Operative Treatment of Adolescent Hallux Valgus

Abstract

The hallux valgus deformity in pediatric patients is a common pathology with no definitive criteria for surgical treatment. The purpose of this study is to present mid-term postoperative results after surgical treatment of this foot deformity. The study included 43 operated feet in 29 patients, with an average age of 14.31 years. Scarf osteotomy was performed in 23 patients, combined with an Akin osteotomy in 14 of the cases; Chevron osteotomy was performed in seven patients, five patients were treated with the mini tightrope technique, two with the Ludloff osteotomy, and six patients with lateral hemiepiphysiodesis of the first metatarsal. We evaluated the change in angular radiographic parameters and the American Orthopaedic Foot & Ankle Society scale for data analysis. The mean follow-up of the study was 48 ± 33.2 months. The mean preoperative hallux valgus angle showed an average improvement of 30.19° to 12.79° (p < 0.001). Loss of correction of the HVA angle of 20.46° was noted at the time of final follow up (p > 0.05). Favourable correction of the intermetatarsal angle was achieved with improvement of 11.44° preoperatively to 7.35° postoperatively. Significant progression was found for the American Orthopedic Foot & Ankle Society score from 57 points (42–85) before surgery to 80 points (54–100) after surgery. The recurrence rate 6 months after surgery is 30.95% (13 cases). Relapse of the deformity after Scarf osteotomy was observed in nine cases; after mini tight rope technique in three cases, and in one case after Chevron osteotomy. In conclusion we state that the most important factor influencing the outcomes of treatment and postoperative recurrence rate is skeletal maturity. Surgical treatment should be indicated after growth plate fusion. Conservative treatment via orthotic devices is recommended until that time.