short dermal incision under X-ray control. The valgosity and rotation of the hallux are corrected by a lateral and possibly plantar shift and by derotation of the head of the metatarsus. The position of the head is ensured by supporting the medial exostosis by a wire inserted by the intramedullary route into the Ist metatarsus. The operation was performed in five female patients aged 37-60 years on nine feet. The results were evaluated after 10-13 months. For osteotomy conic cutters were used (diameter of base 2.1 mm and 5 mm) and a drill (3000 rotations per minute) from the small instrumentarium of SYNTHES Co. The Kirschner wire was removed after four weeks and fixation a with a plaster spica of the toe took, depending on healing, 7-12 weeks after operation. In all instances marked correction of the position of the toe occurred (reduction of the valgosity angle by 8-19 degrees). As to subjective evaluation, four patients evaluated the result as excellent, three as satisfactory, i.e. disappearance or marked reduction of complains and once as unsatisfactory with persisting pain and difficulties as regards footwear. After analysis of the first early results the authors recommend to indicate the operation in valgosity of the toe up to 35 degrees and minimal arthrosis, to perform the osteotomy in a strictly subcapital and extracapsular position and to reduce the period of fixation. The advantage of the method is that the metatarsophalangeal joint is not damaged, the operation is sparing, marked correction of the position of the toes is achieved, the time of operation is short and the scar is not visible.