The Akin Procedure: An Analysis of Results

Abstract

This paper reports the initial and long-term results of 45 Akin procedures done at the Hospital for Joint Diseases/Orthopaedic Institute from 1966 to 1985. Indications for 36 of the 45 operated feet were for an essentially asymptomatic great toe valgus deformity which caused symptoms to develop in the second toe and in 9 of 45 feet for residual hallux valgus after previous hallux valgus surgery. Excellent and good results were reported in 89% of the patients. The most common technical problem reported in 22% of the patients was plantar angulation at the osteotomy site. The only technical problem that was associated with longterm complications was bone apposition of less than 50% which may have lead to a nonunion in one case and recurrence of deformity in another. Shortening of the hallux was observed in all cases secondary to the closing wedge osteotomy. Shortening can be limited if a minimum of bone is removed from the proximal phalanx. A mathematical analysis is presented in this paper which can be used to provide guidelines to osteotomy size so that a minimum of bone necessary for correction can be removed. The Akin procedure should be performed within certain guidelines. Rarely is an Akin procedure alone indicated for the correction of a hallux valgus deformity. In most patients the proximal phalangeal osteotomy needs to be performed in combination with some other procedure to correct all components of the hallux valgus deformity. Furthermore the procedure can be used with success in those patients who present with an essentially asymptomatic great toe valgus deformity at the metatarsophalangeal joint or the interphalangeal joint which causes symptoms and/or deformity to develop in the second toe. One should avoid using an Akin procedure on the hallux deformity associated with an abnormal intermetatarsal angle, or degenerative changes or incongruity of the metatarsophalangeal joint.