Treatment of Adolescent Hallux Valgus With the First Metatarsal Double Osteotomy

Abstract

The 1 metatarsal double osteotomy is described as an effective procedure for the treatment of severe adolescent hallux valgus (AHV) with low recurrence and complication rates. No study to date has evaluated the functional clinical outcome after 1st metatarsal double osteotomy. The purpose of this paper is to report the results at our institution in the treatment of severe AHV with 1st metatarsal double osteotomy. We performed a review of all patients (N = 9, 14 feet) treated at our institution with 1st metatarsal double osteotomy. We reviewed pre- and postoperative hallux valgus (HVA), 1st-2nd intermetatarsal (IMA), and distal metatarsal articular angles (DMAA) and calculated the average angular correction. Functional outcome was measured via the AOFAS Hallux Metatarsophalangeal-Interphalangeal (HMI) scale as well as the duPont Bunion Rating Score (BRS). The average patient was 15 years old at the time of surgery with an average of 27 months follow-up. The mean angular correction was 21.54 degree, 9.25 degree, and 6.21 degree for HVA, IMA, and DMAA, respectively. Ninety percent of the patients reported good to excellent results. We had 2 complications for an overall rate of 14%. The 1st metatarsal double osteotomy is an effective and reliable technique for treatment of severe adolescent hallux valgus. Stiffness of the 1st MTPJ is the major determinant of patient satisfaction.

Surgical treatment of hallux valgus using chevron technique

“…The main indication for surgical option in this series was pain. This was also reported in several other studies [2,13,16,18] .…”

“…Rather those with suture fixation patients were even more comfortable. Johnson et al [16] used double osteotomy for the first metatarsal to correct the hallux valgus deformity. They had reported stiffness of the first metatarso-phalangeal joint as the main disadvantage of this procedure.…”

Outcome of the scarf osteotomy in adolescent hallux valgus

“…Patients who had undergone double metatarsal osteotomy for the correction of moderate to severe hallux valgus deformity were reported to have a high complication rate of first MTP joint stiffness, making the procedure unsuitable for a high-functioning adolescent [15,16].…”

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“…As for open surgeries both in children and in teenagers, we have only found several articles within the literature review [1][2][3][4][5][6][7][8][9][10].…”