First clinical experience of a new surgical technique including correction of bony alignment of first foot ray combined with reconstruction of muscle balance in case of adolescent hallux valgus
- Authors: Fishkin M.V.1, Fomenko M.V.2, Schermann H.3
-
Affiliations:
- Dana Children’s Hospital, Medical Center
- Kaplan Medical Center
- Tel-Aviv Sourasky Medical Center
- Issue: Vol 9, No 2 (2021)
- Pages: 183-193
- Section: Exchange of experience
- URL: https://journals.rcsi.science/turner/article/view/46722
- DOI: https://doi.org/10.17816/PTORS46722
- ID: 46722
Cite item
Abstract
BACKGROUND: Hallux valgus deformity of the big toe in adolescents accounts for 22%–44% of all relevant cases. Despite a relatively large number of surgical treatment methods proposed to correct this deformity, treatment results are not always satisfactory. The problem of imbalance between the external traction of the abductor hallucis muscle and the contracted adductor muscle in hallux valgus remains controversial and is not covered in the literature.
AIM: This study aimed to examine the results of hallux valgus deformity treatment, following the suggested combined technique.
MATERIALS AND METHODS: Eight teenage patients (10 feet), aged 15 years on average, were assessed. Patients were undergoing treatment in the department of pediatric orthopedics of the Dana Hospital, Tel Aviv, within the period from 2015 to 2019. The average postoperative observation period was 30 months. This study suggested a new combined technique, including (1) modified oblique Chevron osteotomy with a V-shaped cut in the distal aspect of the first metatarsal with the dorsal wedge excision performed at the apex of its angulation, (2) valgus osteotomy of the medial cuneiform bone with the insertion of the V-shaped bone allograft, and (3) transfer of the dorsal portion of the pre-split tendon of abductor hallucis muscle to the base of the triangular medial capsular flap of the first metatarsophalangeal joint (MPJ). The tendon received optimal tension to restore the muscular balance.
RESULTS: This surgical technique provided safe and stable correction of the hallux valgus deformity, restored muscular balance, avoided movement restriction of the first MPJ, and restored the function and strength of the abductor halluces muscle that prevented the recurrence of the deformity. The number of good and excellent results was much greater than those in published reports.
CONCLUSIONS: Despite a relatively small group of patients, the suggested technique has shown improvements in hallux valgus deformity in adolescents.
Full Text
##article.viewOnOriginalSite##About the authors
Michael V. Fishkin
Dana Children’s Hospital, Medical Center
Email: mfishkin2003@yahoo.com
ORCID iD: 0000-0003-0719-9983
Israel, Tel-Aviv
Maxim V. Fomenko
Kaplan Medical Center
Author for correspondence.
Email: Fomenko_mv@mail.ru
ORCID iD: 0000-0001-7526-8296
MD, PhD
Israel, RehovotHaggai Schermann
Tel-Aviv Sourasky Medical Center
Email: sheralmi@bu.edu
ORCID iD: 0000-0002-9271-6932
Israel, Tel-Aviv
References
- Mosca VS. Principles and management of pediatric foot and ankle deformities and malformation. Philadelphia: Lippincott Williams & Wilkins (LWW); 2014.
- Coughlin MJ, Roger A. Mann Award. Juvenile hallux valgus: etiology and treatment. Foot Ankle Int. 1995;16(11):682–697. doi: 10.1177/107110079501601104
- Aronson J, Nguyen LL, Aronson EA. Early results of the modified Peterson bunion procedure for adolescent hallux valgus. J Pediatr Orthop. 2001;21(1):65–69. doi: 10.1097/00004694-200101000-00014
- Johnson AE, Georgopoulos G, Erickson MA, Eilert R. Treatment of adolescent hallux valgus with the first metatarsal double osteotomy. J Pediatr Orthop. 2004;24(4):358-362.
- DeOrio J. Technique tip: dorsal wedge resection (uniplanar) in the chevron osteotomy for high distal metatarsal articular angle bunions. Foot Ankle Int. 2007;28(5):642–644. doi: 10.3113/FAI.2007.0642
- Malal JJ, Shaw-Dunn J, Kumar CS. Blood supply to the first metatarsal head and vessels at risk with a chevron osteotomy. J Bone Joint Surg Am. 2007;89:2019–2022. doi: 10.2106/JBJS.F.01030
- 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.
- Iyer S, Demetracopoulos CA, Sofka CM, Ellis SJ. High rate of recurrence following proximal medial opening wedge osteotomy for correction of moderate hallux valgus. Foot Ankle Int. 2015;36(8):756–763.
- Gicquel T, Fraisse B, Marleix S, Chapuis M, Violas P. Percutaneous hallux valgus surgery in children: Short-tern outcomes of 33 cases. Orthop Traumatol Surg Res. 2013;99(4):433–439. doi: 10.1016/j.otsr.2013.02.003
- Harb Z, Kokkinakis M, Ismail H, Spence G. Adolescent hallux valgus: a systematic review of outcomes following surgery. J Child Orth. 2015;9(2):105–112. doi: 10.1007/s11832-015-0655-y
- Peterson HA, Newman SR. Adolescent bunion deformity treated with double and longitudinal pin fixation of the first ray. J Pediatr Orthop. 1993;13(1):80–84. doi: 10.1097/01241398-199301000-00016
Supplementary files
