[Stoffella metatarsal I osteotomy for Hallux valgus correction : an update].

PROBLEM

A Hallux valgus (bunion) is a complex deformity caused by a dysbalance of the static and dynamic elements of the foot. Thus, the aim of an anatomical reconstruction is to normalize the physiological angle between the first and second metatarsal and to realign the balance of periarticular soft tissues. Modern surgical techniques should allow for very early weight-bearing and, at the same time, make immobilizing casts or other devices unnecessary.

SOLUTION

The Stoffella metatarsal I osteotomy is a technique which meets the requirements of statical and dynamic balance in combination with immediate full weight-bearing.

SURGICAL TECHNIQUE

After sparingly removing the medial exostosis (bunion), a distal metatarsal osteotomy is performed. To correct the deformity, the metatarsal head is shifted laterally, plantarwards, and rotated, if required. Fixation is performed by a stable DC clip for osteosynthesis, screwed in place to maintain the correction. Soft tissue balancing is achieved by a transarticular lateral release and medial capsular raphing.

POSTOPERATIVE MANAGEMENT

Early functional rehabilitation, immediate full weight-bearing, normal heel-to-toe gait, lymphatic drainage, soft bandage for big toe for 6 weeks.

RESULTS

A total of 353 patients, thereof 177 patients with simultaneous operation of both sides, were included. Preoperative hallux valgus angle (42°; range 25-60°) improved to 16° (range 6-30°). The intermetatarsal angle averaged 15° (range 10-26°) preoperatively and 10° (range 7-14°) postoperatively. The Kitaoka score improved from 47 points preoperatively to 87 points postoperatively. Complications included 4 deep infects (0.8%), 3 dislocations of the metatarsal head (0.6%), 4 necroses of the metatarsal head (0.8%), and 13 arthrofibroses (2.6%).