A Chevron-Akin double osteotomy for correction of hallux valgus.

Chevron osteotomy of the distal metatarsal combined with Akin osteotomy of the proximal phalanx is described for treatment of painful hallux valgus. Sixteen patients (24 feet) who underwent the Chevron-Akin osteotomy were retrospectively reviewed by questionnaire, physical examination, and comparison of preoperative and postoperative standing X-rays. After a mean follow-up of 29 months, there was 95% satisfaction with regard to pain relief and appearance of the foot. Good postoperative range of motion of the great toe was recorded subjectively and objectively. Mean improvement of the first intermetatarsal angle was 4.1 degrees (P = 0.05). The average preoperative hallux valgus angle was 27 degrees (range 13-40 degrees). Mean improvement with the double osteotomy was 14.3 degrees (P = 0.05). There was no significant shortening of the first ray with the double osteotomy. Degenerative changes of the first metatarsophalangeal joint were seen in two feet with intra-articular extension of the Akin osteotomy. One malunion occurred with shifting of the Chevron osteotomy after pin removal. The Chevron-Akin osteotomy compares favorably with the isolated distal Chevron osteotomy. In this series there was no compromise of joint motion, and a superior correction of the hallux valgus deformity was obtained.