Percutaneous hallux valgus correction using the Reverdin-Isham osteotomy

Introduction: The present study assessed 2-year clinical and radiological results of percutaneous correction of hallux valgus by Reverdin-Isham osteotomy and sought to clarify indications for the technique. Patient and methods: A continuous prospective single-center series of 104 cases of medium-to-moderate hallux valgus was managed by the same percutaneous technique, with a median 2 years' clinical and radiological follow-up (with no loss to follow-up). Uni- and multivariate analysis determined predictive factors for the mobility and degree of correction obtained. Results: American Orthopedic Foot and Ankle Society (AOFAS) functional score rose from a preoperative median of 49/100 to 87.5/100 postoperatively (p < 0.05); 89% of patients were satisfied or very satisfied with their result at end of follow-up. Hallux valgus and distal metatarsal articular angle (DMAA) were significantly reduced (30 and 15 degrees to 15 and 7 degrees, respectively; p < 0.05). Associated lateral ray surgery significantly increased the postoperative risk of MTP1 joint incongruence (p = 0.009). Discussion: Percutaneous correction by Reverdin-Isham osteotomy seemed effective in isolated medium-to-moderate hallux valgus, but involves a learning curve and lacks precision in case of associated lateral metatarsal osteotomy, with a risk of DMAA hypercorrection and increased risk of MTP1 joint incongruence. Indications for percutaneous Reverdin-Isham osteotomy seem to be limited to isolated medium-to-moderate hallux valgus (M1M2 angle < 15 degrees, M1P1 angle around 30 degrees) with elevated DMAA and congruent MTP1 joint. Level of evidence: Level IV. Therapeutic study. (C) 2010 Elsevier Masson SAS. All rights reserved.