Proximal versus distal metatarsal osteotomies for moderate to severe hallux valgus deformity: a systematic review and meta-analysis of clinical and radiological outcomes.

PURPOSE: The conventional surgical treatment of moderate to severe hallux valgus (HV) deformity includes proximal metatarsal osteotomies (PMOs). Recent evidence suggests that the extension of indications for distal metatarsal osteotomies (DMOs) may result in comparable outcomes. The purpose of this study was to compare the efficacy of proximal with that of distal metatarsal osteotomies for moderate to severe HV deformity.

METHODS: We searched PubMed, Scopus, and CENTRAL up to 25 July 2017. We included studies comparing the results of proximal and distal metatarsal osteotomies for moderate to severe HV deformity. The primary outcomes included the assessment of the first intermetatarsal angle (IMA) and American Orthopaedic Foot and Ankle Society (AOFAS) scoring system. For the secondary outcomes, we considered the hallux valgus angle, sesamoid position, and participants' satisfaction. We also reported and analyzed complications. We evaluated all outcomes in the short-term (≤ 1 year) and medium-term (> 1 and < 10 years). The quality assessment was performed using the Cochrane risk of bias and ROBINS-I tools for randomized and non-randomized studies, respectively.

RESULTS: Data from 696 cases were considered in this review. For the assessment of the first IMA, there was a slight advantage in favour of the PMO group in the medium term (SMD was - 0.38, 95% CIs - 0.65 to - 0.12, p < 0.05, I2  = 21%). For the rest outcomes, we did not detect any significant differences between the intervention groups.

CONCLUSIONS: For clinical and radiological outcomes, the quantitative synthesis demonstrated that there were no significant differences between PMO and DMO groups in the medium term. These findings were supported by data from non-randomized studies. For the reported complications, we did not detect any significant differences between the intervention groups.