A minimally invasive technique for surgical treatment of hallux valgus: simple, effective, rapid, inexpensive (SERI)

Abstract

Purpose: Several bony and soft tissue procedures have been described for the treatment of hallux valgus, and currently mini-invasive surgical techniques are preferred in order to reduce surgical trauma, complications, time of surgery and to allow an earlier recovery. The aim of this study is to analyse a series of 1,000 consecutive cases of hallux valgus, surgically treated by the minimally invasive SERI technique, reporting results at mid-term follow-up.

Methods: We prospectively studied 641 patients (1,000 feet) with symptomatic hallux valgus surgically treated by SERI osteotomy. Inclusion criteria were: age between 20 and 65 years, reducible mild or moderate hallux valgus, HVA ≤ 40°, IMA ≤ 20°, and arthritis of the first metatarsophalangeal joint up to grade 2 according to the Regnauld classification.

Results: The American Orthopaedic Foot and Ankle Society (AOFAS) score rose from 46.8 ± 6.7 preoperatively to 89 ± 10.3 at last follow-up. Radiographic control at follow-up showed a complete healing of the osteotomy and remodelling of the metatarsal bone. Low rate of complication has been reported.

Conclusions: This study demonstrated that the SERI technique is effective in treating mild to moderate hallux valgus in terms of relief from symptoms and functional improvement. This technique allowed correction of the main parameters of the deformity, with durable clinical and radiographic results at a mid-term follow-up.

Figures

Fig. 1

Preoperative manual stretching of the adductor hallucis and the lateral capsule, forcing the big toe in varus and plantar flexed position

Fig. 2

Surgical technique. One centimetre incision at the level of the neck of the 1st metatarsal bone (a). Exposure of the metatarsal neck (b). Metatarsal neck osteotomy using a pneumatic saw (c). Inclination of the osteotomy in the frontal plane, in order to maintain or modify the length of the first metatarsal bone (modified with kind permission from Springer Science+Business Media: Clin Orthop Relat Res. Giannini S, et al. The SERI Distal Metatarsal Osteotomy and Scarf Osteotomy Provide Similar Correction of Hallux Valgus. 2013 Epub Mar 14; Fig. 4b) (d). Kirschner wire insertion through the skin incision in a proximal-distal direction into the medial soft tissue adjacent to the bone (e). Kirschner wire is retaken from the tip of the toe (f) until its proximal end reaches the osteotomy line (g). Displacement of the metatarsal head to correct the pathoanatomy of the deformity (h). Kirschner wire reinsertion into the diaphyseal channel of the metatarsal bone, guided by the grooved lever, to stabilise the correction (i). Removal of a small bone wedge from the proximal stump of the osteotomy, if medially prominent (j)

Fig. 3

Kirschner wire is introduced into the soft tissue obliquely as many degrees as necessary to obtain adequate correction of the DMAA (a). Kirschner wire is introduced higher or lower into the soft tissues to obtain, respectively, plantar or dorsal dislocation of the metatarsal head (modified with kind permission from Springer Science+Business Media: Clin Orthop Relat Res. Giannini S, et al. The SERI Distal Metatarsal Osteotomy and Scarf Osteotomy Provide Similar Correction of Hallux Valgus. 2013 Epub Mar 14; Fig. 4a) (b)

Fig. 4

A 44-year-old woman with moderate hallux valgus. Preoperative radiographic aspect of the deformity (a). Postoperative radiographic view showing the osteotomy and the correction maintained by the Kirschner wire (b). Radiographic aspect at 7-year follow-up showing the correction of the deformity with complete healing of the osteotomy and remodelling of the metatarsal bone (c)