Mastering The Akin Osteotomy
- Volume 27 - Issue 7 - July 2014
- 2481 reads
- 0 comments
It is best to address overcorrection sooner than later. As the Akin osteotomy tends to be a closing wedge procedure, correcting the overcorrection often involves adding bone graft to create an opening wedge. If the surgeon identifies this during the index operation, he or she can replace the initial bone from the wedge or a portion of it back into the osteotomy. In the subacute stage, before the osteotomy has healed, one can still add bone graft but the source is either cadaveric or autogenous. Healed malunions require a new osteotomy and, depending on the clinical scenario, can be a medial opening wedge or lateral closing wedge.
The fixation for revision Akin procedures depends on the correction that the surgeon is trying to achieve and whether one has added bone graft. In my experience, plate fixation occurs most often for the revision Akin because there is previous hardware that one is removing and this limits the availability for new hardware. Of course, the specific clinical scenario dictates the hardware choice. Locking plates may provide additional stability and a “T” or “L” plate configuration can fit a variety of osteotomies.
The Akin is an adjunct to bunion surgery and by itself has limited use in bunion surgery today. Since the Akin procedure is such a powerful correction to produce a clinically straight toe, surgeons should be cautious to rely too much on the Akin for bunions.
It is better to correct the true underlying cause of the bunions rather than provide a cheating solution. However, the Akin procedure is a necessary and vital component to bunion surgery, and is probably underutilized today.
Dr. Blitz is in private practice in midtown Manhattan. He is a Diplomate of the American Board of Podiatric Surgery and a Fellow of the American College of Foot and Ankle Surgeons.
1. Rettedal D, Lowery NJ. Proximal phalangeal osteotomies for hallux abductovalgus deformity. Clin Podiatr Med Surg. 2014;31(2):213-20.
2. Frey C, Jahss M, Kummer FJ. The Akin procedure: an analysis of results. Foot Ankle. 1991;12(1):1-6.
3. Lechler P, Feldmann C, Köck FX, Schaumburger J, Grifka J, Handel M. Clinical outcome after Chevron-Akin double osteotomy versus isolated Chevron procedure: a prospective matched group analysis. Arch Orthop Trauma Surg. 2012;132(1):9-13.
4. Garrido IM, Rubio ER, Bosch MN, González MS, Paz GB, Llabrés AJ. Scarf and Akin osteotomies for moderate and severe hallux valgus: clinical and radiographic results. Foot Ankle Surg. 2008;14(4):194-203.
5. McGarvey SR. Internal fixation of the Akin osteotomy. Foot Ankle Int. 1995;16(3):172-3.
6. Walter RP, James S, Davis JR. Akin osteotomy: good staple positioning. Ann R Coll Surg Engl. 2012;94(5):371.
7. Roy SP, Tan KJ. A modified suture technique for fixation of the Akin osteotomy. J Foot Ankle Surg. 2013;52(2):276-8.
Editor’s note: For further reading, see “A Closer Look At An Emerging Fixation Option For The Akin Osteotomy” in the July 2010 issue of Podiatry Today, the April 2012 DPM Blog, “Secrets To Performing Bunion Surgery That Will Stand The Test Of Time” by William Fishco, DPM, FACFAS, “When Bunion Surgery Fails” in the October 2013 issue or “Which Bunionectomy Technique Provides The Most Advantages?” in the January 2013 issue. Access the archives at www.podiatrytoday.com.