The Akin Procedure as Closing Wedge Osteotomy for the Correction of a Hallux Valgus Interphalangeus Deformity

Objective Realignment of the great toe in the case of a hallux valgus interphalangeus by means of a medially based closing wedge osteotomy. Indications Hallux valgus interphalangeus deformity, characterized by an enlarged distal articular surface angle (> 10 degrees). Correction of a hallux valgus interphalangeus deformity as an additional procedure in the case of hallux valgus surgery. Contraindications Incongruent first metatarsophalangeal joint with lateral subluxation of the proximal phalanx. Isolated procedure to correct hallux valgus deformity. Lack of patient compliance. Neurovascular disturbance of the forefoot. Surgical Technique Medially based closing wedge osteotomy of the proximal phalanx to reduce the distal articular surface angle. Fixation with a lag screw, cannulated Herbert screw, memory cramp, threaded Kirschner wire, or interosseous suture. Postoperative Management Wound dressing to assure the position of the great toe. Radiographic documentation of the forefoot in two planes. Strict elevation of the operated foot to prevent postoperative swelling. Mobilization of the patient with a forefoot relief orthosis, until consolidation of the osteotomy is verified radiologically (4-5 weeks). Low-molecular-weight heparin for at least 1 week. Hallux valgus bandage or functional taping for 6 weeks postoperatively in patients with additional metatarsal osteotomy. Results Clinical and radiologic follow-up based on 32 patients showed good results. The postoperative Hallux Score of the American Orthopaedic Foot and Ankle Society improved to 89 points.