Hallux valgus

Last evidence check March 2010

The chevron configuration of the osteotomy was designed to make the osteotomy more stable to dorsal displacement while preserving length. McCluskey(1994) and Acevedo (2002) showed it to be one of the more stable ostotomies to bending and cyclic loading. Low-profile plates have been developed to accommodate the osteotomy shape.

Easley compared the crescentic with the proximal chevron osteotomy in a RCT of 93 patients. Clincal results were the same; radiographic measurements tended to favour the proximal chevron but the difference was non-significant.

Choi (2009) reported a comparative series of 46 PCOs and 52 Ludloff osteotomies; the PCOs were done first and then policy changed to the Ludloff. After a mean of 49 months' follow-up of the PCOs and 22 months of the Ludloffs, there was no difference in correction of IMA or HVA, or in AOFAS hallux scores. The Ludloff osteotomy gave better correction in patients with IMA >20deg at the cost of more 1st MT shortening.

However, while short-term results are comparable to those of the crescentic osteotomy, there have been no reports of the long-term results of the PCO. It has not taken the place as gold standard proximal osteotomy which might have been obtained by a larger trial like Easley's.