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Background <p>Distal Chevron osteotomy is commonly used for mild-to-moderate hallux valgus, but long-term loss of correction and radiographic recurrence remain concerns, particularly when distal articular alignment and sesamoid position are not adequately restored. We compared long-term radiographic and clinical outcomes of a modified rotational wedge distal metatarsal osteotomy versus standard distal Chevron osteotomy in adults with mild-to-moderate symptomatic hallux valgus.</p> Methods <p>In this single-center retrospective cohort study, 100 feet (100 patients) treated between 2010 and 2019 were analyzed (Modified, <i>n</i> = 46; Chevron, <i>n</i> = 54) at a mean follow-up of 101.2 ± 11.5 months. Soft-tissue balancing was standardized, with an intra-articular lateral release performed in both groups. Outcomes included radiographic measures (hallux valgus angle [HVA], intermetatarsal angle [IMA], distal metatarsal articular angle [DMAA], and medial sesamoid position), clinical scores (AOFAS, VAS), recurrence, and complications. Radiographic recurrence was defined as final HVA &gt; 15°.</p> Results <p>Final AOFAS scores were similar between groups (<i>p</i> = 0.621), and the between-group difference in final VAS pain scores did not remain significant after Benjamini-Hochberg false discovery rate (BH-FDR) adjustment (q = 0.057). Compared with the Chevron group, the Modified group demonstrated superior final radiographic alignment, with lower HVA and IMA (both <i>p</i> &lt; 0.001) and lower DMAA (<i>p</i> = 0.002). Despite worse baseline sesamoid subluxation, the Modified group achieved a more central final sesamoid position (<i>p</i> = 0.010). Radiographic recurrence was less frequent in the Modified group (4.3% vs. 27.8%), representing a relative risk of 0.16 (95% CI 0.04–0.65; <i>p</i> = 0.003); this association persisted after inverse probability of treatment weighting (adjusted odds ratio [aOR] 0.09, 95% CI 0.01–0.60; <i>p</i> = 0.013). Complication rates were low and comparable.</p> Conclusions <p>At long-term follow-up, the modified rotational wedge distal osteotomy yielded superior radiographic alignment and a lower recurrence rate than distal Chevron osteotomy, without higher complication rates, while functional outcomes were similar.</p>

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Modified rotational wedge distal metatarsal osteotomy versus chevron osteotomy for hallux valgus: long-term radiographic and clinical outcomes

  • 期刊论文

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  • 发表日期：

    2026年4月17日

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  • Ahmet Aybar,
  • Kemal Gokkus,
  • Erdem Özden,
  • Mehmet Hamdi Çetin,
  • Mehmet Ümit Çetin

摘要

Background

Distal Chevron osteotomy is commonly used for mild-to-moderate hallux valgus, but long-term loss of correction and radiographic recurrence remain concerns, particularly when distal articular alignment and sesamoid position are not adequately restored. We compared long-term radiographic and clinical outcomes of a modified rotational wedge distal metatarsal osteotomy versus standard distal Chevron osteotomy in adults with mild-to-moderate symptomatic hallux valgus.

Methods

In this single-center retrospective cohort study, 100 feet (100 patients) treated between 2010 and 2019 were analyzed (Modified, n = 46; Chevron, n = 54) at a mean follow-up of 101.2 ± 11.5 months. Soft-tissue balancing was standardized, with an intra-articular lateral release performed in both groups. Outcomes included radiographic measures (hallux valgus angle [HVA], intermetatarsal angle [IMA], distal metatarsal articular angle [DMAA], and medial sesamoid position), clinical scores (AOFAS, VAS), recurrence, and complications. Radiographic recurrence was defined as final HVA > 15°.

Results

Final AOFAS scores were similar between groups (p = 0.621), and the between-group difference in final VAS pain scores did not remain significant after Benjamini-Hochberg false discovery rate (BH-FDR) adjustment (q = 0.057). Compared with the Chevron group, the Modified group demonstrated superior final radiographic alignment, with lower HVA and IMA (both p < 0.001) and lower DMAA (p = 0.002). Despite worse baseline sesamoid subluxation, the Modified group achieved a more central final sesamoid position (p = 0.010). Radiographic recurrence was less frequent in the Modified group (4.3% vs. 27.8%), representing a relative risk of 0.16 (95% CI 0.04–0.65; p = 0.003); this association persisted after inverse probability of treatment weighting (adjusted odds ratio [aOR] 0.09, 95% CI 0.01–0.60; p = 0.013). Complication rates were low and comparable.

Conclusions

At long-term follow-up, the modified rotational wedge distal osteotomy yielded superior radiographic alignment and a lower recurrence rate than distal Chevron osteotomy, without higher complication rates, while functional outcomes were similar.