Comparing proximal and distal chevron osteotomy for moderate to severe hallux valgus: A meta-analysis of clinical and radiological outcomes, focusing on hallux valgus angle and intermetatarsal angle.

BACKGROUND

Moderate to severe hallux valgus deformities are traditionally managed with proximal chevron osteotomy (PCO) due to its ability to correct significant angular deviations. However, distal chevron osteotomy (DCO), either alone or in combination with other interventions, has demonstrated promising radiological outcomes. This meta-analysis is the first to compare PCO and DCO in the treatment of moderate to severe hallux valgus.

METHODS

Four studies, including 294 cases, compared PCO and DCO. Primary outcomes were Hallux Valgus Angle (HVA) and Intermetatarsal Angle (IMA). Secondary outcomes included AOFAS scores and postoperative complications.

RESULTS

No significant differences were observed between PCO and DCO for HVA (P = 0.41) or IMA (P = 0.10). Similarly, AOFAS scores showed no statistical difference (P = 0.23).

CONCLUSION

Based on data from non-randomized studies, this meta-analysis found no significant clinical and radiological differences between PCO and DCO for moderate to severe hallux valgus. These findings suggest that DCO can be reliably used as an alternative to PCO, but further high-quality, randomized trials are needed to confirm long-term efficacy. Both techniques have low complication rates. The rehabilitation protocols across all studies included similar early mobilization and K-wire removal timing, but differences in weight-bearing, footwear, and post-operative exercise regimens highlight variability.