Abstract
BackgroundThis study aimed to investigate the efficacy of percutaneous hemiepiphysiodesis for gradual correction of symptomatic juvenile hallux valgus (HV) deformity.MethodsBetween 2012 to 2014, 24 patients with symptomatic juvenile HV were treated by combined percutaneous medial drilling hemiepiphysiodesis of the first proximal phalanx and lateral transphyseal screw hemiepiphysiodesis of the first metatarsal at our institution. Twenty-one of 24 patients fulfilled inclusion criteria had a complete radiological and clinical follow-up of at least 2 years. Preoperative and postoperative radiographs of the feet were reviewed for measurements of hallux valgus angle (HVA), intermetatarsal angle (IMA), proximal metatarsal articular angle (PMAA), proximal phalangeal articular angle (PPAA), and metatarsal length ratio (MTLR). Clinical outcomes were assessed using the AOFAS hallux metatarsophalangeal-interphalangeal score.ResultsThe study included 21 consecutive patients (37 ft) for analysis. The mean age at surgery was 12.0 years (SD = 1.3) and mean follow-up after surgery was 35.1 months (SD = 6.0). With the data available, the HV deformity improved in terms of the reduction of HVA by a mean of 4.7 degrees (P < .001) and the reduction of IMA by 2.2 degrees (P < .001). The PMAA and PPAA also improved significantly in the anteroposterior plane; however, the PMAA difference was insignificant in lateral plane as expected. The mean difference in the MTLR was 0.00 (P = .216) which was indicative of no length discrepancy between first and second metatarsals. The AOFAS score increased from 68.7 to 85.2 (P < .001). In correlation analysis, time to physeal closure was significantly correlated with the final HVA change (r = −.611, P = .003).ConclusionAlthough combined hemiepiphysiodesis does not create a large degree of correction as osteotomy, yet it did improve HV deformity with adequate growth remaining in our series. It is a procedure that can be of benefit to patients with symptomatic juvenile HV from this minimal operative approach before skeletal maturity.Level of evidenceLevel IV, retrospective case series.
Highlights
This study aimed to investigate the efficacy of percutaneous hemiepiphysiodesis for gradual correction of symptomatic juvenile hallux valgus (HV) deformity
Lateral hemiepiphysiodesis of the first proximal metatarsus alone has been proposed by a few previous series to correct the metatarsus varus component in juvenile HV deformity [10, 11]
We retrospectively reviewed the case series of all patients with juvenile HV (HV angle >16 degrees) who received combined hemiepiphysiodesis surgery from 2012 to 2014 at our institution
Summary
This study aimed to investigate the efficacy of percutaneous hemiepiphysiodesis for gradual correction of symptomatic juvenile hallux valgus (HV) deformity. The deformity initially consists of lateral deviation of the great toe with the apex at the first metatarsophalangeal (MTP) joint, The management of HV deformities in skeletally immature patients remain controversial, either conservative or operative treatments. The hemiepiphysiodesis in skeletally immature patients, by tethering marginal physis and creating asymmetrical physeal growth, has been used for treatment of angular deformities of the lower limbs for many years [9]. Lateral hemiepiphysiodesis of the first proximal metatarsus alone has been proposed by a few previous series to correct the metatarsus varus component in juvenile HV deformity [10, 11]. The smaller sample size in previous series was difficult to demonstrate the sequential angular changes and identify factors influencing the efficiency of the hemiepiphysiodesis technique after surgery
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