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Crescentic Osteotomy

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Evidence-Based Bunion Surgery

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Abstract

A proximal crescentic osteotomy can be an effective procedure for triplane correction of a moderate-to-severe hallux valgus deformity with expected improvement in pain and function. The surgical technique consists of the release of the distal soft tissue, excision of the medial eminence, correction of metatarsus primus varus, and supination of the first metatarsal following a proximal crescentic osteotomy. Metatarsus primus varus and the lateral deviation of the sesamoids are corrected by a proximal crescentic osteotomy when supination is employed. As with other surgical procedures for correction of hallux valgus, there is a risk of complications, including recurrence of hallux valgus, hallux varus, and dorsiflexion deformity, which may compromise surgical outcomes. Risk factors for recurrence are undercorrection, postoperative round sign of the lateral edge of the first metatarsal, and incomplete reduction of the sesamoids . Appropriate surgical technique and recognition of risk factors for complications are essential for obtaining satisfactory results.

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References

  1. Mann RA, Rudicel S, Graves SC. Repair of hallux valgus with a distal soft-tissue procedure and proximal metatarsal osteotomy. A long-term follow-up. J Bone Joint Surg Am. 1992;74:124–9.

    Article  PubMed  Google Scholar 

  2. Thordarson DB, Leventen EO. Hallux valgus correction with proximal metatarsal osteotomy: two-year follow-up. Foot Ankle. 1992;13:321–6.

    Article  CAS  PubMed  Google Scholar 

  3. Dreeben S, Mann RA. Advanced hallux valgus deformity: long-term results utilizing the distal soft tissue procedure and proximal metatarsal osteotomy. Foot Ankle Int. 1996;17:142–4.

    Article  CAS  PubMed  Google Scholar 

  4. Coughlin JM. Hallux valgus. J Bone Joint Surg Am. 1996;78:932–66.

    Article  CAS  PubMed  Google Scholar 

  5. Easley ME, Kiebzak GM, Davis WH, Anderson RB. Prospective randomized comparison of proximal crescentic and proximal chevron osteotomies for correction of hallux valgus deformity. Foot Ankle Int. 1996;17:307–16.

    Article  CAS  PubMed  Google Scholar 

  6. Markbreiter LA, Thompson FM. Proximal metatarsal osteotomy in hallux valgus correction: a comparison of crescentic and chevron procedures. Foot Ankle Int. 1997;18:71–6.

    Article  CAS  PubMed  Google Scholar 

  7. Okuda R, Kinoshita M, Morikawa J, Jotoku T, Abe M. Distal soft tissue procedure and proximal metatarsal osteotomy in hallux valgus. Clin Orthop Relat Res. 2000;379:209–17.

    Article  Google Scholar 

  8. Zettl R, Trnka HJ, Easley M, Salzer M, Ritschl P. Moderate to severe hallux valgus deformity: correction with proximal crescentic osteotomy and distal soft-tissue release. Arch Orthop Trauma Surg. 2000;120:397–402.

    Article  CAS  PubMed  Google Scholar 

  9. Veri JP, Pirani SP, Clarige R. Crescentic proximal metatarsal osteotomy for moderate to severe hallux valgus: a mean 12.2 year follow-up study. Foot Ankle Int. 2001;22:817–22.

    Article  CAS  PubMed  Google Scholar 

  10. Okuda R, Kinoshita M, Morikawa J, Yasuda T, Abe M. Proximal metatarsal osteotomy. Relation between 1- to greater than 3-years results. Clin Orthop Relat Res. 2005;435:191–6.

    Article  Google Scholar 

  11. Coughlin MJ, Jones CP. Hallux valgus and first ray mobility. A prospective study. J Bone Joint Surg Am. 2007;89:1887–98.

    PubMed  Google Scholar 

  12. Chow FY, Lui TH, Kwok KW, Chow YY. Plate fixation for crescentic metatarsal osteotomy in hallux valgus: an eight-year follow-up study. Foot Ankle Int. 2008;29:29–33.

    Article  PubMed  Google Scholar 

  13. Yasuda T, Okuda R, Jotoku T, Shima H, Hida T, Neo M. Proximal supination osteotomy of the first metatarsal for hallux valgus. Foot Ankle Int. 2015;36:696–704.

    Article  PubMed  Google Scholar 

  14. Pauli W, Koch A, Testa E, Dopke K, Perry P, Honigmann P. Fixation of the proximal metatarsal crescentic osteotomy using a head locking X-plate. Foot Ankle Int. 2016;37:218–26.

    Article  PubMed  Google Scholar 

  15. Mizuno S, Sima Y, Yamaxaki K. Detorsion osteotomy of the first metatarsal bone in hallux valgus. J Jpn Orthop Assoc. 1956;30:813–9.

    Google Scholar 

  16. Eustace S, Obyrne J, Stack J, Stephens MM. Radiographic features that enable the assessment of first metatarsal rotation: the role of pronation in hallux valgus. Skelet Radiol. 1993;22:153–6.

    Article  CAS  Google Scholar 

  17. Saltzman CL, Brandser EA, Anderson CM, Berbaum KS, Brown TD. Coronal plane rotation of the first metatarsal. Foot Ank Int. 1996;17:157–61.

    Article  CAS  Google Scholar 

  18. Okuda R, Kinoshita M, Toshito Y, Jotoku T, Kitano N, Shima H. The shape of the lateral edge of the first metatarsal head as a risk factor for recurrence of hallux valgus. J Bone Joint Surg Am. 2007;89:2163–72.

    PubMed  Google Scholar 

  19. Okuda R, Yasuda T, Jotoku T, Shima H. Supination stress of the great toe for assessing intraoperative correction of hallux valgus. J Orthop Sci. 2012;17:129–35.

    Article  PubMed  Google Scholar 

  20. Mortier JP, Bernard JL, Maestro M. Axial rotation of the first metatarsal head in a normal population and hallux valgus patients. Orthop Traumatol Surg Res. 2012;98:677–83.

    Article  PubMed  Google Scholar 

  21. Dayton P, Feilmeier M, Hirschi J, Kauwe M, Kauwe JS. Observed changes in radiographic measurements of the first ray after frontal plane rotation of the first metatarsal in a cadaveric foot model. J Foot Ank Surg. 2014;53:274–8.

    Article  Google Scholar 

  22. Okuda R, Yasuda T, Jotoku T, Shima H. Proximal abduction–supination osteotomy of the first metatarsal for adolescent hallux valgus: a preliminary report. J Orthop Sci. 2013;18:129–35.

    Article  Google Scholar 

  23. Dayton P, Feilmeier M, Kauwe M, Hirschi J. Relationship of frontal plane rotation of first metatarsal to proximal articular set angle and hallux alignment in patients undergoing tarsometatarsal arthrodesis for hallux abducto valgus: a case series and critical review of the literature. J Foot Ankle Surg. 2013;52:348–54.

    Article  PubMed  Google Scholar 

  24. Klemola T, Leppilhati J, Kalinainen S, Ohtonen P, Ojala R, Savola O. First tarsometatarsal joint derotational arthrodesis : a new operative technique for flexible hallux valgus without touching the first metatarsophalangeal joint. J Foot Ank Surg. 2014;53:22–8.

    Article  Google Scholar 

  25. Sammarco VJ. Surgical correction of moderate and severe hallux valgus: proximal metatarsal osteotomy with distal soft-tissue correction and arthrodesis of the metatarsophalangeal joint. J Bone Joint Surg Am. 2007;89:2520–31.

    Article  Google Scholar 

  26. Coughlin MJ, Saltzman CL, Anderson RB. Mann’s surgery of the foot and ankle, vol. 1. 9th ed. Philadelphia: Elsevier; 2014. p. 241.

    Google Scholar 

  27. Pinney SJ, Song KR, Chou LB. Surgical treatment of mild hallux valgus deformity: the state of practice among academic foot and ankle surgeons. Foot Ankle Int. 2006;27:970–3.

    Article  PubMed  Google Scholar 

  28. Okuda R, Kinoshita M, Toshito Y, Jotoku T, Kitano N, Shima H. Proximal metatarsal osteotomy for hallux valgus: comparison of outcome for moderate and severe deformities. Foot Ankle Int. 2008;29:664–70.

    Article  PubMed  Google Scholar 

  29. Sammarco GJ, Idusuyi OB. Complications after surgery of the hallux. Clin Orthop Relat Res. 2001;391:58–71.

    Google Scholar 

  30. Okuda R, Kinoshita M, Yasuda T, Jotoku T, Kitano N, Shima H. Postoperative incomplete reduction of the sesamoids as a risk factor for the recurrence of hallux valgus. J Bone Joint Surg Am. 2009;91:1637–45.

    Article  PubMed  Google Scholar 

  31. Okuda R, Kinoshita M, Yasuda T, Jotoku T, Shima H, Takamura M. Hallux valgus angle as a predictor of recurrence following proximal metatarsal osteotomy. J Orthop Sci. 2011;16:760–4.

    Article  PubMed  Google Scholar 

  32. Shurnas PS, Watson TS, Crislip TW. Proximal first metatarsal opening wedge osteotomy with a low profile plate. Foot Ankle Int. 2009;30:865–72.

    Article  PubMed  Google Scholar 

  33. Iyer S, Demetracopoulos CA, Sofka CM, Ellis SJ. High rate of recurrence following proximal medial opening wedge osteotomy for correction of moderate hallux valgus. Foot Ankle Int. 2015;36:756–63.

    Article  PubMed  Google Scholar 

  34. Yamaguchi S, Sasho T, Endo J, Yamamoto Y, Akagi R, Sato Y, Takahashi K. Shape of the lateral edge of the first metatarsal head changes depending on the rotation and inclination of the first metatarsal: a study using digitally reconstructed radiographs. J Orthop Sci. 2015;20:868–74.

    Article  PubMed  Google Scholar 

  35. Dayton P, Kauwe M, DiDomenico L, Feilmeier M, Reimer R. Quantitative analysis of the degree of frontal rotation required to anatomically align the first metatarsal phalangeal joint during modified tarsal-metatarsal arthrodesis without capsular balancing. J Foot Ankle Surg. 2016;55:220–5.

    Article  PubMed  Google Scholar 

  36. Brodsky JW, Beischer AD, Robinson AHN, et al. Surgery for hallux valgus with proximal crescentic osteotomy causes variable postoperative pressure patterns. Clin Orthop Relat Res. 2006;443:280–6.

    Article  PubMed  Google Scholar 

  37. Rosenberg GA, Donley BG. Plate augmentation of screw fixation of proximal crescentic osteotomy of the first metatarsal. Foot Ankle Int. 2003;24:570–1.

    Article  PubMed  Google Scholar 

  38. Ohbo T, Okuda R, Fukunishi K, Yazu M, Tamura R, Ishizu T. Proximal supination osteotomy using locking plate for correction of hallux valgus. Cent Jpn J Orthop Traumatol (in Japanese). 2015;58:745–6.

    Google Scholar 

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Shimizu Hospital, Kyoto, Japan

    Ryuzo Okuda MD

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  1. Ryuzo Okuda MD
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Correspondence to Ryuzo Okuda MD .

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Editors and Affiliations

  1. College of Podiatric Medicine and Surgery, Des Moines University, Des Moines, Iowa, USA

    Paul D. Dayton

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Okuda, R. (2018). Crescentic Osteotomy. In: Dayton, P. (eds) Evidence-Based Bunion Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-60315-5_11

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  • DOI: https://doi.org/10.1007/978-3-319-60315-5_11

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-60314-8

  • Online ISBN: 978-3-319-60315-5

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