Background: Distal osteotomy of the first metatarsal is indicated
for the surgical treatment of mild-to-moderate hallux valgus deformity. The
aim of this study was to evaluate the results of a subcapital distal osteotomy
of the first metatarsal with use of a percutaneous technique.
Methods: From 1996 to 2001, 118 consecutive percutaneous distal
osteotomies of the first metatarsal were performed for the treatment of
painful mild-to-moderate hallux valgus in eighty-two patients. The patients
were assessed with a clinical and radiographic protocol at a mean of 35.9
months postoperatively. The American Orthopaedic Foot and Ankle Society
(AOFAS) hallux-metatarsophalangeal-interphalangeal scale was used for the
Results: The patients were satisfied following 107 (91%) of the 118
procedures. The mean score on the AOFAS scale was 88.2 ± 12.9 points.
The postoperative radiographic assessments showed a significant change (p <
0.05), compared with the preoperative values, in the mean hallux valgus angle,
first intermetatarsal angle, distal metatarsal articular angle, and sesamoid
position. The valgus deformity recurred after three procedures (2.5%), the
first metatarsophalangeal joint was stiff but not painful after eight (6.8%),
and a deep infection developed after one (0.8%). The infection resolved with
Conclusions: The percutaneous technique proved to be reliable for
the correct execution of a distal linear osteotomy of the first metatarsal for
the correction of a painful mild-to-moderate hallux valgus deformity. The
clinical results appear to be comparable with those obtainable with
traditional open techniques, with the additional advantages of a minimally
invasive procedure, a substantially shorter operating time, and a reduced risk
of complications related to surgical exposure.
Level of Evidence: Therapeutic Level IV. See Instructions
to Authors for a complete description of levels of evidence.