From Deformity to Alignment: Clinical Outcomes of the Schnepp Osteotomy in Hallux Valgus in 47 Feet

Authors: Amahtil M , Abartal M , Ouda K , Hamzaou A , Bouziane W , Sadougui M and Daoudi A

DOI: 10.23880/cprj-16000216

Volume 9, Issue 1

Abstract

Background: Hallux valgus is a common deformity that causes pain over the medial prominence of the first metatarsal head and increases forefoot width, complicating shoe fitting. Although conservative measures like hygiene and footwear adjustments are considered, surgical treatment remains the primary option. Since Hueter's first surgery in 1871, over 150 techniques have been developed. Our study aims to evaluate the outcomes of the Schnepp technique in treating severe hallux valgus associated with a significant distal metatarsal articular angle (DMAA). Methods: A retrospective review was conducted on 32 patients (47 feet) treated for severe hallux valgus with elevated DMAA between April 2014 and June 2019, all of whom completed follow-up. The patients underwent Schnepp osteotomy (a distal medial closing osteotomy and a basal open wedge osteotomy) combined with soft tissue release. The cohort included 4 males (6 feet) and 28 females (41 feet), aged 22 to 56 years (mean 41.5 years). Preoperative evaluations showed an average Maryland metatarsophalangeal joint score of the American Orthopaedic Foot & Ankle Society (AOFAS) of 53.3 ± 6.7 and a Visual Analogue Scale (VAS) pain score of 6.0 ± 2.0. Outcomes were assessed by comparing preoperative and postoperative AOFAS and VAS scores, hallux valgus angle (HVA), first-second intermetatarsal angle (1-2IMA), DMAA, and first metatarsal length (FML). Results: All incisions healed primarily, and follow-up lasted 21 to 24 months, with an average of 22.7 months. Two feet experienced complications, including one case of hallux stiffness and necrosis of the first metatarsal head. One year postoperatively, the AOFAS score improved to 89.3 ± 6.4. Of the 47 feet, 38 were rated as excellent, 7 as good, and 2 as poor, yielding a 95.6% satisfaction rate. The VAS score significantly decreased to 1.6 ± 2.1. Radiographic reviews at three months confirmed complete bone healing at the osteotomy sites. At six months and one year postoperatively, significant improvements were observed in HVA, 1-2IMA, and DMAA compared to preoperative values. However, no statistically significant change in FML was noted one-year post-surgery. Conclusion: The Schnepp osteotomy is highly effective in improving clinical symptoms and radiographic parameters in patients with severe hallux valgus and elevated DMAA, with a low complication rate.

Keywords: Schnepp Osteotomy; Hallux Valgus; Deformity; DMAA

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