Dvojitá osteotomie I. metatarzu v léčení juvenilního hallux valgus - naše zkušenosti

JOCHYMEK, Jiří and Tereza PETERKOVÁ. Dvojitá osteotomie I. metatarzu v léčení juvenilního hallux valgus - naše zkušenosti (Double Osteotomy of the First Metatarsal for Treatment of Juvenile Hallux Valgus Deformity - Our Experience). Acta chirurgiae orthopaedicae et traumatologiae čechoslovaca. Praha: Galén, 2016, vol. 83, No 1, p. 32-37. ISSN 0001-5415.

Basic information

• Original name: Dvojitá osteotomie I. metatarzu v léčení juvenilního hallux valgus - naše zkušenosti
• Name (in English): Double Osteotomy of the First Metatarsal for Treatment of Juvenile Hallux Valgus Deformity - Our Experience
• Authors: JOCHYMEK, Jiří (203 Czech Republic, guarantor, belonging to the institution) and Tereza PETERKOVÁ (203 Czech Republic, belonging to the institution).
• Edition: Acta chirurgiae orthopaedicae et traumatologiae čechoslovaca, Praha, Galén, 2016, 0001-5415.

Other information

• Original language: Czech
• Type of outcome: Article in a journal
• Field of Study: 30211 Orthopaedics
• Country of publisher: Czech Republic
• Confidentiality degree: is not subject to a state or trade secret
• Impact factor: Impact factor: 0.560
• RIV identification code: RIV/00216224:14110/16:00100510
• Organization unit: Faculty of Medicine
• UT WoS: 000372138900005
• Keywords in English: children; adolescents; hallux valgus; double osteotomy of the first metatarsal
• Tags: EL OK
• Tags: International impact, Reviewed

Abstract

Hallux valgus je bezesporu nejčastěji se vyskytující komplexní deformitou přednoží a prstů nohy v dospělosti. Etiologie této komplexní statické vady nohy je multifaktoriální. Tuto deformitu však můžeme pozorovat i v dětském věku, a to dokonce již v prvních měsících života. Juvenilní hallux valgus je popisován jako varózní deviace I. metatarzu v kombinaci s valgózní deformitou proximálního článku palce nohy u dětí s neukončeným kostním růstem. Pokud je laterálně vychýlen pouze distální článek palce, je deformita označována jako hallux valgus interphalangeus.

Abstract (in English)

PURPOSE OF THE STUDY The aim of the study was to evaluate the mid-term results in a group of selected patients undergoing corrective surgery for juvenile hallux valgus, using double osteotomy of the first metatarsal. MATERIAL AND METHODS The group included eight patients, seven girls and one boy, with a more severe form of this deformity treated by double osteotomy of the first metatarsal between 2010 and 2013. The indication for corrective surgery was serious pain when walking; all patients had previously undergone conservative treatment with no effect. All patients had pre-operative clinical examination, the affected foot was X-rayed with the patient standing and radiographic assessments of the intermetatarsal and hallux valgus angles were made. The evaluation of treatment outcomes was based on the scoring system of the American Orthopaedic Foot and Ankle Society (AOFAS) and X-ray images of the foot. The average follow-up was 37 months. RESULTS Post-operatively, none of the patients reported pain while walking, only two of them experienced pain during sports activities. The average post-operative AOFAS score was 92 points. Both the intermetatarsal angle and the hallux valgus angle improved after surgery in all patients, with two reporting only mild hallux valgus deformity. One patient showed postoperative restriction of motion at the first metatarsophalangeal joint. This was the only complication recorded in association with the surgery. DISCUSSION Almost all authors dealing with the treatment of hallux valgus deformity primarily prefer conservative therapy. However, this treatment is usually not very effective in severe forms of the disorder. Surgical management is indicated in symptomatic patients or in those with severe juvenile hallux valgus deformity. In paediatric patients it is necessary to respect the presence of an epiphyseal growth plate in the first proximal metatarsal and therefore it is often preferred to use distal first metatarsal osteotomy. At our department, Mitchell's osteotomy for hallux valgus deformity is usually used. However, post-operative outcomes are not satisfactory in severe forms of juvenile hallux valgus in which a high proportion of recurrent deformities is probably related to the growth potential of a juvenile bone. In such cases we use the Peterson and Newman procedure of double first metatarsal osteotomy, which can correct all three components of the deformity while maintaining functional first metatarsal length. This is a great advantage of the method. Although its authors have not reported any post-operative complications, the occurrence of restricted motion in the first metatarsophalangeal joint has been described in the relevant literature. The problem was also recorded in one patient of our group. CONCLUSIONS Deformities of the forefoot and big toe are frequent orthopaedic disorders in children and adolescents. The results of this study confirm that the double first metatarsal osteotomy is an effective method of surgical treatment for serious hallux valgus deformities in paediatric and adolescent patients.