Minimally Invasive Distal Chevron With Supination Corrects First Metatarsal Pronation in Hallux Valgus: A Retrospective Weightbearing Computed Tomography Study

Abstract

Background:

Hallux valgus (HV) significantly impacts patients’ quality of life. The coronal plane deformity is often not captured by traditional 2-dimensional radiographs, yet its correction may be important. This study explores the efficacy of distal chevron osteotomies with supination in correcting first metatarsal (M1) pronation in HV.

Methods:

A retrospective analysis of 58 weightbearing CT scans from HV patients undergoing distal chevron with supination was conducted (29 patients had pre- and postoperative CT scans).

Functional scores (European Foot and Ankle Society [EFAS], EuroQoL–5 levels, 5 dimensions [EQ5L-5D], EuroQoL–visual analog scale [EQ-VAS]) and angular measurements (hallux valgus angle, intermetatarsal angle, metatarsal pronation angle, alpha angle) were assessed pre- and postoperatively. Inter- and intraobserver reproducibility were evaluated using intraclass correlation coefficients.

Results:

Postoperative outcomes demonstrated significant improvement in functional scores for all patients, including an increase in EFAS score (Δ = 6.7, P < .001). Angular measurements, including metatarsal pronation angle (MPA), intermetatarsal angle, hallux valgus angle, and alpha angles, improved postoperatively. Preoperative MPA and alpha angle were 14.7 ± 4.9 and 16.6 ± 5.2 (P < .05). Postoperative MPA and alpha angles were 7.9 ± 3.4 and 7.4 ± 4.8 (P < .05). Intraclass correlation coefficient showed moderate to excellent correlations for angular measurements.

Conclusion:

Distal chevron technique with supination allowed pronational realignment of the M1 head relative to the ground in hallux valgus. Postoperative pronation values were close to the normative ones previously defined in the literature. Although statistically significant improvements were observed, the lack of validated minimal clinically important difference values for EFAS, EQ5L-5D, and EQ-VAS limits confident interpretation of their clinical relevance.