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Comparison of plantar pressure, clinical, and radiographic changes of the forefoot after biplanar austin osteotomy and triplanar boc osteotomy in patients with mild hallux valgus.
Cancilleri F, Marinozzi A, Martinelli N, Ippolito M, Spiezia F, Ronconi P, Denaro V. Foot Ankle Int. 2008 Aug;29(8):817-24
Quote:
BACKGROUND: Boc's modification of the Austin procedure is a triplane distal osteotomy that achieves shortening and plantarflexion of the first metatarsal with a lateral translation of the metatarsal head. The clinical results and influence of the Austin and Boc osteotomies on plantar pressure have been compared retrospectively.
MATERIALS AND METHODS: The patients were divided into two groups: 30 Austin and 30 Boc osteotomies were performed with a mean followup of 37 (range, 29 to 56) months.
RESULTS: Sixty patients with mild hallux valgus deformities and central metatarsalgia, took part in the study. Pressure measurements were performed with a Diagnostic Support system(R) footplate. The average postoperative American Orthopaedic Foot and Ankle Society score of the Austin group was 81.9 and 86.4 for the Boc group. The pressure distributions under the fourth and fifth metatarsal head were comparable in both groups (p > 0.05). The Austin group showed decreased load bearing under the hallux and the first metatarsal head (p < 0.01), consistent with a persistent overloading of the second and third metatarsal head (p > 0.05). The Boc group showed decreased weightbearing under the hallux with better load distribution beneath the second and the third metatarsal head (p < 0.05). Correlation of the American Orthopaedic Foot and Ankle Society scores and pressure variables confirmed a significant negative correlation with altered hallux and central metatarsal head loading (p < 0.01).
CONCLUSION: The Boc triplane osteotomy seems to restore more physiologic loading of the forefoot in comparison to the Austin procedure, reducing the incidence of painful callus under the second and third metatarsal head.
Evaluation of surgical experience and the use of an osteotomy guide on the apical angle of an Austin osteotomy
V.J. Hetherington, J.S. Kawalec-Carroll, J. Melillo-Kroleski, T. Jones, M. Melillo, N. McFarland, M. Blazer and J.A. Favazzo The Foot; Volume 18, Issue 3, September 2008, Pages 159-164
Quote:
Background
Distal osteotomies of the first metatarsal are commonly used to correct hallux valgus deformities. Of the distal osteotomies, the Austin osteotomy is popular among foot surgeons on an international level. The precision of the osteotomy is important to achieve a congruous osteotomy.
Objectives
The purpose of this study was to examine the effects of experience and technique on creating a precise Austin osteotomy.
Method
Three individuals with varying levels of experience (student, resident and podiatric physician) created Austin osteotomies in metatarsal sawbones, using three different techniques (freehand, guide wire and osteotomy guide). The medial and lateral apical angles were measured, and the mean, standard deviation, and range of the angles were calculated. The differences between medial and lateral angles were also calculated.
Results
The results indicated that the mean and range of the angles varied considerably with the freehand and guide wire techniques at all experience levels. The angles were accurate and consistent for all experience levels; however, when an osteotomy guide was used. The use of an osteotomy guide also noticeably reduced the number of divergent and convergent osteotomies.
Conclusions
The use of an osteotomy guide consistently resulted in a more precise Austin osteotomy for all experience levels.
My critique of the surgery is that I believe the surgeon could have moved over the capital fragment a little more to reduce the IM angle slightly more, and that he got a little too aggressive after the fixation. I believe he removed too much of the head of the metatarsal medially, and didn't respect the "sagittal groove", and as a result you can see a little peaking of the tibial sesamoid on the AP view. If he moved the osteotomy over more laterally, he would not have to have compensated by taking so much "bump" medially.
It was standard to remove the resultant ledge after he moved over the capital fragment, but I would not have been as aggressive on the actual medial aspect of the metatarsal head.
Additionally, I believe at the end of the procedure, he took off took much "dorsal" bump where not much really existed. Instead, he could have modified the osteotomy to obtain some mild plantarflexion, if he thought there was some elevatus/dorsiflexion. By removing the dorsal "bump" as much as he did, he actually removed articular cartilage which will result in dorsal adhesions and will restrict the ability of the proximal phalanx of the hallux to dorsiflex on the metatarsal head, since some of the dorsal cartilage has been removed. This is very evident on the lateral view.
I believe that over aggressive dorsal bone removal is often the cause of poor post op range of motion, and can be eliminated by better operative planning such as modifying your osteotomy to slightly plantarflex the head, etc. The articular cartilage must be respected to maintain post operative range of motion.
Austin Bunionectomy on You Tube
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