CIRURGIA MINIMAMENTE INVASIVA DISTAL METATARSAL (OSTEOTOMIA)

Prévia do material em texto

Kaohsiung J Med Sci August 2009 • Vol 25 • No 8 431
© 2009 Elsevier. All rights reserved.
Hallux valgus is a common foot deformity with a
multifactorial etiology [1]. The pathogenesis of hallux
valgus has been described as being due to muscle
imbalance [2,3]. Nonoperative treatment is always
the first option for a patient with hallux valgus defor-
mity [2]. Surgery is proposed when the painful hallux
valgus is not adequately controlled by the nonopera-
tive treatment [3]. More than 130 different operations
have been described for the correction of hallux val-
gus [4]. Good clinical results have been reported with
distal metatarsal osteotomies (DMO) such as chevron
procedures [5,6]. Therefore, these osteotomies have
now become the most common approach for mild-to-
moderate hallux valgus deformity [7]. As orthopedic
surgeons have become more experienced with meta-
tarsal osteotomies, minimally invasive (MI) surgical
techniques have been developed to provide a more
rapid recovery, a better cosmetic appearance, and a
lower rate of complications. Magnan et al [8] evalu-
ated the results of a DMO using a percutaneous tech-
nique for the correction of mild-to-moderate hallux
valgus deformity, and stated that the advantages in-
cluded a shorter operation time and a reduced risk of
Received: Feb 3, 2009 Accepted: Apr 7, 2009
Address correspondence and reprint requests to:
Dr Peng-Ju Huang, Department of Orthopedics,
Kaohsiung Medical University Hospital, 100
Tzyou 1st Road, Kaohsiung 807, Taiwan.
E-mail: roger01@ms4.hinet.net
MINIMALLY INVASIVE DISTAL METATARSAL
OSTEOTOMY FOR MILD-TO-MODERATE
HALLUX VALGUS DEFORMITY
Yu-Chuan Lin, Yuh-Min Cheng, Je-Ken Chang, Chung-Hwan Chen, and Peng-Ju Huang
Department of Orthopedics, Kaohsiung Medical University Hospital, and 
Department of Orthopedics, Faculty of Medicine, College of Medicine, 
Kaohsiung Medical University, Kaohsiung, Taiwan.
Minimally invasive surgery has recently been introduced for foot and ankle surgery, and hallux
valgus surgery is no exception. The purpose of our study was to analyze the early results and to
present our experience of minimally invasive distal metatarsal osteotomy in correcting mild-to-
moderate hallux valgus deformities. Between September 2005 and December 2006, 31 consecutive
patients (47 feet) with mild-to-moderate hallux valgus deformities underwent minimally invasive
distal metatarsal osteotomies. The clinical and radiographic outcomes were assessed. The satis-
faction rate was 90.32%. The mean total American Orthopedic Foot and Ankle Society hallux-
metatarsophalangeal-interphalangeal scale was 92.7 points. Complications included two (4.26%)
episodes of stiffness, six (12.77%) episodes of pin tract infection, and one (2.13%) deep infection.
There were no cases with nonunion, malunion, overcorrection, transfer metatarsalgia or osteonecro-
sis. On weight-bearing anteroposterior foot radiographs, the mean hallux valgus angle and first
intermetatarsal angle corrections were 11.8° and 6.3°, respectively, which is a statistically significant
difference (p < 0.001) between the preoperative and postoperative status. Here, minimally invasive
distal metatarsal osteotomy was associated with good satisfaction, functional improvement and low
complication rates. This technique offers an effective, safe and simple way to treat hallux valgus
with a first intermetatarsal angle less than 15°.
Key Words: hallux valgus, minimally invasive
(Kaohsiung J Med Sci 2009;25:431–7)
brought to you by COREView metadata, citation and similar papers at core.ac.uk
provided by Elsevier - Publisher Connector 
https://core.ac.uk/display/82525363?utm_source=pdf&utm_medium=banner&utm_campaign=pdf-decoration-v1
Kaohsiung J Med Sci August 2009 • Vol 25 • No 8432
Y.C. Lin, Y.M. Cheng, J.K. Chang, et al
complications related to surgical exposure. The pur-
pose of our study was to analyze the early results and
to present our experience with MI DMO to correct
mild-to-moderate hallux valgus deformities.
MATERIALS AND METHODS
Patient selection and perioperative data
Between September 2005 and December 2006, 31 con-
secutive patients (47 feet) with hallux valgus defor-
mities underwent MI DMO by senior surgeons at 
our institute (PJH and YMC). The inclusion criterion
was painful primary mild-to-moderate hallux valgus
deformity with a first intermetatarsal angle ≤ 15° [2].
Exclusion criteria were hallux rigidus or a history of
previous surgery on the affected hallux. All patients
received conservative treatment for at least 2 months
before surgery.
The demographic and baseline characteristics of the
study population are summarized in Table 1, includ-
ing sex, age, preoperative symptoms, operative pro-
cedures and operation time. There were four (12.9%)
males and 27 (87.1%) females. The mean age was 40.8
years (range, 13–63 years). All patients complained of
bunion pain due to footwear. Bilateral MI DMO was
performed at the same time in 16 (51.6%) patients.
The mean operation time for unilateral MI DMO was
14.4 minutes, and the mean operation time for bilat-
eral MI DMO was 27.2 minutes.
Surgical technique
The MI DMO approach used here was modified from
the method described by Magnan et al [9] but with-
out fluoroscopy. First, a 1.5-cm skin incision was done
and centered over the medial aspect of the first meta-
tarsal neck. The incision was carried directly to the
bone. The periosteum was elevated, and the osteotomy
site was brought into vision. The osteotomy was per-
formed at the subcapital level with an oscillating 
saw in a single plane, perpendicular to the metatarsal
shaft axis.
Then, a 2.0-mm Kirschner wire was inserted percu-
taneously from the level at the middle of the proximal
phalanx and advanced manually in a distal-to-proximal
direction along the medial aspect of the metatarsal
head in a parosteal position until the tip was observed
in the incision wound. The wire can be inserted more
dorsally or plantarly for metatarsal head plantar or
dorsal translation later in accordance with the oper-
ating plan. Usually, however, the wire is placed in the
midline for optimum metatarsal head engagement
and control. Lateral translation of the metatarsal head
was done and the wire was introduced under direct
vision into the medullary canal of the metatarsal shaft.
The correction of the big toe was determined grossly.
Then, the wire was driven through the first tarso-
metatarsal joint for greater stabilization (Figure 1).
A plantar pad was placed under the operated foot
to reduce weight-bearing pressure under the first
metatarsal head area. An elastic bandage was used as
a postoperative dressing to hold the big toe in align-
ment. It was taped in a supination manner to coun-
teract pronation of the big toe [10]. Postoperatively,
the patients were allowed to bear weight with spe-
cially designed shoes on the day after surgery. The
Kirschner wire was removed 6 weeks postoperatively.
Patients were allowed to bear weight with normal
shoes, and range of motion exercises of the first meta-
tarsophalangeal joint was carried out from then on.
Clinical assessment
Clinical assessments were recorded postoperatively,
including the visual analog scale, satisfaction, com-
plications and the hallux-metatarsophalangeal-inter-
phalangeal (Hallux-MTP-IP) scale proposed by the
American Orthopedic Foot and Ankle Society (AOFAS)
[11]. Satisfaction was evaluated as the patient’s willing-
ness to undergo surgery again or not. Complications
included any infection, nonunion, malunion, transfer
Table 1. Demographic and baseline characteristics for
31 patients who underwent minimally invasive distal
metatarsal osteotomies*
Sex
Male 4 (12.9)
Female 27 (87.1)
Age (yr) 40.8 ± 13.8 (13–63)
Preoperative symptoms
Bunion pain due to footwear 31 (100)
Operation procedure
Unilateral 15 (48.4)
Bilateral 16 (51.6)
Operation time (min)
Unilateral 14.4 ± 4.9 (6–21)
Bilateral 27.2 ± 9.1 (16–51)
*Data presented as n (%) or mean ± standard deviation (range).
metatarsalgia, osteonecrosisand overcorrection (sec-
ondary hallux varus), for example. All analyses of
clinical data were performed by a single observer to
decrease potential bias.
Radiographic assessment
Weight-bearing anteroposterior and lateral radio-
graphs were taken preoperatively, postoperatively
and at the time of final follow-up. Radiographic pa-
rameters included the hallux valgus angle (HVA) and
the first intermetatarsal angle (FIMA), which were
measured as described by Mitchell et al [12] using the
center of the articular surface of the metatarsal head
and the proximal articulation as reference points to
draw the first metatarsal axis. All analyses of radio-
graphic data were performed by a single observer to
decrease potential bias.
Statistical analysis
Standard paired Student’s t test was used to compare
the preoperative hallux valgus angle and first inter-
metatarsal angle with the values at the final follow-up.
The level of significance was set at p < 0.05.
RESULTS
Clinical results
The mean follow-up period was 23.7 weeks, ranging
from 16 to 68 weeks. The average visual analog scale
score was 9.02 points. Twenty-eight (90.32%) patients
were willing to undergo the same surgery again.
Complications included two (4.26%) episodes of stiff-
ness, six (12.77%) episodes of pin tract infection, and
one (2.13%) deep infection. There were no episodes of
nonunion, malunion, overcorrection, transfer meta-
tarsalgia or osteonecrosis.
The overall follow-up AOFAS scores of the 47
consecutive MI DMOs are presented in Table 2. The
mean total AOFAS score was 92.7 points. The overall
pain score averaged 35.7 points. There was no pain in
27 feet (57.45%), and mild pain in 20 feet (42.55%).
The mean overall functional score and alignment
score were 43.6 points and 13.4 points, respectively.
Radiographic results
The radiographic results of the 47 consecutive MI
DMOs are presented in Table 3. The mean HVA
decreased from 26° preoperatively to 14.2° at the final
follow-up (p < 0.001). The FIMA decreased from an
average of 11.6° preoperatively to 5.3° at the final 
follow-up (p < 0.001).
Distal metatarsal osteotomy for hallux valgus
Kaohsiung J Med Sci August 2009 • Vol 25 • No 8 433
Table 2. Overall follow-up American Orthopedic 
Foot and Ankle Society hallux-metatarsophalangeal-
interphalangeal scores for 47 consecutive minimally
invasive distal metatarsal osteotomies*
Pain (40 points) 35.7 ± 5 (30–40)
Function (45 points) 43.6 ± 2.3 (40–45)
Alignment (15 points) 13.4 ± 3 (8–15)
Total (100 points) 92.7 ± 6.2 (78–100)
*Data presented as mean ± standard deviation (range).
Figure 1. (A) Preoperative and (B) postoperative weight-bearing anteroposterior radiographs show satisfactory correction of both 
the hallux valgus and the first intermetatarsal angles. (C) Follow-up weight-bearing anteroposterior radiographs of this patient show
well-healed osteotomies and proper first intermetatarsal angles.
A B C
DISCUSSION
In recent years, MI techniques have been developed
for foot and ankle surgery [13], and hallux valgus
surgery is no exception [8,9,14–17]. MI distal first
metatarsal osteotomy with a percutaneous technique
was first described by Bösch et al in 1990 [14], and a
satisfactory result was reported in a 7–10-year follow-
up study [15]. Portaluri achieved an 89% satisfaction
rate with the Bösch method [16] and stated that the
advantages of this technique included short opera-
tion time and low incidence of complications. Sanna
and Ruiu reported excellent results in a long-term
follow-up study of percutaneous distal first meta-
tarsal osteotomies [17]. Magnan et al reported that
the patients were satisfied following 107 (91%) of 118
percutaneous distal first metatarsal osteotomies [8].
Numerous studies have revealed that MI hallux valgus
surgery can achieve a good satisfaction rate similar to
other open techniques [6,10,12,18–23].
The DMO in our study was a MI simple bony pro-
cedure without other advanced soft tissue procedures.
We did not perform bunion resection, formal capsu-
lorrhaphy, lateral release or capsulotomy. We did not
use a fluoroscopic image intensifier and to prevent
exposure to irradiation. The procedure was simpli-
fied and soft tissue damage was reduced as much as
possible. The advantages of MI surgical techniques,
including shorter operation time, better cosmetic ap-
pearance and smaller wound size, were gained, and
the satisfaction rate was 90.32% in this study.
The AOFAS Hallux-MTP-IP scale is a popular
instrument that assesses the clinical outcomes of hal-
lux valgus surgery. In previous studies that used
open techniques, the mean total AOFAS scores range
from 83 to 93 points [19,22,23]. Magnan et al reported
a mean total AOFAS score of 88.2 points using percu-
taneous distal osteotomy [8]. In our study, the total
average AOFAS score was 92.7 points. This indicated
that good functional improvement can be achieved
with MI hallux valgus surgery.
In Magnan et al’s and our studies, the Kirschner
wire was uniquely transfixed to the first metatarso-
phalangeal joint medial capsule instead of being used
to fix the bony capital fragment. Because the Kirschner
wire was stabilized proximally, the stiffness of the
wire contributed to the lateral translation of the capi-
tal fragment. Thus, there bunion resection was not
necessary in our procedures because more medial
eminence was preserved and resulted in greater lat-
eral translation of the capital fragment. In our study,
the mean HVA and FIMA corrections were 11.8° and
6.3° (Table 3) compared with 17.8° and 5.1° in Magnan
et al’s study [8]. It has been demonstrated that the
mean HVA correction ranged from 8.8° to 26°, and
the mean FIMA correction ranged from 3.8° to 11° in
studies that used open techniques [1,10,18–23]. Our
results indicate that this MI technique can achieve
angular correction that is as good as that achieved
using traditional techniques.
A limitation of this approach is that we were unable
to control the magnitude of lateral translation. This
method simply relied on the stiffness of the Kirschner
wire and the size of the capital fragment to achieve
lateral translation. We believe that the magnitude of
angular correction might limit the use of our approach
to treat more severe hallux valgus deformities. This
explains why the inclusive criterion in our study was
set at first intermetatarsal angle ≤ 15°.
The absence of lateral release or formal capsulor-
rhaphy might explain the absence of hallux varus
after surgery [8]. In Magnan et al’s and our studies,
there were no episodes of hallux varus (overcorrec-
tion). However, the HVA might increase after removal
of the Kirschner wire without such soft tissue proce-
dures. The valgus deformity recurrence rate reported
by Magnan et al was 2.5%. In our study, we also found
a tendency towards an increase in HVA after remov-
ing the Kirschner wire. In other studies that used
open techniques in association with soft tissue proce-
dures, the recurrence rate ranged from 0% to 10%
[10,12,20–22,24]. Although some of our cases had an
Kaohsiung J Med Sci August 2009 • Vol 25 • No 8434
Y.C. Lin, Y.M. Cheng, J.K. Chang, et al
Table 3. Radiographic results of 47 consecutive minimally invasive distal metatarsal osteotomies*
Preoperative Follow-up Correction p
Hallux valgus angle 26 ± 4.9° (18–36.9) 14.2 ± 6.7° (0–26.3) 11.8 ± 5.8° (3.5–24.5) < 0.001
First intermetatarsal angle 11.6 ± 1.6° (8–14.7) 5.3 ± 2.3° (0.1–10.3) 6.3 ± 2.1° (2.2–11.4) < 0.001
*Data presented as mean ± standard deviation (range).
increase in HVA after Kirschner wire removal, the
HVA and FIMA were significantly decreased at final
follow-up (Table 3).
We considered approaches to avoid under correc-
tion. First, a slight overcorrection was needed to pre-
vent recurrence of the deformity. We found that most
of the cases with under correction were early cases in
our series who did not undergo slight overcorrection
during surgery. Second, the Kirschner wire insertion
level in our study was at the middle of the proximal
phalanx.We thought that a more distal percutaneous
insertion level of the Kirschner wire, as in Magnan 
et al’s study, might achieve a greater correction of the
hallux valgus angle because of a longer level arm to
abduct the big toe.
Postoperative stiffness of the first metatarsopha-
langeal joint is a significant concern in hallux valgus
surgery. Soft tissue dissection around the first meta-
tarsophalangeal joint causes stiffness in proportion to
the extent of dissection [25]. Stiffness of first metatar-
sophalangeal joint was reported to range from 0% 
to 37.8% using open techniques with capsulotomy
[10,20,21,24]. In MI DMO, because capsulotomy was
not performed, the effect on the postoperative range
of motion of the hallux was thought to be limited.
Eight (6.8%) first metatarsophalangeal joints were
stiff in Magnan et al’s study [8]. In our study, the stiff-
ness rate was 4.26%. The reason for the postoperative
stiffness might be due to unsuccessful rehabilitation
after removing the Kirschner wire.
Transfer metatarsalgia, which might affect clinical
outcomes, is a serious complication after first meta-
tarsal osteotomy [10]. Transfer metatarsalgia occurred
with a range from 0% to 40% in studies that used other
open techniques [10,21,23,24]. Transfer metatarsalgia
was not reported in our series, and it was not men-
tioned by Magnan et al [8]. The absence of transfer
metatarsalgia might be due to two factors. First, the
osteotomy performed in MI DMO was in a single
perpendicular plane, which was unable to cause over-
shortening of the first metatarsal. Second, there was
no dorsiflexion of the capital fragment in the lateral
radiographic image after surgery (Figure 2).
In our study, there were no episodes of nonunion,
malunion or osteonecrosis of the first metatarsal head.
The overall infection rate was 14.9% (7 feet). One
(2.13%) of these was a deep infection, which healed
after removal of the Kirschner wire 3 weeks postop-
eratively. However, the deformity recurred in this case.
Other cases (12.77%) were pin tract infection, which
was treated with oral antibiotics and pin tract care,
without further complications, and did not influence
the final results.
In conclusion, we have reported preliminary results
for MI DMO. Good satisfaction, functional improve-
ment, and low complication rates were achieved with
this technique. Thus, MI DMO offers an effective, safe
and simple way of treating mild-to-moderate hallux
valgus deformities. We now routinely use this tech-
nique to treat hallux valgus with a first intermetatarsal
angle less than 15°. For cases with a larger first inter-
metatarsal angle, we believe that a formal distal soft
tissue procedure in combination with other distal or
proximal metatarsal osteotomy is more appropriate.
A well-designed prospective randomized controlled
study with long-term results of a large study population
is needed to support general use of this MI technique.
REFERENCES
1. Mann RA, Coughlin MJ. Hallux valgus—etiology,
anatomy, treatment and surgical considerations. Clin
Orthop Relat Res 1981;157:31–41.
Distal metatarsal osteotomy for hallux valgus
Kaohsiung J Med Sci August 2009 • Vol 25 • No 8 435
Figure 2. Postoperative weight-bearing lateral radiographs show
neither shortening of the first metatarsal nor dorsiflexion of the
capital fragment.
2. Coughlin MJ. Instructional course lectures, The Ameri-
can Academy of Orthopaedic Surgeons—hallux valgus.
J Bone Joint Surg Am 1996;78:932–66.
3. Robinson AHN, Limbers JP. Modern concepts in the
treatment of hallux valgus. J Bone Joint Surg Br 2005;
87:1038–45.
4. Kelikian H. Hallux valgus. In: Mann RA, Coughlin MJ,
eds. Allied Deformities of the Forefoot and Metatarsalgia.
Philadelphia: WB Saunders, 1965:213–25.
5. Ferrari J, Higgins JPT, Prior TD. Interventions for 
treating hallux valgus (abductovalgus) and bunions.
Cochrane Database Syst Rev 2004;1:DOI:10.1002/
14651858.CD000964.pub2.
6. Torkki M, Malmivaara A, Seitsalo S, et al. Surgery vs
orthosis vs watchful waiting for hallux valgus: a ran-
domized controlled trial. JAMA 2001;285:2474–80.
7. Pinney S, Song K, Chou L. Surgical treatment of mild
hallux valgus deformity: the state of practice among
academic foot and ankle surgeons. Foot Ankle Int 2006;
27:970–3.
8. Magnan B, Pezze L, Rossi N, et al. Percutaneous distal
metatarsal osteotomy for correction of hallux valgus. 
J Bone Joint Surg Am 2005;87:1191–9.
9. Magnan B, Bortolazzi R, Samaila E, et al. Percutaneous
distal metatarsal osteotomy for correction of hallux
valgus. Surgical technique. J Bone Joint Surg Am 2006;
88:135–48.
10. Kuo CH, Huang PJ, Cheng YM, et al. Modified Mitchell
osteotomy for hallux valgus. Foot Ankle Int 1998;19:
585–9.
11. Kitaoka HB, Alexander IJ, Adelaar RS, et al. Clinical
rating systems for the ankle-hindfoot, midfoot, hallux,
and lesser toes. Foot Ankle Int 1994;15:349–53.
12. Mitchell CL, Fleming JL, Allen R, et al. Osteotomy-
bunionectomy for hallux valgus. J Bone Joint Surg Am
1958;40:41–60.
13. Chalk DE, Sammarco GJ. Minimum incision surgery.
Foot Ankle 1992;13:157–60.
14. Bösch P, Markowski H, Rannicher V. Technik und 
erste ergebnisse der subkutanen distalen metatarsale-
I-osteotomie. Orthopädische Praxis 1990;26:51–6. [In
German]
15. Bösch P, Wanke S, Legenstein R. Hallux valgus correction
by the method of Bösch: a new technique with a seven-
to-ten-year follow-up. Foot Ankle Clin 2000;5:485–98.
16. Portaluri M. Hallux valgus correction by the method 
of Bösch: a clinical evaluation. Foot Ankle Clin 2000;
5:499–511.
17. Sanna P, Ruiu GA. Percutaneous distal osteotomy of
the first metatarsal (PDO) for the surgical treatment of
hallux valgus. Chir Organi Mov 2005;90:365–9.
18. Calder JDF, Hollingdale JP, Pearse MF. Screw versus
suture fixation of Mitchell’s osteotomy: a prospective,
randomised study. J Bone Joint Surg Br 1999;81:621–4.
19. Caminear DS, Pavlovich JR, Pietrzak WS. Fixation of
the chevron osteotomy with an absorbable copolymer
pin for treatment of hallux valgus deformity. J Foot
Ankle Surg 2005;44:203–10.
20. Johnson KA, Cofield RH, Morrey BF. Chevron osteotomy
for hallux valgus. Clin Orthop Relat Res 1979;142:44–7.
21. Klosok JK, Pring DJ, Jessop JH, et al. Chevron or Wilson
metatarsal osteotomy for hallux valgus. A prospective
randomised trial. J Bone Joint Surg Br 1993;75:825–9.
22. Oh IS, Kim MK, Lee SH. New modified technique of
osteotomy for hallux valgus. J Orthop Surg (Hong Kong)
2004;12:235–8.
23. Schneider W, Knahr K. Keller procedure and chevron
osteotomy in hallux valgus: five-year results of different
surgical philosophies in comparable collectives. Foot
Ankle Int 2002;23:321–9.
24. Austin DW, Leventen EO. A new osteotomy for hallux
valgus: a horizontally directed “V” displacement
osteotomy of the metatarsal head for hallux valgus and
primus varus. Clin Orthop Relat Res 1981;157:25–30.
25. Helal B, Gupta SK, Gojaseni P. Surgery for adolescent
hallux valgus. Acta Orthop Scand 1974;45:271–95.
Kaohsiung J Med Sci August 2009 • Vol 25 • No 8436
Y.C. Lin, Y.M. Cheng, J.K. Chang, et al
Kaohsiung J Med Sci August 2009 • Vol 25 • No 8 437
收文日期：98 年 2 月 3 日
接受刊載：98 年 4 月 7 日
通訊作者：黃鵬如醫師
高雄醫學大學附設醫院骨科
高雄市 807三民區自由一路 100號
使用微創遠端蹠骨切骨手術治療輕至
中度大腳趾外翻
林育全 鄭裕民 張瑞根 陳崇桓 黃鵬如
高雄醫學大學附設醫院 骨科
高雄醫學大學 醫學院醫學系 骨科學
近年來，微創手術在足踝手術領域漸趨發展，其中當然包括應用於大腳趾外翻。我們
研究的目的，乃針對輕至中度大腳趾外翻施行微創遠端蹠骨切骨手術，並對其治療結
果及預後進行分析。從 2005 年 9 月至 2006 年 12 月，共有 31 位輕度至中度大腳趾
外翻的病人 (共 47 隻腳 ) 接受微創切骨手術。我們根據其臨床及影像結果來評估。在
臨床上，病人滿意度達 90.32%，而美國足踝學會功能量表平均分數有 92.7 分。併發
症包括 2 例術後關節僵硬，6 例鋼釘傷口感染，僅 1 例深部感染，並沒有發現切骨處
未癒合、癒合不良、過度矯正、轉移性蹠骨疼痛及骨缺血性壞死等問題。在 X 光影像
上，大腳趾外翻角度及第一蹠骨間角度分別可被矯正 11.8 度及 6.3 度，和手術前比
較具統計上顯著性差異。因此，我們的微創切骨手術不僅能達到良好的滿意度及功
能，並且有低併發症發生率，對於輕至中度大腳趾外翻而言，確實是個有效、安全且
簡單的治療方法。
關鍵詞：大腳趾外翻，微創
(高雄醫誌 2009;25:431–7)