Comparative Analysis of Hallux Valgus Surgical Techniques: A Systematic Review

Category: Bunion; Midfoot/Forefoot Introduction/Purpose: Hallux valgus is a foot deformity where the distal portion of the hallux deviates laterally, forming a bunion. Here we review three surgical techniques for correction of the deformity: lapidus arthrodesis (LA), minimally invasive surgery (MIS), or proximal chevron osteotomy (PCO). The purpose of this study was to compare the hallux valgus angle (HVA) and intermetatarsal angle (IMA) for radiologic outcomes, and the American Orthopaedic Foot & Ankle Society Score (AOFAS) score for quality of life outcomes, between treatment groups. Methods: We performed a literature search, with strict inclusion and exclusion criteria, for identifying pertinent references. After review, and resolution of any disagreements by consensus among 5 raters, a total of 42 studies were included in this analysis. Results: The mean HVA difference (postoperative to preoperative) was 23.68 for PCO and 21.40 for LA. The mean IMA difference was 9.53 for PCO and 8.12 for LA. The mean of postoperative HVA was calculated to be11.81 for MIS and 9.13 for LA. The mean of postoperative IMA was calculated to be 8.39 for MIS and 6.60 for LA. The postoperative AOFAS mean was 86.00 for MIS and 86.46 for LA. No studies directly compared surgical methods; the results that follow describe each technique summarized separately. Conclusion: We discovered that HVA and IMA difference means were higher in PCO vs LA, with a larger difference signifying better radiologic correction. HVA and IMA postoperative means were lower in LA vs MIS. A smaller postoperative angle signifies more physiologic correction. Postoperative AOFAS means were similar in MIS vs LA. Further research should be done to evaluate an ideal procedure and explore better techniques for hallux valgus correction.