BACKGROUND: The modified Ludloff proximal first metatarsal osteotomy
is indicated for the surgical correction of moderate-to-severe hallux valgus
deformity associated with metatarsus primus varus. We report the
intermediate-term results of this procedure.
METHODS: Ninety-nine patients (111 feet) with a mean age of
fifty-six years underwent a modified Ludloff proximal first metatarsal
osteotomy and a distal soft-tissue procedure at two institutions for the
treatment of a moderate-to-severe hallux valgus deformity. The American
Orthopaedic Foot and Ankle Society score and weight-bearing radiographs of the
foot were assessed preoperatively and after a mean duration of follow-up of
thirty-four months. Clinical and radiographic outcome was also compared
between younger and older patients, with the arbitrarily chosen age of sixty
years dividing the two groups.
RESULTS: The mean American Orthopaedic Foot and Ankle Society score
improved significantly (p < 0.0001) from 53 points preoperatively to 88
points at the time of the most recent follow-up. The mean American Orthopaedic
Foot and Ankle Society score for patients who were sixty years of age or less
was significantly higher than that for patients who were more than sixty years
of age (91 compared with 83 points; p = 0.0057). The mean hallux valgus angle
decreased significantly from 35° preoperatively to 9° at the time of
the most recent follow-up (p < 0.0001), and the mean intermetatarsal angle
decreased significantly from 17° to 8° (p < 0.0001). All osteotomy
sites united without dorsiflexion malunion but with a mean first metatarsal
shortening of 2.2 mm.
CONCLUSIONS: To our knowledge, the present report describes the
largest cohort of patients undergoing a modified Ludloff osteotomy for the
correction of hallux valgus deformity that has been reported in the
literature. Our intermediate-term results demonstrate that the procedure
achieves significant correction of moderate-to-severe hallux valgus deformity,
significant reduction in forefoot pain, and significant improvement in
functional outcome. Patients with an age of sixty years or less appear to have
a more favorable outcome.
LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions
to Authors for a complete description of levels of evidence.