Lotan Raphael, Shlomov Benzion, Dotan Amit, Bermant Alex, Hershkovich Oded
Department of Orthopedic Surgery, Wolfson Medical Center, Holon 5822012, Israel.
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel.
J Clin Med. 2023 Mar 30;12(7):2607. doi: 10.3390/jcm12072607.
Hallux valgus (HV) is a common adult foot deformity. There is uncertainty concerning the effect of HV surgery on foot width. We examined the effect of chevron first metatarsal osteotomy on forefoot width using calibrated pre and postoperative standing radiographs.
A retrospective cohort of 50 patients underwent chevron osteotomy HV surgery. All had HVA > 30°, IMA > 11°, DMMA > 3°, >6-month follow-up, and calibrated pre and postoperative standing foot radiographs. Bony width (BW) and soft tissue width (STW) were used to measure the surgery's effect on foot width. Measurements were made preoperatively and 3-6 months following surgery.
The study group included 42 women with an average age of 63.4 (±8.3) and a mean BMI of 28.7 (±4.9). Preoperative HVA and IMA were 31.7° (±6.8°) and 13.4° (±2.8°), respectively. Following surgery, HVA and IMA improved significantly, by 15.6° (±5.7°) and 8.7° (±2.3°), respectively. The preoperative average BW was 9.4 cm (±0.6), and the STW was 10.6 cm (±0.7). Following surgery, significant changes in BW and STW were measured, with a mean narrowing of 1.2 cm (±0.4) in BW ( < 0.001) and 0.95 cm (±0.5) in STW ( < 0.001). Paradoxically, an increase in age led to a lower correction of the IMA ( = 0.04, r = 0.57), but higher BW and STW reductions ( = 0.01, r = 0.35 and = 0.008, r = 0.37, respectively).
This study reinforced chevron osteotomy as a valid treatment option that significantly narrows forefoot width; it is thus expected to improve cosmetic outcomes, shoe selection options, and quality of life. This study also found that older age correlates with better forefoot narrowing following hallux valgus repair, possibly due to stiffer soft tissues.
拇外翻（HV）是一种常见的成人足部畸形。关于HV手术对足宽的影响尚无定论。我们使用校准后的术前和术后站立位X线片研究了V形截骨术对前足宽度的影响。
一项回顾性队列研究，50例患者接受了V形截骨HV手术。所有患者的HVA>30°，IMA>11°，DMMA>3°，随访时间>6个月，且有校准后的术前和术后站立位足部X线片。采用骨宽度（BW）和软组织宽度（STW）来衡量手术对足宽的影响。术前及术后3 - 6个月进行测量。
研究组包括42名女性，平均年龄63.4（±8.3）岁，平均BMI为28.7（±4.9）。术前HVA和IMA分别为31.7°（±6.8°）和13.4°（±2.8°）。术后，HVA和IMA显著改善，分别改善了15.6°（±5.7°）和8.7°（±2.3°）。术前平均BW为9.4 cm（±0.6），STW为10.6 cm（±0.7）。术后，BW和STW有显著变化，BW平均缩小1.2 cm（±0.4）（P<0.001），STW平均缩小0.95 cm（±0.5）（P<0.001）。矛盾的是，年龄增加导致IMA矫正程度降低（P = 0.04，r = 0.57），但BW和STW缩小程度更高（分别为P = 0.01，r = 0.35和P = 0.008，r = 0.37）。
本研究强化了V形截骨术作为一种有效的治疗选择，它能显著缩小前足宽度；因此有望改善外观效果、鞋子选择范围和生活质量。本研究还发现，年龄较大与拇外翻修复术后前足缩窄效果较好相关，可能是由于软组织更僵硬。
