Xing Yachang, Wang Xinwen, Li Yi, Liu Cheng
The Second Ward of Orthopedics Department, the Second People's Hospital of Nanyang, Nanyang Henan, 473000, P. R. China.
Foot and Ankle Surgery Ward, Honghui Hospital, Xi'an Jiaotong University, Xi'an Shaanxi, 710054, P. R. China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2025 Jul 15;39(7):843-847. doi: 10.7507/1002-1892.202504095.
To explore the effectiveness of triple osteotomy in correcting severe hallux valgus with the first metatarsal pronation deformity.
A retrospective analysis was conducted on the clinical data of 29 patients (40 feet) with severe hallux valgus accompanied by the first metatarsal pronation deformity, who were admitted between January 2022 and December 2023 and met the selection criteria. There were 8 males (10 feet) and 21 females (30 feet), with an average age of 50.0 years (range, 44-62 years). The disease duration ranged from 5 to 9 years (mean, 6.5 years). All patients underwent triple osteotomy to correct the deformity. The American Orthopaedic Foot and Ankle Society (AOFAS) score and visual analogue scale (VAS) score were used to evaluate joint function and pain before and after operation. Based on pre- and post-operative X-ray films, hallux valgus angle (HVA), intermetatarsal angle (IMA), and distal metatarsal articular angle (DMAA) were measured to evaluate the correction of hallux valgus; the shape classification of the lateral edge of the first metatarsal and the pronation of first metatarsal angle (PFMA) were observed to assess the correction of the first metatarsal pronation deformity.
A superficial infection occurred in 1 foot and the incison healed after dressing change; the remaining incisions healed by first intention. All patients were followed up 12-18 months (mean, 12.6 months). Three cases (4 feet) experienced limited movement of the metatarsophalangeal joint after operation, and the joint function recovered after strengthening functional exercises. During follow-up, no recurrence of deformity or secondary metatarsal pain occurred. Compared with preoperative scores, the AOFAS score increased and the VAS score decreased at last follow-up, and the differences were significant ( <0.05). Radiographic examination showed that the osteotomy achieved bony healing, with the healing time of 2.5-6.2 months (mean, 4.1 months). The hallux valgus deformity was corrected, and the IMA, HVA, and DMAA were significantly smaller at last follow-up when compared with those before operation ( <0.05). The first metatarsal pronation deformity was also corrected; there was no R-type (R-type for pronation deformity) on the lateral edge of the first metatarsal at last follow-up, and the PFMA decreased compared with preoperative levels ( <0.05) and was corrected to the normal range.
Triple osteotomy can achieve good effectiveness for correcting severe hallux valgus with the first metatarsal pronation deformity. The functional training of the first metatarsophalangeal joint needs to be strengthened.
探讨三截骨术矫正伴有第一跖骨内翻畸形的重度拇外翻的有效性。
回顾性分析2022年1月至2023年12月收治的29例（40足）伴有第一跖骨内翻畸形的重度拇外翻患者的临床资料，患者均符合入选标准。其中男性8例（10足），女性21例（30足），平均年龄50.0岁（范围44 - 62岁）。病程5至9年（平均6.5年）。所有患者均接受三截骨术矫正畸形。采用美国矫形足踝协会（AOFAS）评分和视觉模拟量表（VAS）评分评估手术前后的关节功能和疼痛情况。根据手术前后的X线片，测量拇外翻角（HVA）、跖间角（IMA）和第一跖骨头远端关节角（DMAA）以评估拇外翻的矫正情况；观察第一跖骨外侧缘的形态分类和第一跖骨内翻角（PFMA）以评估第一跖骨内翻畸形的矫正情况。
1足发生浅表感染，换药后切口愈合；其余切口一期愈合。所有患者均获随访12 - 18个月（平均12.6个月）。3例（4足）术后出现跖趾关节活动受限，经加强功能锻炼后关节功能恢复。随访期间，无畸形复发或继发性跖骨疼痛发生。与术前评分相比，末次随访时AOFAS评分升高，VAS评分降低，差异有统计学意义（<0.05）。影像学检查显示截骨处达到骨性愈合，愈合时间为2.5 - 6.2个月（平均4.1个月）。拇外翻畸形得到矫正，末次随访时IMA、HVA和DMAA均显著小于术前（<0.05）。第一跖骨内翻畸形也得到矫正；末次随访时第一跖骨外侧缘无R型（内翻畸形的R型），PFMA较术前降低（<0.05）并矫正至正常范围。
三截骨术矫正伴有第一跖骨内翻畸形的重度拇外翻可取得良好疗效。需加强第一跖趾关节的功能训练。
