Chevron osteotomy: immobilisation by cast or walking boot?

Deformity of the big toe is a common orthopedic problem, and 33% of the general Dutch population has a hallux valgus. This deformity of the big toe can ultimately lead to pain and gait deviations. A symptomatic hallux valgus is often treated surgically, to correct the anatomic deformity. The Chevron osteotomy is a much used surgical technique for this. Postoperative immobilisation can be done by means of a plaster cast or a removable walking boot. An advantage of the walking boot is that it is more comfortable compared to a plaster cast. However, it is unknown whether immobilisation by means of the walking boot results in a remained correction of the hallux valgus. The hallus valgus correction might be better preserved by means of a plaster cast, becaus the reefed capsule gets a better change for scarring in the by surgery obtained position. To date, there is a lack of studies in which the effectiveness of the two types of postoperative immobilisation following Chevron osteotomy - a plaster cast or a removable walking boot - has been compared.



Primary aim of the study is to compare the preservation of the correction of hallux valgus angle by means of a Chevron osteotomy with postoperative immobilisation by means of a plaster cast or a removable walking boot, one year following surgery. Secondary aims are to compare the effectiveness of the immobilisation by means of a plaster cast or a walking boot for the recovery of plantar pressure during walking, and recovery of physical functioning and health-related quality of life.



A prospective randomised controlled trial will be conducted. Two types of postoperative immobilisation following Chevron osteotomy wil be compared. The control group will receive postoperative immobilisation by means of a removable walking boot. The study group will receive postoperative immobilisation by means of a (non-removable) plaster cast. Measurements will take place preoperatively, and 6 weeeks, 3, 6 and 12 months postoperatively.

Immobilisation by means of a plaster cast will result in a better correction and retaining of the hallux valgus correction at one year following chevron osteotomy.
Additionally, it is hypothesised that immobilisation by means of a plaster cast will also result in a better recovery of plantar pressure during walking, and a better recovery of physical functioning and health-related quality of life.

- Preoperatively

- 6 weeks postoperatively

- 3 months postoperatively

- 6 months postoperatively

- 1 year postoperatively

Treatment of the study group (Chevron osteotomy with postoperative immobilisation by means of a plaster cast): Postoperative immobilisation following Chevron osteotomy will be performed by means of a (non-removable) plaster cast, for a period of six weeks. Only partial weightbearing is allowed (only the heel). This plaster cast will be created by a master caster.



Treatment of the control group (Chevron osteotomy with postoperative immobilisation by means of a removable walking boot): Postoperative immobilisation following chevron osteotomy will be performed by means of a removable walking boot, for a period of six weeks. Complete weightbearing is allowed. This walking boot will be created by an orthopedic shoemaker.