In a long-term follow-up study (average, 10.7 years) of 222 patients
(351 feet), the results after proximal phalangeal osteotomy (the Akin
procedure) for hallux valgus deformity were found to be unsatisfactory,
both subjectively and objectively. The range of motion in the
metatarsophalangeal joint was limited postoperatively in 90 per cent of the
patients, and in 21 per cent there was recurrence of deformity. The
appearance of the foot was poor in 75 per cent. Only 53 per cent of the
patients expressed satisfaction with the result of the operation. There was
a direct relationship between the development of subluxation or dislocation
of the metatarsophalangeal joint and postoperative dissatisfaction of the
patient. We concluded that the operation is biomechanically unsound because
it does not address the principal mechanical factors that are responsible
for the deformity: abnormal function of the adductor hallucis and the
abnormal intermetatarsal angle. The Akin procedure is indicated only in
combination with other operations that are designed to correct the two
cited abnormalities.