The Chevron osteotomy is a widely used surgical technique for correction of mild to moderate hallux valgus. This procedure involves a V-shaped cut in the distal first metatarsal bone, and is fixed with a screw or suture.
The chevron osteotomy method offers many advantages over other – also minimally invasive – methods of treating hallux valgus. These include:
Minimally Invasive
The surgical approach for hallux valgus is minimally invasive using the chevron osteotomy technique. A longitudinal incision is made on the medial border of the foot straddling the first metatarsophalangeal joint. This enables careful dissection in the loose areolar tissue plane that naturally exists in this area. Dissection in this plane allows for better visualization of the capsular structures, makes it safer to dissect, and avoids creation of full-thickness soft-tissue flaps that are prone to swelling.
In addition, there is less injury to the surrounding soft tissue which makes it possible to achieve stable fixation and reduce postoperative foot pain sooner. This is particularly important for older patients, who require quick recovery to allow them to return to their daily activities.
Compared to other, also minimally invasive hallux surgery techniques such as the scarf osteotomy or the McBride osteotomy, the chevron technique results in significantly less soft-tissue disruption and a shorter time until the patient can return to walking and other mobility-intensive activities. Moreover, the chevron osteotomy has proven to be just as stable as these other minimally invasive methods.
After the surgical wound has healed, a physiotherapist supports the healing process with manual therapy, e.g. lymph drainage to reduce swelling in the joints, and targeted movement exercises for the affected foot. This helps the patient to regain mobility faster and to return to wearing normal shoes as soon as possible.
Stable Fixation
The chevron osteotomy results in stabilization of the first metatarsophalangeal (MTP) joint through repositioning of the medial eminence and opening up of the distal metatarsal head. This results in the MTP joint becoming more stable with less movement than other operations for severe hallux valgus. This enables the foot to function better and reduces pain. In the long term, it also prevents early wear of the MTP joint.
During surgery, the surgeon makes a longitudinal incision along the midline on the medial edge of the foot straddling the MTP joint. Careful dissection is then carried out in the loose areolar tissue plane which naturally forms over the capsule of the MTP joint. This allows for a quicker and more precise dissection. It also avoids the formation of full-thickness soft-tissue flaps and their subsequent retraction which may lead to loss of the desired angular correction of the MTP joint.
The chevron or Austin osteotomy is a good option for older patients who still wish to perform a certain amount of physical activity. However, it is important that all conservative measures have been exhausted before a surgical operation for a bunion is performed. This includes appropriate shoes, inserts and physiotherapy.
Less Soft-Tissue Disruption
The technique is less traumatic than a traditional chevron osteotomy because the first metatarsal bone, or the part of the big toe that sits in the joint, is only partially removed. This means that the tendons that pull the toe toward the middle, which are often tight in hallux valgus, can still exert their normal force without tension and pulling on the bone.
This minimally invasive technique also reduces disruption to the surrounding soft tissue and minimizes the number of small titanium screws that are placed in the bone. This reduces the potential for postoperative complications such as infection or non-union.
The procedure is performed under spinal anesthesia and a pneumatic tourniquet. A stab incision is made over the lateral aspect of the first metatarsophalangeal (MTP) joint. The MTP capsule is pierced with a Kirschner wire and percutaneously fenestrated to allow the surgeon to perform a distal chevron osteotomy, which includes a proximal release of the adductor hallucis tendon and the lateral suspensory ligament of the sesamoid bone.
The authors of a study that compared the performance of the chevron osteotomy with scarf osteotomy for MTP deformities found that the distal chevron osteotomy was superior to the traditional technique. The distal chevron osteotomy also had the advantage of correcting the MTP joint deformity more quickly than the traditional method, allowing patients to return to their regular activities earlier.
Shorter Recovery
As a minimally invasive procedure, the chevron osteotomy may allow for a quicker recovery and a return to normal activity than other surgeries. Minimally invasive methods have become increasingly popular in foot and ankle surgery, particularly with regard to hallux valgus correction. In one study, a combined MIS chevron and Akin osteotomy provided radiographic results similar to the open surgical technique (p .001). The representative primary radiographic indicators of HVA, IMA, and DMAA all improved after surgery.
Most of us have seen patients with a slight hallux valgus deformity: a crooked big toe that causes a little bit of pain or discomfort when walking or wearing shoes, especially when doing certain activities. In some cases, this pain can be so persistent that it triggers the desire for surgery.
There are many different operations that can be performed to correct hallux valgus, including distal chevron, Ludloff, scarf, and proximal first metatarsal osteotomies. In a survey of academic foot and ankle surgeons, chevron osteotomy was the procedure of choice for mild deformities, while resection arthroplasty or arthrodesis were preferred in more severe cases.
To determine which method of correcting hallux valgus is the best, a group of researchers conducted a systematic review and meta-analysis of randomized clinical trials. They analyzed the radiological outcomes of HVA and IMA, as well as the clinical measures of American Orthopaedic Foot & Ankle Society score (AOFAS). Funnel plots did not show evidence of publication bias.