Guiding patients to make the most appropriate choice among options to correct hallux valgus has long been a challenge: Distal metatarsal osteotomy (DMO) is liked for its shorter incision, low level of invasiveness, lower complication rate, and its ability to improve pain and functionality across a wider range of deformities. Proximal metatarsal osteotomy (PMO), on the other hand, has better, more durable corrective power; however, it is a technically demanding technique that uses a longer incision, requires more operating time, and has a higher potential for complications.
Studies have shown both PMO and DMO to be effective, but sample sizes have been small. Now orthopedic researchers from Greece have conducted a meta-analysis that looked at nearly 700 cases from studies comparing the use of PMO to DMO in moderate to severe hallux valgus. Key outcomes included assessment of the first intermetatarsal angle (IMA).
While the meta-analysis showed both DMO and PMO was effective for the surgical treatment of hallux valgus in the short term (≤1 year), using a Cochrane risk of bias and ROBINS – 1 tools, the authors found a slight favor for the PMO group in the assessment of the IMA in the medium term (>1 year and <10 years). There were no significant differences between the PMO and DMO groups in the medium term for clinical and radiological outcomes, and the researchers did not find any significant differences between the groups.
Given the increasing prevalence of hallux valgus with aging, clinicians can expect to see more patients requesting correction. Understanding the long-term benefits of each procedure will allow for better patient engagement in the decision-making process. Long-term data will be particularly useful as more younger women present for this surgical choice.
Tsikopoulos K, Papaioannou P, Kitridis D, et al. Proximal versus distal metatarsal osteotomies for moderate to severe hallux valgus deformity: a systematic review and metaanalysis of clinical and radiological outcomes. Int Orthop. 2018;Feb 10. doi: 10.1007/s00264-018-3782-5. [Epub ahead of print]