Basal osteotomy with lateral soft tissue release and medial plication in the correction of moderate to severe hallux valgus

Moderate and severe hallux valgus usually consists of metatarsus varus and incongruency of the joints. Basal osteotomy and distal soft tissue release provides adequate correction of intermetatarsal angle (IMA) and joint alignment.This is a retrospective study of 26 feet in 20 patients. American Orthopaedics Foot and Ankle Society Score (AOFAS) and subjective grading system for patient's satisfaction were used for assessment. The surgical technique consisted of crescentic basal osteotomy, lateral distal soft tissue release and medial capsular plication according to Roger Mann. Fourteen osteotomies were fixed with K wires and Barouk Screws were used in 12 feet. Patients were mobilised in high heeled shoe post-operatively.Average age was 55.2 years and average follow-up was 25.8 months. The average preoperative hallux valgus angle (HVA) and IMA were 37.38 and 17.27°, respectively. The average post-operative HVA and IMA were 13.3 and 6.4°, respectively. All incongruent joints became congruent after surgery. Sesamoid position improved in 25 feet. Average AOFAS score was 88.8. Ninety-four percent patients were highly satisfied.Complications included breakage of K wire in one leading to change in practice, decreased sensations over medial side of toe in three and mild metatarsalgia in one foot.Basal osteotomy with distal soft tissue release provides good correction of moderate to severe deformity and has high patient satisfaction. Barouk screw provides stable fixation.