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Background: The most popular types of osteotomies for the correction of a moderate to severe hallux valgus are the scarf, closing wedge, opening wedge, the crescentic osteotomy and the proximal chevron osteotomy. There are many reports about good results in favorable fitting preoperative anatomical conditions. There are also reports about not satisfying results under nonfavorable preoperative anatomic conditions. We tried to find a surgical method which could normalize the well-known important forefoot parameters also under disadvantageous conditions. These parameters are lateralization, plantarization and derotation of the Ist metatarsal head and also a normalization of the Distal Metatarsal Articular Angle (DMAA). Part of the corrective process is also a soft tissue correction. Methods: We developed a new operation technique and new fixation plates with special insertion/drill target devices for the goal of optimum results, without the disadvantages of shortening or the need for unloading. In the same way as in our previous study describing the subcapital osteotomy with intramedullary fixation, we performed a simple transverse lazy-L osteotomy located in the area of the proximal metaphysis and after an additional soft tissue release the distal fragment of the Ist metatarsal was restored to its preplanned optimum position concerning the above mentioned criteria. Fixation was achieved with an intramedullary angle stable transfixed 36 mm titanium plate. Interfragmental compression or solid bone contact were unnecessary due to the extreme rigidity of the implant. The goal was only an optimal correction. All patients were allowed to ambulate with full weightbearing immediately after the operation. Results: We retrospectively reviewed 48 patients (55 feet) who underwent shaft/base osteotomy between January 2011 and December 2012; 42 were women and 6 men; their mean age was 56 years. The follow-up investigation was performed on average after 72 months. The AOFAS Score improved from 48.15 to 98.36 (t = 39.55, p < 0.001), the IM angle was reduced from 17.15° to 4.60 ° (t = 74.76, p < 0.001), the HV angle from 33.15° to 9.13 ° (t = 38.52, p < 0.001). The DMAA was improved from 21.65 ° to 4.09° (t = 12.24, p < 0.001). The amount of shortening of the first metatarsal was in average of 0.8 mm and no recurrence of the hallux valgus was observed. Conclusion: We present a new access to surgery of moderate to severe hallux valgus. A rigid intramedullary fixation device was the guarantee for rapid bone healing and an interfragmental compression or even interfragmental contact was not necessary. We found no malunion and no recurrence of hallux valgus. The method demonstrated excellent results with a patient satisfaction of 93.75%.

A New Shaft/Base Osteotomy for The Correction of a Moderate to Severe Hallux Valgus Using an Intramedullary Locking Plate