Effect Of Sesamoid Bones Reduction On The Outcomes Of Chevron Osteotomy Combined With Lateral Soft Tissue Release For Hallux Valgus

Objective:To study the relationship between position of sesamoid bone and clinical outcome of Chevron osteotomy by anatomical features and measurements.Methods:The anatomical data were collected from sesamoid bone and attached tendon of 20 cadaveric limbs.Then we collected 60 cases of Hallux Valgus in 48 patients from 2017 to 2019.We mesured Hallux Abductus Valgus Angle(HVA),Inter-metatarsal Angle(IMA),Distal Metatarsal Articular Angle(DMAA),recorded the sesamoid bone division of Hallux Valgus angle before operation,after operation and at the last follow-up from the patients.The AOFAS scoring system and satisfaction questionnaire were used to analysis the recovery of position and symptoms.Result 1.The sesamoid bone is round or oval in shape.The position of the sesamoid bone is directly affected by the Adductor hallucis and the abductor hallucis.The Adductor hallucis and abductor hallucis is the key to lateral traction.2.We reviewed 48 patients(60 feet)with moderate and severe hallux valgus.HVA recovered from 40.66±11.85 ° to 15.64±7.20°,the last follow-up was 15.89±7.10°.IMA recovered from 15.36±3.89 ° to 9.37±2.53°,the last follow-up was 9.50±2.49°.DMAA recovered from 20.94±7.03 ° to 7.12±3.29°,the last follow-up was 7.48 ± 3.07 °.Statistically significant between before surgery and after surgery and last follow-up.The position of the Sesamiod bone after the operation and the last follow-up is better than before the operation.HVA is positively correlated with Sesamiod bone index.3 AOFAS score recovered from 33.98±12.97 points to 76.23±10.83 points,the last follow-up was 77.08±11.21 points.Statistically significant between before surgery and after surgery and last follow-up.4.Post-operative satisfaction survey:The patient’s post-operative shoe wearing degree of comfort was"very satisfied" and "satisfied" was 98.3%,the post-operative appearance of the opponent was "very satisfied" and "satisf ed" was 95.0%.Degree means that "very satisfied" or "satisfied" is 93.3%.Conclusion:1.The change of sesamoid bone position was closely related to the degree of Metatarsal Valgus,Abductor hallucis and Adductor hallucis.2.The Chevron osteotomy combined with lateral soft tissue release has a good effect on reduction of sesamoid bone in moderate and severe Hallux Valgus,and the effect of operation is good.