Hallux valgus

Last evidence check March 2010

Hohmann was credited by Mitchell as being the first to use an osteotomy to realign the first ray. Hohmann removed an extra-articular wedge of bone from the 1st MT neck to tilt the ray out of valgus. Originally there seems to have been no lateral displacement of the distal fragment, but most modern authors have incorporated this step. In addition, the osteotomy is now usually stabilised with a screw or wire.

Clinical results

Faber (2004) reported a RCT comparing the Hohmann osteotomy to the Lapidus procedure. The clinical results were similar, even in patients with first ray hypermobility. The Hohmann patients had a mean AOFAS hallux score of 90/100, and the mean visual analogue pain score was 1/10. The Hohmann procedure shortened the first ray more and there were 4 patients with metatarsalgia. Fourteen percent had wound infections, which was attributed to the use of K-wires.

Grace (1988) compared the results of 31 Hohmann and 31 Wilson osteotomies retrospectively. The overall results were similar. 24/31 Hohmann patients reported 80-100% pain relief, 22 80-100% satisfaction with the appearance and 20 80-100% overall satisfaction. Mean HVA was improved from 34 to 18deg and IMA from 13 to 11 deg. The mean metatarsal shortening was 6.4%. The toe was in contact with the floor for 60% of stance phase. Degenerative changes were common after the Hohmann osteotomy - the possibility that this was due to avascular necrosis was mentioned by the authors.

Christensen and Hansen (1995) reported good results in 88% of 145 patients. 12% had residual pain or problems with shoewear.