PubMed · 1403742
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A R Goel. 1992. Crescentic osteotomy.. https://doi.org/10.7547/87507315-82-9-491
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BACKGROUND: Surgical management of hallux valgus and hallux rigidus is influenced by deformity severity, surgeon training, and evolving techniques. Previous surveys in Australia (2012), Switzerland (2015), and Israel (2023) using identical hypothetical cases demonstrated marked regional differences and a recent rise in minimally invasive Chevron-Akin (MICA). Whether these advances have altered contemporary Swiss practice remains unclear. METHODS: An electronic survey replicating the original questionnaire was distributed to members of the Swiss Foot and Ankle Society. Three standardized clinical cases were presented: mild hallux valgus, severe hallux valgus, and hallux valgus et rigidus. Respondents selected nonoperative versus operative management and specified procedures and fixation methods. Demographics, subspecialty training, and surgical volume were recorded. Current results were compared with prior Swiss data to assess temporal change. RESULTS: Eighty surgeons completed the survey (94% foot and ankle specialists). For mild hallux valgus, 87.7% recommended surgery; Scarf osteotomy remained most common (49.4%), followed by Chevron (21.0%) and Minimally Invasive Hallux Valgus correction (14.8%). Minimally Invasive adopters were predominantly mid-career (83% aged 41-50), high-volume surgeons. For severe hallux valgus, 95.1% favoured surgery; MTPJ arthrodesis was preferred (50.6% isolated; 11.1% with Lapidus), while Minimally Invasive Hallux Valgus correction was rarely chosen (2.5%). In hallux valgus et rigidus, 96% selected MTPJ fusion, most commonly plate-and-screw fixation (45.1%). Compared with 2015, fixation strategies evolved, yet procedure selection remained largely unchanged. CONCLUSION: Despite global expansion of minimally invasive bunion surgery, Swiss surgeons continue to favour established open techniques, particularly Scarf osteotomy and fusion-based strategies. Adoption of MIS remains limited and concentrated among high-volume, mid-career specialists, indicating a cautious national diffusion pattern. LEVEL OF EVIDENCE: IV, survey study.
Bunion surgery is one of the most frequently performed operations on the foot. The majority of established procedures use some form of soft tissue manipulation with or without an osteotomy as the means of achieving correction. Long-term success depends on operative technique and adequate postoperative immunobilization. The authors describe a custom-molded thermoplast splint that effectively maintains hallux position in the healing phase of hallux valgus surgery. It is easy to construct, comfortable to wear, and has several advantages over other forms of immobilization.
A new proximal osteotomy for hallux valgus correction, which has several advantages, is presented. These advantages include good stability; ease of rigid, two-point internal fixation; accurate, reproducible correction of the intermetatarsal angle; minimal shortening or elevation of the metatarsal; and early weightbearing. Preliminary results on 12 feet of 12 patients over a 3-year period have been encouraging and may indicate that this osteotomy is a viable alternative when considering proximal osteotomy for correction of hallux valgus.