Hello, my name is David Decke, and I am presenting the treatment of moderate to severe hallux valgus without osteotomy, or arthrodesis, on behalf of my co-authors. This work was performed at the Mayo Clinic in Arizona. We do not have any disclosures relevant to this presentation. Our purpose was to describe a treatment for moderate to severe hallux valgus without osteotomy that provides long-term maintenance of correction. To do so, we performed a retrospective chart review to identify all patients with moderate to severe hallux valgus who underwent primary proximal metatarsal realignment with a modified McBride soft tissue procedure. Patients were indicated for surgery if they presented with painful moderate to severe hallux valgus and failed non-operative management. This was defined radiographically as an HVA greater than 25 degrees and a 1-2 metatarsal angle of 13 to 20 degrees. The cohort was then further stratified into moderate and severe groups. Patients with a hypermobile first ray, hallux rigidus, or mild hallux valgus were indicated for different surgical procedures and thus were not included. Patients undergoing concomitant forefoot surgery, such as lesser-toe procedures, were eligible to be included. No other procedures were performed for this specific pathology during this time period. At the preoperative assessment, an additional dorsal plantar radiograph was obtained with the midfoot wrapped circumferentially with self-adherent elastic to assess mobility and realignment of the first metatarsal. All procedures were performed by the senior author. After modified McBride was performed, the first metatarsal was manually reduced and brought parallel to the second. It is then held temporarily with a 0.045K wire and its position assessed with fluoroscopy to ensure the first and second metatarsal heads are in the same transverse plane to prevent relative plantar or dorsal flexion of the first ray. After drilling and countersinking, fixation is achieved with a bioresorbable screw placed obliquely from the base of the first metatarsal into the bases of the second and third metatarsals. A K wire is then removed and clinical and radiographic alignment are then confirmed. Medial capsuloratopy of the metatarsophalangeal joint is then performed. The patient is then placed in a short-leg Robert Jones compressive dressing with a stirrup splint maintaining the ankle in neutral positioning. Here's our demographic information for the total cohort of 134 with 83 moderate and 51 severe palix valigis patients. There were no differences in the demographic features between the two groups. Mean preoperative assessment of palix valigis angle was 32 degrees and this was decreased compared with preoperative values after surgery at all follow-up time intervals. Postoperatively at two weeks, it measured an average of 10.4, six weeks 11.1, three months 12.1 degrees, one year was 12.7 degrees and two years was 10.8 degrees. Mean preoperative IMA was 14.8 and this significantly decreased with surgery at all follow-up time intervals. Two weeks six degrees, six weeks 6.8 degrees, three months 7.8 degrees, one year 7.9 degrees and two years eight degrees. Mean preoperative DMAA was 30.8 degrees and this additionally was significantly decreased with surgery at all follow-up time intervals. At two weeks it was 5.5, six weeks 6.6, three months 7.5, one year 7.9 degrees and two years 7.2 degrees. Overall complications were few but included iatrogenic palix varus in two patients, peri-implant fractures at the second metatarsal base in three patients and asymptomatic valgus relapse requiring reoperation in three individuals. Reoperation consisted of revision metatarsal realignment for a single patient and metatarsophalangeal arthrodesis for two patients. All three patients had subsequent resolution of their deformity. Patients who developed iatrogenic palix varus had resolution of their deformity with splinting and peri-implant fractures that occurred in the postoperative period were treated with a walking boot and activity modification. All had complete healing of their fracture with non-operative treatment. Here are our preoperative three-month and six-year radiographs showing that maintenance of correction. In conclusion, when combined with a modified McBride bunionectomy, proximal metatarsal realignment provides a simple and effective method for the treatment of moderate to severe hallux valgus without osteotomy or arthrodesis. We demonstrate a maintenance of reduction with a low rate of reoperation. This relatively simple to perform surgery does not burn any bridges. Thank you.

hallux valgus

treatment

proximal metatarsal realignment

bioreabsorbable screw

complications