Foot & Ankle International - June 2017 - 636
636
angle, distal metatarsal articular angle, tibial sesamoid position, and first metatarsal length. The distance between the
beam origin and detector plate was 100 cm in all cases. All
radiologic measurements were performed accurately using
the Picture Archiving and Communication System
(PiViewSTAR; Infinitt, Seoul, Korea). The hallux valgus
angle (HVA) was defined as the angle formed by the intersection of the longitudinal axis of the proximal phalanx and that
of the first metatarsal, which was determined by connecting
the centers of the first metatarsal head and proximal articular
surface.15,28 The first-second IMA was obtained by determining the angle formed by a line bisecting the second metatarsal
shaft and a line drawn between the centers of the first metatarsal head and the proximal articular surface.15,16 To measure
the distal metatarsal articular angle (DMAA), a reference line
was drawn connecting 2 points at the medial and lateral
aspect of the articular surface of the first metatarsal. The
angle was formed by the line perpendicular to the first metatarsal articular surface, and a line parallel and bisecting the
first metatarsal. The DMAA was a positive value when the
first metatarsal surface faced laterally, and negative when it
faced medially.14,26 The position of the sesamoids was defined
by the position of the medial sesamoid in relation to a longitudinal line bisecting the first metatarsal shaft and was classified as grade 0, 1, 2, or 3.29 The relative length of the first to
the second metatarsal was measured on anteroposterior
radiographs using the methods of Hardy and Clapham.9
Clinical Outcome Measurements
The American Orthopaedic Foot & Ankle Society (AOFAS)
hallux metatarsophalangeal-interphalangeal score (MTP-IP)
was administered preoperatively and at the time of final
follow-up.12
Foot & Ankle International 38(6)
Results
Radiographic Outcomes
The mean hallux valgus angle, intermetatarsal angle, distal
metatarsal articular angle, and tibial sesamoid position at the
final follow-up did not differ significantly between the
bipartite group and the nonbipartite group (P > .05). In addition, when we performed statistical analyses separately for
distal and proximal chevron osteotomy, there was no significant difference between the 2 groups (Figures 2 and 3). The
mean first metatarsal shortening was 2.4 mm (-2 to 9) in the
bipartite group and 2.5 mm (0 to 9) in the nonbipartite group
on final follow-up, but this difference was not significant
(P = .651).
Clinical Outcomes
The AOFAS hallux metatarsophalangeal interphalangeal
(MTP-IP) scores showed significant improvement at final
follow-up in both groups. However, there were no significant differences between the bipartite and nonbipartite
group (P > .05). The subgroup analysis (distal and proximal
chevron osteotomy) showed equivalent results (Figure 4).
Bilateral Chevron Osteotomy in Unilateral
Bipartite Hallucal Sesamoid
Five patients who had unilateral bipartite sesamoid underwent bilateral hallux valgus surgery. We found no significant differences in radiographic and clinical outcomes
between both feet at final follow-up (Mann-Whitney test,
P > .05).
Complications
Statistical Analysis
The normality of the data was assessed with the KolmogorovSmirnov test. The Mann-Whitney test was used to determine the significance of intergroup differences in the age of
patients at the time of surgery, BMI, follow-up duration,
HVA, IMA, DMAA, tibial sesamoid position, first metatarsal shortening, and AOFAS score. Categorical variables
such as sex of the patient, level of metatarsal osteotomy,
and performance of proximal phalangeal osteotomy were
compared using the chi-square test and the prevalence of
complications were compared using the Fisher exact test.
Post hoc power analysis indicated that this study has 0.84
power to detect an effect size of 0.59 between bipartite and
nonbipartite groups with a type I error probability of 0.05.
Significance was defined at a P value <.05 and statistical
analyses were performed using SPSS v20.0 (SPSS Inc,
Chicago, IL).
A total of 13 cases (7.7%) of complications were observed,
2 cases (6.5%) in the bipartite group and 11 cases (8.0%) in
the nonbipartite group (Fisher exact test, P = .767). In the
bipartite group, there was 1 patient with recurrent asymptomatic hallux valgus and 1 patient with superficial wound
infection. For the recurrent patient, we chose observation
and pain did not develop by the final follow-up. The patient
with a superficial wound infection was treated with dressing changes and oral antibiotics in the outpatient clinic.
However, the patient complained of intermittent pain on
final follow-up. In the nonbipartite group, there were 1
patient with hallux varus, 3 patients with recurrent asymptomatic hallux valgus, 1 patient with transfer metatarsalgia
due to shortening of the first metatarsal, 3 patients with
superficial wound infection, and 3 patients with screw protrusion. Hallux varus and recurrent hallux valgus patients
were asymptomatic and the patients did not want further
Table of Contents for the Digital Edition of Foot & Ankle International - June 2017
Contents
Foot & Ankle International - June 2017 - Intro
Foot & Ankle International - June 2017 - Cover1
Foot & Ankle International - June 2017 - Cover2
Foot & Ankle International - June 2017 - i
Foot & Ankle International - June 2017 - ii
Foot & Ankle International - June 2017 - Contents
Foot & Ankle International - June 2017 - iv
Foot & Ankle International - June 2017 - v
Foot & Ankle International - June 2017 - vi
Foot & Ankle International - June 2017 - vii
Foot & Ankle International - June 2017 - viii
Foot & Ankle International - June 2017 - 1A
Foot & Ankle International - June 2017 - 1B
Foot & Ankle International - June 2017 - ix
Foot & Ankle International - June 2017 - x
Foot & Ankle International - June 2017 - xi
Foot & Ankle International - June 2017 - xii
Foot & Ankle International - June 2017 - 2A
Foot & Ankle International - June 2017 - 2B
Foot & Ankle International - June 2017 - xiii
Foot & Ankle International - June 2017 - xiv
Foot & Ankle International - June 2017 - xv
Foot & Ankle International - June 2017 - xvi
Foot & Ankle International - June 2017 - 3A
Foot & Ankle International - June 2017 - 3B
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Foot & Ankle International - June 2017 - CT1
Foot & Ankle International - June 2017 - CT2
Foot & Ankle International - June 2017 - 4A
Foot & Ankle International - June 2017 - 4B
Foot & Ankle International - June 2017 - Cover3
Foot & Ankle International - June 2017 - Cover4
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