Is The Miami Phalangeal Osteotomy A Viable Alternative To The Akin Osteotomy?

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Author(s): 
Michael M. Cohen, DPM, FACFAS

Examining The Efficacy Of The Miami Phalangeal Osteotomy

A study focused on 36 oblique proximal phalangeal osteotomies performed in 32 patients with an average age of 49.9 years.5 At a follow-up of three to 21 months, angular correction ranged from 7 to 22 degrees and the hallux interphalangeal angle was corrected to within 5 degrees of neutral. There were no nonunions or delayed unions, no hardware loosening and only one patient had a mild loss of correction. The time to achieve healing ranged from four to eight weeks. No bone callus or osteoarthritis occurred.

   At an average of 11 months follow-up, the total range of motion ranged from 82 to 87 degrees.5 All patients were ambulating at a mean of nine weeks in a tennis shoe. (I should note here that patients underwent proximal metatarsal osteotomies concurrently.) The average shortening was 1 mm (range 0 to 2 mm). There were no cases of extensor and flexor tendonitis. There were two radiographic overcorrections. Two cases of mild varus rotation of the hallux occurred (these were undetectable to the patient) due to an excessively steep osteotomy (>40 degrees).

In Conclusion

Studies indicate that phalangeal osteotomies are a useful addition to hallux valgus surgery.4-7 The Miami phalangeal osteotomy has provided consistently good outcomes and has proven to be an excellent alternative to the Akin osteotomy in the treatment of hallux valgus. At this time, our institution has performed approximately 200 osteotomies with very reliable results.

   The Miami phalangeal osteotomy offers several advantages, which include precise correction and minimal shortening. In addition, the osteotomy is a stable construct that is easily fixated. By preserving the medial capsule and ligaments, the technique lends itself to a sound plication. The procedure is useful in addressing the malaligned Akin osteotomy and as an adjunct in the treatment of hallux limitus while posing few potential complications.

   Dr. Cohen is the Chief of Podiatric Surgery for the Surgical Service at the Veterans Affairs Medical Center in Miami. He is a Fellow of the American College of Foot and Ankle Surgeons.

References

1. Akin OF. The treatment of hallux valgus: a new operative procedure and its results. Med Sentinel. 1925; 33:678-679.
2. Goldberg I, Bahar A, et al. Late results in the correction of hallux valgus deformity by basilar phalangeal osteotomy. J Bone Joint Surg. 1987; 69(1):64-67.
3. Frey C, Jahss M. The Akin procedure. Foot Ankle. 1991; 12(1):1-16.
4. Springer KR. The role of the Akin osteotomy for hallux abducto valgus, Clin Pod Med Surg. 1989; 6(1):115-131.
5. Cohen MM. The oblique proximal phalangel osteotomy in the correction of hallux valgus deformity. J Foot Ankle Surg. 2003; 42(5):282-9.
6. Mitchell L, Baxter D. A Chevron Akin double osteotomy for correction of hallux valgus. Foot Ankle. 1991; 12(1):7-14.
6. Barouch LS, Barouk P, Baudet B, Toullec E. The great toe proximal phalanx osteotomy: the final step of the bunionectomy. Foot Ankle Clin. 2005; 10(1):141-155.

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