Review Question - QID 3663

Distal metatarsal osteotomy (Chevron) includes a lateral translation of the metatarsal head after osteotomy. The Chevron osteotomy can be used for a congruent or incongruent deformity that have hallux valgus angles less than 25-30 degrees and intermetatarsal angles less than 13 degrees.

The review by Easley et al states that an extensive lateral capsular release in addition to a Chevron ostetomy can be used to help correct deformity but can increase the risk of metatarsal head osteonecrosis. The risk of osteonecrosis with these combined procedures has been recently debated.

The Level 1 study by Saro et al prospectively randomized 100 hallux valgus patient to either a Chevron osteotomy or a Lindgren osteotomy. The corrections of the HVA and IMA were better in the Lindgren group. This was probably due to the fact that the Lindgren osteotomy permitted more lateral displacement than the originally described chevron osteotomy. Clinical outcomes demonstrated no differences between the osteotomy procedures.

Trnka et al performed a Level 4 review of 66 patients that underwent a distal Chevron osteotomy for mild hallux valgus. They found that at 5-year follow-up the Chevron osteotomy was found to be a dependable procedure for the correction of mild hallux valgus deformity. The osteotomy did not adversely affect MTP range of motion, had low recurrence, and had clinical outcomes that did not vary with age.

Illustration A and B shows the Chevron and Lindgren osteotomies, respectively.

Illustration C demonstrates how to measure the HVA and IMA on radiographs.

Video A is a surgical demonstration by Dr. Easley in the evaluation of hallux valgus and peforming a Chevron osteotomy.