Syndesmosis Procedure vs Osteotomy Procedures in Advantages

SyndesmosisOsteotomy/Arthrodesis
1. MainstreamX X X Not yet√ √ √ > 95% of all bunion surgeries1,2
2. Peer supportX X X Minimal√ √ √
3. One technique for all severity correction√ √ √ 3X X X > 20 procedures for different conditions
4. Minimal trauma, post-op pain and swelling√ √ √X X Sacrificing normal bones and joints
5. Fewer and milder complications√ √ 4-6X X Hi-risk for secondary problems7,8, unwittingly
6. Immediate toe exercises and min. stiffness√ √ √ 4-6X Less often than yes
7. Easy recovery, self-physiotherapy √ √ 4-6X X Professional reliance is the norm.
8. Proven consistent function restoration√ √ √ 5X X X Not yet objectively-13
9. Unrestricted activities & shoes, Min. recurrence√ √ √ 6X X Not recommended, recurrence well known14,15
10. More natural cosmetic result√ √ 6X X Straight but uneasy and hard-pressed appearance
11. Same time both feet correction4,5,6√ √ √ 4-6X X Not usually recommended
12. A non-bridge-burning surgery√ √ √X X X Permanent anatomic change for better or worse
  1. Pinney SJ, Song KR, Chou LB. Operative treatment of mild hallux valgus deformity: the state of practice among academic foot and ankle surgeons. Foot Ankle Int 2006;27(11):970-3.
  2. Pinney SJ, Song KR, Chou LB. Operative treatment of severe hallux valgus deformity: the state of practice among academic foot and ankle surgeons. Foot Ankle Int 2006;27(12):1024.
  3. Wu DY, Lam KF. Osteodesis for hallux valgus correction: is it effective? Clin Orthop Relat Res. 2015;473(1): 328-36.doi:10.1007/s11999-014-3938-6.
  4. Wu DY. A Retrospective Study of 63 Hallux Valgus Corrections Using the Osteodesis Procedure. J Foot Ankle Surg. 2015 May-Jun;54(3):406-11. doi: 10.1053/j.jfas.2014.09.011
  5. Wong DW, Wu DY, Man HS, Leung AK. The use of a syndesmosis procedure for the treatment of hallux valgus: good clinical and radiological results two years post-operatively. Bone Joint J. 2014 Apr;96-B(4):502-7. doi: 10.1302/0301-620X.96B4.32193.
  6. Wu DY, Lam EKF. Can the Syndesmosis Procedure Prevent Metatarsus Primus Varus and Hallux Valgus Deformity Recurrence? A 5-Year Prospective Study. J Foot Ankle Surg. 2018 Mar - Apr;57(2):316-324. doi: 10.1053/j.jfas.2017.10.012.
  7. Richardson EG. Complications after hallux valgus surgery. Instr Course Lect 1999;48:331-42
  8. Laughlin TJ. Complications of distal first metatarsal osteotomies. J Foot Ankle Surg 1995 Nov-Dec;34(6):524-31 discussion 593-4
  9. Dhukaram V, Hullin MG, Senthil Kumar C. The Mitchell and Scarf osteotomies for hallux valgus correction: a retrospective, comparative analysis using plantar pressures. J Foot Ankle Surg. 2006 Nov-Dec;45(6):400-9.
  10. Brodsky JW et al. Surgery for hallux valgus with proximal crescentic osteotomy causes variable postoperative pressure patterns. Clin Orthop Relat Res. 2006 Feb;443:280-6.
  11. Kernozek TW1, Sterriker SA. Chevron (Austin) distal metatarsal osteotomy for hallux valgus: comparison of pre- and post-surgical characteristics. Foot Ankle Int. 2002 Jun;23(6):503-8.
  12. Vittas D1, Jansen EC, Larsen TK. Gait analysis before and after osteotomy for hallux valgus.
  13. Foot Ankle. 1987 Dec;8(3):134-6.
  14. Cancilleri F1, Marinozzi A, Martinelli N, et al. Comparison of plantar pressure, clinical, and radiographic changes of the forefoot after biplanar Austin osteotomy and triplanar Boc osteotomy in patients with mild hallux valgus. Foot Ankle Int. 2008 Aug;29(8):817-24. doi: 10.3113/FAI.2008.0817.
  15. Jeuken RM, Schotanus MG, et al. Long-term Follow-up of a Randomized Controlled Trial Comparing Scarf to Chevron Osteotomy in Hallux Valgus Correction. Foot Ankle Int. 2016 Jul;37(7):687-95. doi: 10.1177/1071100716639574.
  16. Raikin SM, Miller AG, Daniel J. Recurrence of hallux valgus: a review. Foot Ankle Clin. 2014 Jun;19(2):259-74. doi: 10.1016/j.fcl.2014.02.008.