Transverse Z-Osteotomy: Is It A Viable Adjunctive Option For Hallux Limitus?

By Daniel K. Lee, DPM, and Gregory E. Tilley, DPM

Assessing The Pros And Cons Of The Procedure

The advantages of the procedure include:    • complete anatomical protection for the attachments of the adductor hallucis, abductor hallucis, flexor hallucis brevis, capsule and ligamentous attachments;    • correction of a pathologically long proximal phalanx of the hallux;    • correction of a pathologic hallux abductus interphalangeus or hallux equinus, sparing the first metatarsophalangeal joint;    • excellent stability along the osteotomy site;    • increased range of motion at the first metatarsophalangeal joint by relaxing the muscular, capsular and ligamentous structures after shortening of the proximal phalanx;    • no contraindication with mild osteopenia;    • an immediate return to weightbearing assuming no contraindicating proximal procedure;    • a procedure that is technically less difficult than the Regnauld procedure;    • a lack of complications associated with an autogenous bone graft;    • the ability to use a Kirschner wire osteotomy guide to ensure accurate and reproducible osteotomies;    • a reduced risk of avascular necrosis; and    • an excellent extraarticular, joint sparing osteotomy alternative for the young patient.    Disadvantages include the requirement of internal fixation and all complications inherent with any osteotomy.    In addition to all the advantages of other classic hallux osteotomies over the Regnauld procedure, the transverse Z-osteotomy, by design, provides complete anatomical protection of the sesamoidal apparatus attachments in the plantar base of the proximal phalanx. This may or may not contribute to good mobility of the sesamoidal apparatus. Also, this procedure includes the ability to correct for transverse plane deformities of the hallux or a pathologic hallux abductus interphalangeus.17-22

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