Proximal metatarsal osteotomy and distal soft tissue reconstruction for hallux valgus in juveniles

Abstract

Surgical correction of hallux valgus through a lateral soft tissue release, resection of the exostosis and proximal first metatarsal osteotomy. Hallux valgus with a subluxated metatarsophalangeal joint. Significant rigidity between first and second metatarsals. When the intermetatarsal angle is 50°. Presence of significant osteoarthritis or spasticity. First incision: longitudinal over dorsal aspect of first intermetatarsal space. Release of soft tissue contracture between lateral sesamoid and metatarsal head. Division of transverse metatarsal ligament. Release of lateral joint capsule. Second incision: longitudinal over exostosis. Inverted L-shaped incision of capsule, resection of exostosis. Capsulorrhaphy. Third incision: longitudinal over base of first metatarsal. Crescentic osteotomy, correction and internal screw fixation. Twenty-seven juveniles (33 feet), average age at surgery 15.9 years, average follow-up 5 years. Using the subjective rating scale 30 feet were excellent, 2 good and 1 fair. Based on the duPont rating scale the results were excellent in 29 feet, twice good and twice fair. The following complications were noted: hallux varus 4, breakage of Kirschner wire 1 and 1 undercorrection.