A study of the proximal wedge shelf osteotomy for correction of large IM angle HAV deformity.

Many procedures have been identified to correct hallux abducto valgus deformity of the foot. Due to surgical skill level, complexity, and risk of complications, more procedures have been defined for distal than proximal correction. The senior author has used an alternative proximal procedure to correct larger hallux abducto valgus deformities, which may prove to be as effective as traditional procedures. The purpose of this study was to examine the short-term clinical and radiographic results of the proximal wedge shelf osteotomy and evaluate its potential as a satisfactory option for correction of larger bunion deformities. The study revealed many positive outcomes as measured radiographically in preoperative and postoperative hallux abductus, intermetatarsal and metatarsal elevation/declination angles, and clinically by first metatarsophalangeal joint scores and patients' subjective postoperative responses. From a review of the literature and results of the study, the authors conclude that the wedge shelf osteotomy can be used as an effective alternative for correcting larger bunion deformities with an intermetatarsal angle as large as 20° and a hallux valgus angle up to 38°. The advantages of this procedure include ability to correct in more than one plane, good bone-to-bone contact, and ease of fixation with 2 screws in an easily visible dorsal-to-plantar area. Disadvantages include the technical challenge of the procedure and its learning curve and some shortening of the first metatarsal. Levels of Evidence : Therapeutic Level IV.