A new technique for severe hallux valgus: mid-shaft chevron osteotomy with spear plate fixation - a retrospective case series.

BACKGROUND: Severe hallux valgus deformity with hallux valgus angle (HVA) greater than 40° presents significant challenges in surgical management. The metatarsal mid-shaft chevron osteotomy (MSCO) with spear plate fixation represents a novel approach for addressing these complex deformities. This study aimed to evaluate its clinical and radiographic outcomes in patients with severe hallux valgus. METHODS: This retrospective case series evaluated 54 patients (64 feet) who underwent MSCO with spear plate fixation for severe hallux valgus between January 2023 and March 2024. Inclusion criteria included symptomatic hallux valgus with preoperative HVA greater than 40°, skeletal maturity, and minimum 12-month follow-up. Clinical outcomes were assessed using visual analog scale pain scores (VAS) and American Orthopedic Foot and Ankle Society hallux metatarsophalangeal-interphalangeal (AOFAS-MTP-IP) scale. Radiographic parameters included HVA, intermetatarsal angle (IMA), and tibial sesamoid position. Osteotomy healing was defined as observed bridging of callus from the two segments. RESULTS: The cohort included 46 females and 8 males with mean age of 50.0 years. Mean osteotomy healing time was 3.1 months. HVA improved significantly from 44.1° preoperatively to 7.5° at final follow-up (p < 0.01). IMA decreased from 17.7° to 2.8° (p < 0.01). Tibial sesamoid position showed significant improvement (p = 0.02). VAS pain scores decreased from 5.4 to 0.8 (p < 0.01), and AOFAS-MTP-IP scores improved from 28.0 to 81.6 points (p < 0.01). Five complications (7.8%) occurred: one osteoarthritis, one hallux varus, and three hallux valgus recurrences. CONCLUSIONS: MSCO with spear plate fixation demonstrates excellent clinical and radiographic outcomes for severe hallux valgus deformity, with significant improvements in deformity correction, pain relief, and functional scores, accompanied by low complication rates and reliable bone healing. LEVEL OF EVIDENCE: Level IV, case series.