[Treatment of mild or moderate hallux valgus by Austin osteotomy combined with lateral soft tissue release through a single medial incision].

OBJECTIVE: To evaluate the primary clinical effectiveness of Austin metatarsal osteotomy combined with transection of adductor muscle and transverse metatarsal ligament for treating mild or moderate hallux valgus through a single medial incision.

METHODS: Between May 2006 and January 2009, 41 patients (45 feet) with mild or moderate hallux valgus were treated. There were 9 males (10 feet) and 32 females (35 feet) with an average age of 45.3 years (range, 23-71 years). The hallux valgus angle (HVA) was (33.1 +/- 1.4) degrees, and the first and second inter-metatarsal angle was (20.4 +/- 1.1) degrees. The American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot score of the affected foot's function was 47.2 +/- 3.7. A longitudinal medial incision was made at the first metatarsophalangeal joint. By the incision, Austin metatarsal osteotomy and lateral soft tissue release (including transection of adductor muscle and the transverse metatarsal ligament) were performed at the same time.

RESULTS: During operation, 1 case had superficial peroneal nerve branch injury and suture repair was done microsurgically. All incisions healed by first intention postoperatively. All patients were followed up 16-36 months (mean, 26 months). Medial forefoot numbness occurred in 2 feet at 3 days after operation and relieved within 6 weeks. The X-ray films showed bone healing at osteotomy site within 8 weeks after operation. At last follow-up, the HVA was (10.7 +/- 1.7) degrees, showing significant difference when compared with preoperative value (t=22.32, P=0.00), and the first and second inter-metatarsal angle was (12.1 +/- 1.7) degrees, also showing significant difference when compared with preoperative value (t=21.17, P=0.03). The postoperative AOFAS ankle and hindfoot score of the affected foot's function was 84.9 +/- 4.5, showing significant difference when compared with preoperative score (t=20.75, P=0.01). No foot hallux varus, hallux valgus, or metatarsal necrosis occurred during follow-up.

CONCLUSION: The Austin metatarsal osteotomy combined with transection of adductor muscle, transverse metatarsal ligament through a single medial incision can effectively correct the mild or moderate hallux valgus, and avoid the scar and injury of deep peroneal nerve branches by traditional lateral incision.