Clinical and biomechanics effects of modified Helal osteotomy with screw fixation in forefoot reconstruction

Purpose The object of this study was to assess the efficacy of Helal metatarsal osteotomy with screw fixation in patients with hammertoe deformities. Methods Thirty-five patients (66 feet, 66 metatarsals) with hammertoe deformity underwent Helal osteotomy with screw fixation after first ray reconstruction. Pre- and postoperative AOFAS scale results, podobarometry (in-shoe plantar pressure), and X-ray (angular) parameters were analyzed. The patients were examined before the operation and two, six, and 24 months postoperatively. Results The average AOFAS score was 59 (± 2.4) preoperatively and 96 (± 1.2) in 12 months after the operations. Pressure under the second and third metatarsal heads was decreased from 396 (± 52.3) kPa preoperatively to 240 (± 22.3) kPa 12 months postoperatively. Lateral subluxation of the second and third toes before the operation was observed in 62 (94%) feet, average metatarsophalangeal angle was 28.1 (± 3.3) degrees. While it was not found in any case 12 months after operation, in four (6.1%) feet, it became recurrent 24 months postoperatively; the average metatarsophalangeal angle was 5° (± 0.6). Conclusion Helal osteotomy with screw fixation demonstrated good-to-excellent results in 24 months postoperatively. It allows for a three-dimension lesser rays reconstruction: shortening, elevating, and lateral or medial displacement of the metatarsal head.