High Yield Overview

CHEVRON OSTEOTOMY FOR MILD HALLUX VALGUS

Medial longitudinal approach to 1st metatarsal head and neck | intermediate

Critical Danger Structures - 5 Anatomical Zones

Danger 1: Dorsomedial Cutaneous Nerve

Location: Multiple branches cross surgical field 3-5mm dorsal to incision line

Protection: Identify under loupe magnification during superficial dissection, retract gently with vessel loop, sharp dissection under direct vision

Danger 2: Medial Plantar Digital Nerve

Location: Runs 8-10mm plantar to MTP joint line, vulnerable during eminence resection

Protection: Keep incision 2-3mm dorsal to joint, limit saw depth during eminence removal, never extend cut >5mm plantar to articular surface

Danger 3: Medial Plantar Sesamoid

Location: 5-6mm plantar to metatarsal head articular surface, attached to flexor hallucis brevis

Protection: Direct osteotomy cuts dorsally, limit plantar eminence resection to 3-4mm, check sesamoid integrity after eminence removal

Danger 4: Lateral Neurovascular Bundle

Location: Runs 5mm lateral to lateral MTP capsule, at risk during lateral release

Protection: If lateral release needed, stay on capsule, blunt dissection only, release adductor from lateral base P1 under direct vision

Danger 5: Metatarsal Head Blood Supply

Location: Dorsal and plantar terminal branches enter at neck level, 3-4mm proximal to articular cartilage

Protection: Minimize periosteal stripping at neck, limit translation to 50% width, apex at dome preserves both vascular territories

Mnemonic

C.H.E.V.R.O.N.CHEVRON - Indication Criteria

Mnemonic

S.T.A.B.L.E. VSTABLE V - Technical Keys for Chevron Stability

Indications

Primary Indications

Mild-moderate hallux valgus: HVA 15-30°, IMA 10-13°
Symptomatic bunion: Pain, difficulty with shoe wear, cosmetic concerns
Failed conservative management: Orthotics, wider shoes, activity modification tried for 3-6 months
Congruent 1st MTP joint: Critical requirement - joint surfaces parallel on AP radiograph
Good soft tissue quality: Adequate skin elasticity, no previous surgery/scarring

Adjunct Procedures

Akin osteotomy: Add if DASA >10° (interphalangeal valgus) or residual HVA >15° after chevron
Lateral soft tissue release: If tight lateral structures prevent sesamoid reduction
Medial capsular reefing: Routine to address soft tissue laxity component

Contraindications

Absolute:

Severe deformity (HVA >30°, IMA >13°) - use scarf or proximal osteotomy
Incongruent MTP joint - requires proximal realignment
Active infection
Severe peripheral vascular disease
Neuropathic arthropathy (Charcot)

Relative:

Rheumatoid arthritis with MTP synovitis (high recurrence)
Previous failed chevron (consider revision with proximal osteotomy)
Metatarsus primus elevatus (risk transfer metatarsalgia)
Hypermobility first ray (consider lapidus fusion)
Age <16 years (growth plates open)
Heavy manual labour within 3 months

Preoperative Assessment

Clinical Examination

Deformity assessment: Flexible vs fixed, sesamoid position
First MTP ROM: Normal 60-70° dorsiflexion, 20-30° plantarflexion
Transfer metatarsalgia: Calluses under lesser metatarsal heads
Neurological: Sensation, motor function, Tinel's signs
Vascular: Pulses, capillary refill, skin quality

Radiographic Measurements

HVA: Normal <15°, mild-moderate 15-30°, severe >30°
IMA: Normal <9°, chevron suitable 10-13°, severe >13°
DASA: Normal <10°, >10° indicates need for Akin
MTP joint congruity: Parallel articular surfaces = congruent
Sesamoid position: Grade 0-3, aim for Grade 0-1 postop
First metatarsal length: Relative to second metatarsal
Arthritis: Degenerative changes preclude osteotomy

Patient Counselling

Success rate: 85-90% satisfaction with appropriate patient selection
Recurrence: 5-15%, higher if severe deformity or non-compliance
Recovery timeline: 6-8 weeks protected weight bearing, 3-4 months full activity
Complications: Stiffness 10-20%, transfer metatarsalgia 5-10%, nerve injury 5-10%
Footwear: Avoid high heels 6 months, may need wider toe box permanently

Positioning and Preparation

Patient Position: Supine with foot at end of table. Hip bump optional for easier foot positioning. Ankle block or general anaesthesia. Tourniquet on ankle (250mmHg) or thigh (300mmHg for ankle block).

Surgical Approach: Medial longitudinal approach to 1st metatarsal head and neck

Incision: Medial longitudinal 3-4cm over 1st metatarsal head and neck, centered on eminence

Equipment Required:

Microsagittal or 0.5mm sagittal saw
2.0mm headless compression screw system
Small osteotomes and rongeurs
Bunion dressing materials
C-arm fluoroscopy

Step-by-Step Technique

Step 1: Marking & Incision

Mark bunion deformity, MTP joint line, and planned incision with sterile pen. Make medial longitudinal incision 3-4cm long from mid-proximal phalanx to mid-metatarsal neck. Position incision 2-3mm dorsal to palpable joint line to avoid plantar digital nerve. Use #15 blade through skin only.

Exam Pearl

Technical Tip: "I mark the incision 2-3mm dorsal to the MTP joint line. The medial plantar digital nerve runs 8-10mm plantar to the joint - staying dorsal protects it. I make a 3-4cm medial longitudinal incision centered on the prominent eminence."

Dangers at this step

Dorsomedial cutaneous nerve branches (3-5mm dorsal to incision)
Incision too plantar risks medial plantar digital nerve
Skin flap necrosis if overly aggressive retraction

Step 2: Superficial Dissection

Deepen through subcutaneous tissue with sharp dissection. Identify and PROTECT dorsomedial cutaneous nerve branches crossing the surgical field. Use vessel loops to retract nerves gently. Small branches can be sacrificed if unavoidable, but major branches >1mm should be preserved. Continue dissection to MTP capsule.

Exam Pearl

Technical Tip: "I use sharp dissection to identify the dorsomedial cutaneous nerve branches under loupe magnification. These cross the field in 80% of cases. I protect them with vessel loops - injury causes troublesome numbness or neuroma in 5-10% of cases."

Dangers at this step

Dorsomedial cutaneous nerve injury causing numbness/neuroma
Skin edge devascularization from excessive retraction
Damage to superficial veins causing hematoma

Step 3: Capsulotomy

Perform inverted-L or straight longitudinal capsulotomy along dorsomedial aspect of 1st metatarsal and MTP joint. Incise from proximal metatarsal neck, along medial eminence, to proximal phalanx base. Preserve capsular tissue as thick flaps for later reefing. Elevate capsule to expose medial eminence and metatarsal neck. Place Hohmann retractors dorsally and plantarly.

Exam Pearl

Technical Tip: "I perform inverted-L capsulotomy creating thick capsular flaps. The inverted-L gives excellent exposure of both the eminence and the metatarsal neck. I preserve all capsular tissue - it's critical for later reefing to maintain correction."

Dangers at this step

Excessive capsular stripping causing devascularization
Inadvertent damage to lateral capsule/sesamoid complex
Loss of tissue for reefing if capsule divided rather than preserved

Step 4: Medial Eminence Resection

Resect medial eminence with microsagittal saw oriented parallel to medial border of metatarsal shaft. Remove enough bone to eliminate prominence when corrected (typically 3-4mm). DO NOT over-resect - excessive removal destabilizes sesamoids and medial column. Saw cut should exit at level of normal medial metatarsal shaft contour. Irrigate continuously to prevent thermal necrosis. Remove prominent bone with rongeur and smooth with rasp.

Exam Pearl

Technical Tip: "I resect the eminence in line with the medial shaft, removing 3-4mm. This eliminates the prominence after correction without destabilizing the sesamoids. I orient the saw parallel to the shaft and irrigate continuously to prevent thermal necrosis."

Dangers at this step

Over-resection (>5mm) destabilizes sesamoids and causes lateral subluxation
Cut extending too plantar injures medial plantar digital nerve or sesamoid
Thermal necrosis if inadequate irrigation
Intra-articular violation if saw angles dorsally

Step 5: Chevron Osteotomy Planning

Mark the chevron V-osteotomy with marking pen or electrocautery. Apex positioned at DOME (geometric center) of metatarsal head - this is the critical landmark for stability. Mark 60° V-shaped pattern with equal-length arms (8-10mm each). First arm from dorsomedial to plantar lateral, second arm from plantar medial to dorsolateral. Ensure cuts will exit at lateral cortex.

Exam Pearl

Technical Tip: "The chevron is a 60° V-shaped osteotomy with the apex at the DOME of the metatarsal head. This central location is critical - too dorsal causes instability, too plantar damages sesamoids. I mark equal-length arms of 8-10mm to balance forces."

Dangers at this step

Apex too dorsal (proximal to dome) = unstable, risks malunion/nonunion
Apex too plantar = sesamoid damage, plantar cortex fracture
Arms too short (<6mm) = increased fracture risk during translation
Arms unequal = asymmetric stress, deformity

Step 6: Osteotomy Cuts

Using microsagittal or 0.5mm sagittal saw, make the V-shaped cuts precisely as marked. First limb: dorsomedial to plantar lateral at 60° angle to shaft axis. Second limb: plantar medial to dorsolateral, meeting first cut at apex. Cuts should be complete through lateral cortex for mobility. Irrigate copiously throughout to prevent thermal necrosis. Complete cuts with small osteotome if necessary to avoid soft tissue injury.

Exam Pearl

Technical Tip: "I make the V-cuts with a microsagittal saw at exactly 60° angle. Copious irrigation prevents thermal necrosis which can cause AVN. The cuts must be complete through the lateral cortex - incomplete cuts cause fracture when I translate the head."

Dangers at this step

Incomplete cuts through lateral cortex = fracture during translation
Thermal necrosis if inadequate irrigation (AVN risk)
Saw blade drift causing asymmetric V (instability)
Soft tissue injury if saw penetrates lateral cortex excessively

Step 7: Capital Fragment Translation

Mobilize capital fragment by gently distracting and rotating. Translate capital fragment LATERALLY typically 3-4mm (up to 50% of metatarsal shaft width maximum). Use impaction technique with mallet on medial eminence to seat V-shape and achieve stability. Can also plantarflex capital fragment 1-2mm if first metatarsal relatively long or concern for transfer metatarsalgia. Check alignment clinically and with fluoroscopy.

Exam Pearl

Technical Tip: "I translate the capital fragment laterally 3-4mm - this corrects the IMA by 6-12°. Maximum translation is 50% of shaft width, typically 3-4mm. I impact the V-shape which provides excellent stability. If needed, I can plantarflex 1-2mm to prevent transfer metatarsalgia."

Dangers at this step

Excessive translation >50% width = loss of stability, increased AVN risk, nonunion
Dorsiflexion malposition = transfer metatarsalgia to lesser metatarsals
Inadequate lateral translation = undercorrection of IMA
Fracture of plantar cortex with excessive force

Step 8: Fixation

Fix osteotomy with SINGLE screw perpendicular to osteotomy plane. Preferred: 2.0mm headless compression screw (fully buried, no removal needed). Drill guide wire perpendicular to osteotomy, confirm position with fluoroscopy. Over-drill proximal fragment (glide hole), under-drill distal fragment (thread hole) for lag effect. Insert headless screw achieving compression. Alternative: 2.0-2.7mm cortical screw with washer (may require removal if symptomatic). Confirm fixation stability manually.

Exam Pearl

Technical Tip: "I fix with a single 2.0mm headless compression screw perpendicular to the osteotomy. Headless screws are preferred - they're fully buried and don't require removal. The perpendicular orientation maximizes compression. Single screw is adequate given the inherent chevron stability."

Dangers at this step

Screw prominence causing pain if not fully buried
Inadequate compression if screw not perpendicular to osteotomy
MTP joint penetration if screw too long or misangulated
Loss of correction if unstable fixation (check manually before closure)

Step 9: Check Sesamoid Alignment

Assess sesamoid position clinically by palpating plantar foot and with intraoperative fluoroscopy. Sesamoids should be REDUCED under metatarsal head (Grade 0-1 position). If sesamoids remain laterally subluxated (Grade 2-3), this indicates either tight lateral structures requiring release OR deformity too severe for chevron alone. Persistent subluxation predicts recurrence.

Exam Pearl

Technical Tip: "I check that the sesamoids are reduced under the metatarsal head to Grade 0-1 position. I assess this clinically and confirm with fluoroscopy. Persistent lateral subluxation means I need lateral soft tissue release, or suggests the deformity is too severe for chevron alone."

Dangers at this step

Unreduced sesamoids (Grade 2-3) = high recurrence risk, poor outcome
May indicate procedure selection error (deformity too severe)
Requires decision for lateral release or consider aborting and planning proximal osteotomy

Step 10: Distal Soft Tissue Procedure (if needed)

If sesamoids not adequately reduced or lateral structures tight: Perform lateral soft tissue release. Options: through same medial incision (blunt dissection laterally) or separate 1cm lateral incision at MTP joint. Release adductor hallucis from lateral base of proximal phalanx. Release lateral MTP capsule. PROTECT lateral digital neurovascular bundle which runs 5mm lateral to lateral capsule. Assess correction - aim for slight overcorrection into varus which settles to neutral.

Exam Pearl

Technical Tip: "If lateral structures are tight, I perform lateral release of adductor hallucis and lateral capsule. I can do this through the medial incision with blunt dissection or through a small lateral incision. Critical to protect the lateral neurovascular bundle 5mm lateral to the capsule."

Dangers at this step

Lateral digital nerve injury (5mm lateral to capsule) causing numbness/neuroma
Lateral digital artery injury causing vascular compromise
Overcorrection into hallux varus if too aggressive (2-5% complication)
Inadequate release = persistent sesamoid subluxation

Step 11: Akin Osteotomy (adjunct if needed)

Add Akin (proximal phalanx closing wedge osteotomy) if: residual HVA still >15° after chevron correction, DASA >10° (interphalangeal valgus/deviation), or to fine-tune alignment. Create medial-based closing wedge 2-3mm at base of proximal phalanx. Remove wedge with microsagittal saw. Close wedge and fix with 2.0mm screw, 2.0mm K-wire, or memory staple. Assess correction clinically and radiographically.

Exam Pearl

Technical Tip: "I add Akin osteotomy if there's residual HVA >15° after the chevron, or if DASA >10° indicating interphalangeal deviation. I create a medial closing wedge of 2-3mm at the proximal phalanx base and fix with screw or staple. This fine-tunes the alignment."

Dangers at this step

Overcorrection into interphalangeal varus if excessive wedge
Undercorrection if insufficient wedge
Interphalangeal joint stiffness (dorsiflexion limited)
Proximal phalanx fracture if poor bone quality

Step 12: Capsular Closure

Reef (imbricate) medial capsule using pants-over-vest technique or direct repair with 2-3mm overlap. Use 2-0 absorbable sutures. Capsular reefing addresses soft tissue laxity and helps maintain osseous correction. Avoid excessive tension which causes stiffness - aim for toe alignment in neutral to slight varus (0-5°) which settles to neutral. Test MTP range of motion - should achieve 50-60° dorsiflexion minimum.

Exam Pearl

Technical Tip: "I reef the medial capsule using pants-over-vest technique with 2-3mm overlap. This addresses the soft tissue component and maintains the correction. I avoid excessive tension - the goal is neutral to slight varus alignment which settles to neutral. I check ROM achieves at least 50-60° dorsiflexion."

Dangers at this step

Overcorrection into varus if capsule too tight
Stiffness if excessive reefing (most common cause post-op stiffness)
Undercorrection if inadequate capsular plication
Capsular rupture if sutures too tight

Step 13: Closure & Dressing

Close subcutaneous tissue with 3-0 absorbable sutures. Close skin with 4-0 subcuticular absorbable or interrupted 4-0 nylon. Apply BUNION DRESSING: gauze pad between 1st and 2nd toes maintaining corrected alignment, hallux held in slight varus/neutral position, fluffed gauze around foot, compression wrap (not too tight). Apply postoperative stiff-soled shoe or bunion boot.

Exam Pearl

Technical Tip: "I close skin and apply bunion dressing which is critical for maintaining correction. Gauze between 1st-2nd toes, toe held in corrected position with compression wrap. The dressing maintains alignment during early healing. Postop stiff-soled shoe for 6 weeks."

Dangers at this step

Wound dehiscence (5-10% risk, higher with tension)
Dressing too tight causing vascular compromise
Loss of correction if inadequate dressing/splinting
Skin necrosis at pressure points

Step 14: Intraoperative Imaging

Obtain AP, lateral, and sesamoid axial fluoroscopic views. Confirm: adequate osteotomy position, appropriate screw placement (perpendicular to osteotomy, not penetrating joint), sesamoid reduction to Grade 0-1, overall alignment with HVA <15° and IMA <9°. Document images for medical record.

Exam Pearl

Technical Tip: "I obtain AP, lateral, and sesamoid axial views with fluoroscopy. I confirm the osteotomy position, screw perpendicular to the osteotomy and not in the joint, sesamoids reduced to Grade 0-1, and alignment corrected with HVA <15° and IMA <9°."

Dangers at this step

Inadequate imaging missing malposition/joint penetration
Radiation exposure (minimize with low-dose settings, pulsed mode)
Unrecognized screw prominence

Step 15: Final Irrigation & Hemostasis

Deflate tourniquet before closure (optional - some surgeons close with tourniquet up). Irrigate wound thoroughly with 500ml-1L normal saline. Achieve meticulous hemostasis with bipolar electrocautery (avoid monopolar near nerves). Ensure no active bleeding before dressing to prevent hematoma.

Exam Pearl

Technical Tip: "I irrigate copiously with 1 liter of saline to wash out bone debris and reduce infection risk. I use bipolar cautery for hemostasis near neurovascular structures. Meticulous hemostasis prevents hematoma which increases infection and stiffness risk."

Dangers at this step

Hematoma formation if inadequate hemostasis
Nerve injury if monopolar cautery used near neurovascular structures
Wound complications from retained debris

Post-operative Care

Immediate Post-operative (0-2 weeks)

Dressing: Bunion dressing maintains corrected position, change at 48 hours by surgeon or trained nurse
Elevation: Foot elevated above heart level majority of time for 72 hours to reduce swelling
Ice: 15-20 minutes every 2-3 hours while awake for first 3-5 days
Weight bearing: Heel weight bearing in postoperative stiff-soled shoe or bunion boot, avoid forefoot loading
Pain management: Multimodal analgesia (paracetamol, NSAIDs if not contraindicated, opioids short-term if needed)
Thromboprophylaxis: Low risk procedure, early mobilization usually adequate, consider aspirin 100mg daily if high-risk patient

Early Post-operative (2-6 weeks)

Suture removal: 10-14 days (if non-absorbable used)
Dressing: Transition to simple protective dressing, can shower after sutures removed
Weight bearing: Continue heel weight bearing in postop shoe for 6 weeks total
ROM exercises: Start gentle MTP dorsiflexion/plantarflexion exercises at 2 weeks, 10 reps 3-4 times daily
Radiographs: 6-week post-op X-rays to assess union, alignment, hardware position
Physiotherapy: Consider formal PT if stiff (dorsiflexion <40° at 4 weeks)

Intermediate Post-operative (6-12 weeks)

Transition to shoes: Gradual transition to supportive athletic/walking shoes at 6-8 weeks
Weight bearing: Full weight bearing in regular shoes permitted at 6-8 weeks once radiographic healing confirmed
ROM: Continue ROM exercises daily, add resisted exercises, toe curls
Activity: Walking for exercise encouraged, avoid impact activities until 3 months
Swelling: Expect residual swelling for 3-4 months, compression stockings may help

Late Post-operative (3-6 months)

Return to sport: Impact sports, running permitted at 3-4 months if pain-free and radiographic union
Footwear: Can return to fashion footwear 3-4 months, avoid high heels >5cm for 6 months
Final radiographs: 3-month X-rays assess union, alignment, any early complications
Maximal improvement: Expect continued improvement in swelling, comfort, ROM up to 6-12 months

Long-term (6+ months)

Footwear education: Permanent lifestyle modification - avoid narrow toe box, excessive heel height (>7cm)
Orthotic use: If flexible flatfoot or biomechanical factors contributed, continue orthotics
Activity modification: Can return to all pre-injury activities if pain-free
Follow-up: Routine follow-up 6 months, 1 year, then as needed for any concerns

Exam Viva Scenarios

Practice these scenarios to excel in your viva examination

VIVA SCENARIOStandard

EXAMINER

"Why is the chevron osteotomy inherently stable and what are the biomechanical principles that allow single screw fixation?"

EXCEPTIONAL ANSWER

The chevron osteotomy is inherently stable due to three biomechanical principles. First, the V-shaped geometry creates a large bone-to-bone contact surface area compared to straight osteotomies - this distributes load over a greater area. Second, the V-configuration provides mechanical interdigitation - when impacted, the dovetail geometry resists shear forces and translation. Third, the apex positioned at the dome of the metatarsal head with equal-length arms (8-10mm each) creates balanced compression forces across the osteotomy. When lateral translation is performed, compression is generated perpendicular to the osteotomy plane. These factors combined create rotational stability and axial stability sufficient for single screw fixation. Multiple randomized trials have shown no difference in outcomes between single versus double screw fixation for chevron, confirming that the geometry itself provides the stability rather than relying solely on the fixation.

VIVA SCENARIOStandard

EXAMINER

"What is the maximum lateral translation for a chevron osteotomy and what are the biomechanical and biological consequences of exceeding this limit?"

EXCEPTIONAL ANSWER

The maximum lateral translation is 50% of the metatarsal shaft width, which typically corresponds to 3-4mm in most patients. This 50% rule is based on both biomechanical and biological principles. Biomechanically, translation beyond 50% reduces the bone contact area to less than half the cross-section, which significantly reduces the stability of the V-configuration. The interdigitation effect is lost and there is insufficient surface area to resist shear forces, increasing malunion and nonunion risk. Biologically, excessive translation places greater tension on the periosteal attachments and soft tissue envelope at the metatarsal neck. This compromises the dual blood supply to the metatarsal head which comes from both dorsal and plantar terminal arteries entering at the neck level. While chevron AVN risk is very low at less than 1% with appropriate technique, excessive displacement increases this risk. Additionally, translation beyond 50% creates a prominent lateral edge of the proximal fragment which can be painful and require secondary resection. Each millimeter of lateral translation corrects the IMA by approximately 2-3 degrees, so 3-4mm achieves 6-12 degrees of correction which is appropriate for mild-moderate deformity.

VIVA SCENARIOStandard

EXAMINER

"Why is the AVN risk lower with distal chevron osteotomy compared to proximal metatarsal osteotomies, and what are the anatomical factors responsible?"

EXCEPTIONAL ANSWER

The AVN risk with distal chevron is less than 1% compared to 2-3% with proximal osteotomies, and this relates to the dual blood supply to the metatarsal head and the different impact of proximal versus distal procedures on this supply. The metatarsal head receives blood from two sources: dorsally from the dorsal metatarsal artery which is a branch of the dorsalis pedis, and plantarly from the plantar metatarsal arteries which arise from the plantar arch. Both dorsal and plantar terminal branches enter the metatarsal at the neck level approximately 3-4mm proximal to the articular cartilage. With the chevron osteotomy, the apex positioned at the dome of the metatarsal head is distal to where these vessels enter. Therefore, both vascular territories remain intact and perfusion is preserved. The limited soft tissue dissection at the head level and minimal periosteal stripping also help maintain blood supply. In contrast, proximal metatarsal osteotomies such as proximal chevron, crescentic, or Ludloff are performed at or proximal to the neck where the terminal vessels enter. These procedures require more extensive periosteal elevation and the osteotomy disrupts one or both of the terminal arteries. Even with careful technique, the distal capital fragment may lose a significant portion of its blood supply, relying on remaining soft tissue attachments for perfusion. This explains the higher AVN rate of 2-3% with proximal procedures. The limited translation with distal chevron - maximum 50% or 3-4mm - also reduces tension on periosteal attachments compared to proximal osteotomies which allow greater displacement.

Chevron Osteotomy - Exam Day Summary

High-Yield Exam Summary

References

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. [Original description of chevron osteotomy technique and biomechanical principles]
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Kaufmann G, Mörtlbauer L, Hofer-Picout P, et al. Five-year follow-up of minimally invasive distal metatarsal chevron osteotomy in comparison with the open technique: a randomized controlled trial. J Bone Joint Surg Am. 2020;102(10):873-879. [RCT comparing open versus minimally invasive chevron with 5-year outcomes data]
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Pochatko DJ, Schlehr FJ, Murphey MD, Hamilton JJ, Lackey JT. Distal chevron osteotomy with lateral release for treatment of hallux valgus deformity. Foot Ankle Int. 1994;15(9):457-461. [Outcomes of chevron with concurrent lateral soft tissue release, sesamoid reduction correlation]
Jones S, Al Hussainy HA, Ali F, Betts RP, Flowers MJ. Scarf osteotomy for hallux valgus. A prospective clinical and pedobarographic study. J Bone Joint Surg Br. 2004;86(6):830-836. [Comparison of scarf versus chevron osteotomy for different deformity severities]
Okuda R, Kinoshita M, Yasuda T, Jotoku T, Kitano N, Shima H. The shape of the lateral edge of the first metatarsal head as a risk factor for recurrence of hallux valgus. J Bone Joint Surg Am. 2007;89(10):2163-2172. [Anatomical factors predicting recurrence after chevron osteotomy, patient selection criteria]
Shibuya N, Kyprios EM, Panchani PN, Martin LR, Thordarson DB, Jupiter DC. Factors associated with early loss of hallux valgus correction. J Foot Ankle Surg. 2018;57(2):236-240. [Recurrence risk factors including deformity severity, soft tissue procedures, patient compliance]
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Chevron Osteotomy for Mild Hallux Valgus