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Patient-Reported Outcomes of Minimally Invasive Distal Linear Metatarsal Osteotomy for Hallux Valgus

Hiroyuki Seki MD, PhD1, Yasunori Suda MD, PhD2,3, Kenichiro Takeshima MD, PhD3,4, Masaki Nagashima MD, PhD1,4, and Ken Ishii MD, PhD3,4
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  • 1 Department of Orthopaedic Surgery, International University of Health and Welfare (IUHW) Mita Hospital, Minato-ku, Tokyo, Japan.
  • | 2 Department of Orthopaedic Surgery, International University of Health and Welfare (IUHW) Shioya Hospital, Yaita City, Tochigi, Japan.
  • | 3 Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare (IUHW), Narita City, Chiba, Japan.
  • | 4 Department of Orthopaedic Surgery, International University of Health and Welfare (IUHW) Narita Hospital, Narita City, Chiba, Japan.
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Background: Modified Bösch osteotomy, or distal linear metatarsal osteotomy (DLMO), is one of the minimally invasive correctional operations for hallux valgus deformity. Although the clinical and radiographic results of DLMO have been previously shown, the relationship between clinical outcomes using a validated patient-reported outcome measure and radiographic corrections have yet to be evaluated.

Methods: A total of 70 patients (97 feet) treated at our hospital were included in the study. The Self-Administered Foot Evaluation Questionnaire (SAFE-Q) and radiographic data were evaluated at a minimum 1-year follow-up.

Results: Scores of all five SAFE-Q subscales showed a statistically significant improvement: pain and pain-related (from 63.3 to 86.6), physical functioning and daily living (from 81.3 to 92.7), social functioning (from 79.5 to 94.4), shoe-related (from 43.1 to 72.3), and general health and well-being (from 67.7 to 92.1). The mean hallux valgus angle improved from 39.1° to 9.3°, and the mean intermetatarsal angle improved from 16.6° to 7.0°. Recurrence and hallux varus at the final follow-up occurred in nine feet (9.3%) and 15 feet (15.5%), respectively. Four of the five SAFE-Q subscale scores improved significantly even in patients with hallux varus.

Conclusions: Distal linear metatarsal osteotomy improves foot-related quality of life in patients with hallux valgus deformity despite of the high rate of postoperative radiographic complication, especially hallux varus. Patients might be willing to tolerate mild hallux varus after DLMO, as indicated by patient-centered clinical results.

Corresponding author: Hiroyuki Seki, MD, PhD, Department of Orthopaedic Surgery, International University of Health and Welfare (IUHW) Mita Hospital, 1-4-3 Mita, Minato-ku, Tokyo, 108-8329, Japan. (E-mail: hiro-seki@max.hi-ho.ne.jp)