ArticleArchives of orthopaedic and trauma surgery2026
Modified rotational wedge distal metatarsal osteotomy versus chevron osteotomy for hallux valgus: long-term radiographic and clinical outcomes.
Article in Archives of orthopaedic and trauma surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Not yet cited in PubMed.
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Abstract
backgroundDistal Chevron osteotomy is commonly used for mild-to-moderate hallux valgus, but long-term loss of correction and radiographic recurrence remain concerns, particularly when distal articular alignment and sesamoid position are not adequately restored. We compared long-term radiographic and clinical outcomes of a modified rotational wedge distal metatarsal osteotomy versus standard distal Chevron osteotomy in adults with mild-to-moderate symptomatic hallux valgus.
methodsIn this single-center retrospective cohort study, 100 feet (100 patients) treated between 2010 and 2019 were analyzed (Modified, n = 46; Chevron, n = 54) at a mean follow-up of 101.2 ± 11.5 months. Soft-tissue balancing was standardized, with an intra-articular lateral release performed in both groups. Outcomes included radiographic measures (hallux valgus angle [HVA], intermetatarsal angle [IMA], distal metatarsal articular angle [DMAA], and medial sesamoid position), clinical scores (AOFAS, VAS), recurrence, and complications. Radiographic recurrence was defined as final HVA > 15°.
resultsFinal AOFAS scores were similar between groups (p = 0.621), and the between-group difference in final VAS pain scores did not remain significant after Benjamini-Hochberg false discovery rate (BH-FDR) adjustment (q = 0.057). Compared with the Chevron group, the Modified group demonstrated superior final radiographic alignment, with lower HVA and IMA (both p < 0.001) and lower DMAA (p = 0.002). Despite worse baseline sesamoid subluxation, the Modified group achieved a more central final sesamoid position (p = 0.010). Radiographic recurrence was less frequent in the Modified group (4.3% vs. 27.8%), representing a relative risk of 0.16 (95% CI 0.04–0.65; p = 0.003); this association persisted after inverse probability of treatment weighting (adjusted odds ratio [aOR] 0.09, 95% CI 0.01–0.60; p = 0.013). Complication rates were low and comparable.
conclusionsAt long-term follow-up, the modified rotational wedge distal osteotomy yielded superior radiographic alignment and a lower recurrence rate than distal Chevron osteotomy, without higher complication rates, while functional outcomes were similar.
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