First Metatarsal Osteotomy with an Intramedullary Locking Plate is a Good Alternative for the Reintervention of Recurrent Hallux Valgus

This study describes the results of first metatarsal (M1) distal osteotomy with an intramedullary locking plate in persistent/recurrent painful hallux valgus (HV) deformity (without advanced degenerative changes) after primary surgery. Outcomes included postoperative incidences of HV angle (HVA)<16°, intermetatarsal angle (IMA)<9°, proximal articular set angle (PASA)<10°, and the American Orthopedic Foot and Ankle Society (AOFAS) score. Data normality was assessed with the Shapiro-Wilk test, and preoperative vs. postoperative comparisons, as well as postoperative angles vs. preestablished thresholds, were performed with the Wilcoxon signed rank test or the paired Student's t-test, as applicable. Firth's penalized logistic regression analyzed the association between severe complications and undergoing surgery before 2017. Thirty-two patients were included, with a median (range) age of 62.5 (40.0 - 84.0) years; 31 (96.9%) were females. The minimum follow-up was 24 months. Postoperative incidences (95%CI) of HVA<16°, IMA<9°, and PASA<10° were, respectively, 75.0% (57.9 - 86.8%), 93.8% (79.9 - 98.3%), and 56.0% (33.6 - 66.4%). Median postoperative HVA, IMA, PASA, and AOFAS score values improved significantly (p <0.001 for all). Postoperative HVA and IMA were significantly better than preestablished thresholds (p = 0.008 and p <0.001, respectively), but the PASA was not (p=0.507). Seven (21.9%) patients experienced Clavien-Dindo ≥IIIa complications, all in the early implementation period (first 5 years), corresponding to the first 20 surgeries performed (p=0.046). In conclusion, distal M1 osteotomy plus stabilization with an intramedullary plate offers a viable joint-preserving alternative for recurrent moderate to severe HV deformities in patients without severe arthritic changes or hypermobility of the first TMT joint. LEVEL OF EVIDENCE: IV.