Distal Akin osteotomy for hallux valgus interphalangeus
Introduction
Hallux valgus interphalangeus (HVI) is a complex deformity involving the joint as well as the neighboring soft tissue influences. The deformity usually presents early in life and can rapidly progress during growth spurts. Older patients typically present a more rigid deformity and arthrodesis of the interphalangeal joint is often recommended to provide reliable and long-lasting correction. Possible etiologies of HVI reported by Barnett included obliquity of the articular surface of the proximal phalangeal head and an asymmetrical shape of the distal phalanx [1]. Sorto et al. found a deviation of the articular surfaces of the interphalangeal joint in patients with HVI [2]. Cansü cited lateralization of the extensor hallucis longus (EHL) tendon insertion as an influencing factor [3]. Many reports have focused on the existence of concomitant hallux pathology predisposing to an interphalangeal valgus deformity, Coughlin and Shurnas reported an average HVI angle of 18° in patients with hallux rigidus [4].
Only few studies, involving a limited number of cases, reported on the treatment of this deformity [5], [6]. The aims of this study were to assess the intraoperative and postoperative complications and to evaluate clinical and radiological outcomes in patients who underwent distal Akin osteotomy for hallux valgus interphalangeus.
Section snippets
Patient population
We retrospectively reviewed a series of 15 consecutive patients (17 feet), which have been treated for a hallux valgus interphalangeus deformity between 2008 and 2016. At surgery, the mean age of the patients was 36.2 ± 20.5 years with a median age of 25 years. Four patients were males and eleven were females. All patients gave an informed consent to participate in the study. The study was carried out in accordance with the World Medical Declaration of Helsinki.
Surgical technique
Planning of the operation was
Results
The mean follow up was 28.9 ± 10.7 months after surgery. The average AOFAS score significantly improved at last follow-up to an average of 85 ± 13, while preoperatively it was 38 ± 45 (p < 0.05).
Among 15 patients, the 52.9% (9 patients) stated to be “very satisfied”, the 41.2% (7 patients) “satisfied” and just a 5.9% (one patient) was “not satisfied”.
The mean HVI value decreased from 24.9° ± 7.8° preoperatively to 13.1° ± 5.8° postoperatively at last follow up (p < 0.05). Recurrence was observed in one case.
Discussion
In 1935 Daw established the term hallux valgus interphalangeus, to describe an outward deflection of the great toe at the interphalangeal (IP) joint [9]. Lateral deviation that exceeds 10° should be considered a pathologic hallux valgus interphalangeal deformity [8]. The criteria and performance of the actual procedure to perform the distal Akin are very similar to those described regarding the proximal Akin procedure. Important exceptions are surgical indication that have to be an abnormal
Conclusions
Based on this findings we would conclude that the distal Akin osteotomy play a definite role in the surgical correction of HVI proving to be able to correct symptomatic deformities either isolated or associated with other forefoot deformities.
Funding sources
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Competing interest
The authors declare no conflict of interests related to this manuscript.
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