Modified rotational wedge distal metatarsal osteotomy versus chevron osteotomy for hallux valgus: long-term radiographic and clinical outcomes

Distal Chevron osteotomy is commonly used for mild-to-moderate hallux valgus, but long-term loss of correction and radiographic recurrence remain concerns, particularly when distal articular alignment and sesamoid position are not adequately restored. We compared long-term radiographic and clinical outcomes of a modified rotational wedge distal metatarsal osteotomy versus standard distal Chevron osteotomy in adults with mild-to-moderate symptomatic hallux valgus. In this single-center retrospective cohort study, 100 feet (100 patients) treated between 2010 and 2019 were analyzed (Modified, n = 46; Chevron, n = 54) at a mean follow-up of 101.2 ± 11.5 months. Soft-tissue balancing was standardized, with an intra-articular lateral release performed in both groups. Outcomes included radiographic measures (hallux valgus angle [HVA], intermetatarsal angle [IMA], distal metatarsal articular angle [DMAA], and medial sesamoid position), clinical scores (AOFAS, VAS), recurrence, and complications. Radiographic recurrence was defined as final HVA > 15°. Final AOFAS scores were similar between groups (p = 0.621), and the between-group difference in final VAS pain scores did not remain significant after Benjamini-Hochberg false discovery rate (BH-FDR) adjustment (q = 0.057). Compared with the Chevron group, the Modified group demonstrated superior final radiographic alignment, with lower HVA and IMA (both p < 0.001) and lower DMAA (p = 0.002). Despite worse baseline sesamoid subluxation, the Modified group achieved a more central final sesamoid position (p = 0.010). Radiographic recurrence was less frequent in the Modified group (4.3% vs. 27.8%), representing a relative risk of 0.16 (95% CI 0.04–0.65; p = 0.003); this association persisted after inverse probability of treatment weighting (adjusted odds ratio [aOR] 0.09, 95% CI 0.01–0.60; p = 0.013). Complication rates were low and comparable. At long-term follow-up, the modified rotational wedge distal osteotomy yielded superior radiographic alignment and a lower recurrence rate than distal Chevron osteotomy, without higher complication rates, while functional outcomes were similar.