Acquired Hallux Varus Research Articles

Acquired Hallux Varus Deformity Correction: Pivotless Distraction Technique.

Acquired hallux varus deformity secondary to postburn contracture is a rare condition. It causes cosmetic disfigurement, pain, and inability to wear a shoe. Soft-tissue procedures and tendon transfers have been described for correction; however, these may require multiple operations and the outcome may be poor. We report a 6-year-old neglected case of hallux varus deformity secondary to burn contracture successfully managed by contracture release with pivotless distraction technique using a biplanar distractor and skin grafting with Z-plasty in the same procedure. The deformity was corrected to a lesser extent and with good functional outcomes. The scar was excised and Z-plasty was performed. The medial joint capsule was released. We used gradual differential distraction with monitoring on sequential radiographs. Pain-free flexion of 45° and extension of 40° were achieved and the patient was able to wear shoes after 4 weeks postoperatively. Hallux varus is a multidimensional deformity. A severe and rigid deformity might not respond well to tendon transfers in a single stage. Our described technique can be used to correct rigid hallux varus deformity with preservation of joint function.

Rare Case of a Right Hallux Varus: About a Case and Review of the Literature

Hallux varus deformity is generally defined by three components: medial deviation of the hallux at the first metatarsophalangeal (MTP) joint, supination of the phalanx, and interphalangeal (IP) flexion or claw toe deformity. The deformation can be congenital or acquired. Hallux varus is most commonly seen as an iatrogenic complication of bunion surgery, resulting from overcorrection of hallux valgus. The incidence is relatively rare, with reports ranging between 2% and 15.4% in the literature. Besides iatrogenic hallux varus, several other etiologies cause acquired hallux varus: trauma, severe burn injury with contracture, systemic inflammatory disorders such as rheumatoid or psoriatic arthritis, Charcot-Marie-Tooth disease, avascular necrosis of the first metatarsal head, and paralysis or poliomyelitis. The goal of treatment is to obtain a functional, pain-free, shoeable foot. It is desirable to achieve a stable, aligned hallux while maintaining or maximizing joint mobility when possible.

Acquired Hallux Varus. Etiology, Pathology, Classification, and Treatment Algorithm. Literature Review.

Iatrogenic hallux varus is formed due to an imbalance between the bone, tendon, and ligamentous-articular structures in the first metatarsophalangeal joint (MJ), with the progression of the medial deviation of the big toe. A secondary factor is an imbalance between excessive medial tension and weakness or excessive soft tissue release of lateral capsular-ligamentous structures. The article is devoted to a rare but no less complex postoperative complication of hallux valgus deformity, acquired hallux varus. Based on the literature data on this topic, in the work, the clinical anatomy of the first metatarsophalangeal joint, the pathogenesis of the development of tendon-muscle imbalance in the above joint, and the leading causes of hallux varus are described. Also, the issues of the clinic, X-ray diagnostics, and classification of this type of foot pathology are considered with a description of the appropriate surgical tactics for different types of deformity.

Management of neglected congenital hallux varus in a 13 year old boy: A case report

Introduction: Congenital hallux varus is a rare condition. Primary congenital hallux varus results because of over activity of adductor halluces whereas secondary congenital hallux varus results due to various conditions like polydactyl, metatarsus bracket and metatarsus adducts. Acquired hallux varus results due to damage to articular cartilage and lax collateral ligaments seen in inflammatory arthropathies like psoriasis, rheumatoid arthritis and trauma. Treatment of neglected congenital hallux varus in adult is challenging due to soft tissue contractures and rigid bony deformities.Case report: We present here a case of a 13 years old male patient who presented to outpatient department of SDM Medical College Sattur, Dharwad – Karnataka with neglected congenital hallux varus of secondary type. Patient had an extra rudimentary great toe (polydactyl) which was obvious on radiographs. We have treated this patient by farmer`s procedure. Intra-operatively phalangeal, metatarsal and tarsal alignment was held with k-wire and post-operatively reduction maintained with specially formed splint. We have more than 14 month follow-up of indexed case. No recurrence of deformity was noted.Conclusion: Congenital hallux varus is a rare condition. Treatment of neglected congenital hallux varus is challenging due to soft tissue contractures and bony rigidity. Farmer`s procedure is an effective surgery to restore near normal anatomy, post-operative splint prevents recurrence of deformity.

Post-traumatic dynamic hallux varus instability.

Acquired hallux varus secondary to traumatic disruption of the lateral joint structures of the 1st MTPJ is uncommon and has only been reported in the literature once previously.(4) We present a case of traumatic hallux varus that is unique since the deformity is dynamic in nature. In our patient the hallux remained reduced on standing weight bearing films, and luxated only during fluoroscopic stress testing. We also describe our surgical correction where a soft tissue anchor alone was utilized to stabilize the joint through repair of the lateral capsule and collateral ligament. One year following the described repair the patient reports no limitations in performing activities of daily living, and complains of only mild pain with recreational activities.

Use of the Mini TightRope ® for Correction of Hallux Varus Deformity

The flexible form of acquired hallux varus has historically been treated with a number of applicable soft tissue procedures, most of which combine medial capsular release with adjunct procedures aimed at restoring the transverse plane balance of the digit. In this report, a surgical technique for correction of hallux varus that employs the use of an implanted button and suture device, namely the Mini TightRope ®, is described. Rather than relying on the patient’s own soft tissues, this device applies tension to anchor the hallux in the proper alignment. The device is easily adjusted during the course of the surgery and readily enables accurate correction of the hallux in the transverse plane. The indications, technical execution, postoperative care, and potential complications related to our use of the Mini TightRope ® for correction of hallux varus are described, and the case of an adult woman who underwent the procedure for correction of acquired hallux varus is presented. In the authors’ experience, the Mini TightRope ® is a viable option that mimics restoration of the lateral collateral ligaments of the first metatarsophalangeal joint, and we believe this technique to be superior to other soft tissue surgical procedures used to repair flexible hallux varus.

Hallux Varus: Correction With the Abductor Hallucis Tendon Transfer and Suture Button Construct Insertion

Hallux varus is an uncommon deformity that may present with cosmetic dissatisfaction, difficulty with shoe wear, function impairment, and pain. It is classified into 2 forms: congenital and acquired forms. This technique paper will mainly focus on the acquired variant of hallux valgus. There are many causes of acquired hallux varus, but the most common is because of attempted correction of a hallux valgus deformity. Over the years, different techniques for hallux varus correction ranging from simple soft tissue releases to releases with tendon transfers to osseous intervention have been described. This study modernizes a procedure describing the use of the abductor hallucis tendon for the correction of the varus deformity. As the abductor hallucis muscle is a deforming force in hallux varus, release of the tendon is necessary to correct the deformity. Instead of just letting the tendon retract after being released, this procedure transfers the tendon to correct the dynamic imbalance at the first metatarsophalangeal joint and uses supplementary stabilization. It obviates the sacrifice of the extensor hallucis longus or extensor hallucis brevis tendons and spares the interphalangeal joint of the hallux.

Management of Acquired Hallux Varus With an Endobutton

Management of Acquired Hallux Varus With an Endobutton

Acquired hallux varus.

Acquired hallux varus most commonly occurs after hallux valgus surgery. Sagittal plane, coronal plane, and varus deformities are present at the metatarsophalangeal joint. Evaluation of both the metatarsophalangeal and interphalangeal joints for mobility is necessary in surgical decision making. Not all patients require surgery. The anatomy, incidence, pathogenesis, evaluation, classification, and treatment of acquired hallux varus are discussed in this review.

Acquired hallux varus and clinical tolerability.

This retrospective study was undertaken to determine the long-term clinical problems, residual disability, and need for further surgery in patients with iatrogenic hallux varus. Between 1975 and 1985, in 16 (19 feet) of 83 patients who underwent foot surgery for hallux valgus or metatarsus primus varus, hallux varus deformity was noted at 1-year follow-up on dorsoplantar roentgenograms obtained with the patients bearing weight. Thirteen of those patients (16 feet) were reexamined at an average of 18.3 years (220 months) after surgery. The average hallux varus deformity in this group was 10.1 degrees. Eleven patients (12 feet) rated their results as excellent. The average hallux metatarsophalangeal interphalangeal score for all patients was 91.5 points. Only those with extreme hallux varus deformity were dissatisfied or required further surgery.

Biomechanical assessment of a new tenodesis for correction of hallux varus.

Each of six below-the-knee amputation specimens were transfixed to a wooden block and mounted to a jig on an amputee testing device preloaded with 5 N applied to the proximal phalanx and displaced at a constant rate of 2 mm/min. Load displacement curves were generated for the intact joint and after sequential incisions of the lateral capsule, the adductor hallucis, and the lateral slip of the flexor hallucis brevis tendon, which caused varus dislocation of the hallux. An extensor hallucis brevis tenodesis was performed after the varus dislocation. Division of the lateral capsule, the adductor, and the flexor brevis reduced the force required to displace the hallux by 42.2%, an additional 25.2%, and a further 14.2%, respectively. Use of the extensor hallucis brevis tenodesis restored the load displacement curves to that of the normal joint. We conclude that the extensor hallucis brevis tendon may be useful as a tenodesis for reconstructing the deformity of acquired hallux varus.

Pathomechanics of congenital and acquired hallux varus: a clinical and anatomical study.

Hallux varus was observed in 69 feet among patients from a rural Indian population. This included three types of congenital hallux varus. The congenital "primary" type was the commonest and was not associated with any other foot deformity. Among the acquired forms was idiopathic hallux varus of middle age, which developed spontaneously in unshod persons and progressed gradually. Hallux varus following chronic arthritis was part of a consistent pattern of foot deformities in which the first ray collapsed in a zig-zag manner in two planes. Although the development of hallux varus is often due to intrinsic muscle imbalance, hallux varus secondary to chronic arthritis seems to occur as a result of both intrinsic and extrinsic muscle imbalance associated with midtarsal and subtalar arthritis. Muscular factors contribute to progression of the deformity also. No anatomical basis for a racial predilection for the deformity was noted. Failure to use footwear could account for the higher incidence of hallux varus in India.

Acquired hallux varus

Acquired hallux varus deformity of either the static or the dynamic type results from surgery to correct hallux valgus deformity and the accompanying bunion. The dynamic type is disfiguring, uncomfortable, and disappointing to the patient and surgeon alike. Linear as well as rotational forces are at work to produce the deformity. When recognized early, before fixation of the first digit has occurred in the deviated and clawed position, resection of the base of the proximal phalanx will correct the deformity. More radical treatment is required in the patient who is treated late. The experience with seven feet of five patients with acquired hallux varus deformity is presented here.

Acquired Hallux Varus: Cause, Prevention and Correction

Acquired Hallux Varus: Cause, Prevention and Correction