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Surgical treatment of hallux valgus associated with flexible flatfoot during growing age

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Abstract

Purpose

During growth, hallux valgus could present associated with flatfoot. Considering the current disagreement about correction of hallux valgus during growth and the lack of reports about simultaneous correction of hallux valgus associated with flexible flatfoot, we present simultaneous treatment of both deformities during growth combining subtalar arthroeresis and SERI first metatarsal osteotomy, reporting results at an average five-year follow-up.

Methods

Thirty-two children (64 feet, age range 8–12 years) affected by hallux valgus associated with flexible flatfoot underwent surgical treatment combining SERI first metatarsal osteotomy and subtalar arthroereisis with bioabsorbable endorthotic implant. Clinical evaluation was summarized with AOFAS score, and standard standing radiographs were performed.

Results

AOFAS score ranged from 86 ± 2 to 98 ± 2 (hindfoot) and from 80 ± 4 to 98 ± 2 (forefoot). HVA ranged from 21° ± 2 to 5° ± 2, IMA from 14° ± 2 to 7° ± 2, DMAA from 18° ± 2 to 2° ± 2, and Meary’s angle from 162° ± 11 to 175° ± 4. Complications included one case of delayed wound healing, inflammatory skin reaction around the outlet of the percutaneous Kirschner wire in two cases, displacement of the endorthotic implant in one case, and a second surgery to replace the implant.

Conclusions

SERI osteotomy and subtalar arthroereisis resulted in an effective, technically simple and easily combined approach, with a high rate of good results and low rate of complications at mid-term follow-up. These techniques performed simultaneously represent a viable option in case of hallux valgus associated with flexible flatfoot during growth. Nevertheless, considering the limitations of this study, we believe that a larger case series and a longer follow-up should be desirable.

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References

  1. Root M, Orien W, Weed J (1977) Normal and abnormal function of the foot, vol 2. Clinical Biomechanics Corp., Los Angeles, CA

  2. Coughlin MJ (1995) Roger A. Mann Award. Juvenile hallux valgus: etiology and treatment. Foot Ankle Int 16:682–697

    Article  CAS  PubMed  Google Scholar 

  3. Kalen V, Brecher A (1988) Relationship between adolescent bunions and flatfeet. Foot Ankle 8:331–336

    Article  CAS  PubMed  Google Scholar 

  4. Giannini S (1998) Kenneth A. Johnson Memorial Lecture. Operative treatment of the flatfoot: why and how. Foot Ankle Int 19:52–58

    Article  CAS  PubMed  Google Scholar 

  5. Luba R, Rosman M (1984) Bunions in children: treatment with a modified Mitchell osteotomy. J Pediatr Orthop 4:44–47

    Article  CAS  PubMed  Google Scholar 

  6. Mann RA, Coughlin MJ (1981) Hallux valgus--etiology, anatomy, treatment and surgical considerations. Clin Orthop Relat Res 157:31–41

    PubMed  Google Scholar 

  7. Coughlin MJ, Mann RA (1987) The pathophysiology of the juvenile bunion. Instr Course Lect 36:123–136

    CAS  PubMed  Google Scholar 

  8. Helal B (1981) Surgery for adolescent hallux valgus. Clin Orthop Relat Res 157:50–63. doi:10.3109/17453677408989149

    PubMed  Google Scholar 

  9. Kitaoka HB, Alexander IJ, Adelaar RS et al (1994) Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int Am Orthop Foot Ankle Soc Swiss Foot Ankle Soc 15:349–353. doi:10.1177/107110079701800315

    Article  CAS  Google Scholar 

  10. Hoke M (1931) An operation for the correction of extremely relaxed flat feet. J Bone Jt Surg 13:773–783

    Google Scholar 

  11. Giannini S, Faldini C, Nanni M et al (2013) A minimally invasive technique for surgical treatment of hallux valgus: simple, effective, rapid, inexpensive (SERI). Int Orthop 37:1805–1813. doi:10.1007/s00264-013-1980-8

    Article  PubMed  PubMed Central  Google Scholar 

  12. Geissele AE, Stanton RP (1990) Surgical treatment of adolescent hallux valgus. J Pediatr Orthop 10:642–648

    Article  CAS  PubMed  Google Scholar 

  13. Pontious J, Mahan KT, Carter S (1994) Characteristics of adolescent hallux abducto valgus. A retrospective review. J Am Podiatr Med Assoc 84:208–218

    Article  CAS  PubMed  Google Scholar 

  14. Scranton PE, Zuckerman JD (1984) Bunion surgery in adolescents: results of surgical treatment. J Pediatr Orthop 4:39–43

    Article  PubMed  Google Scholar 

  15. Scranton PE (1982) Adolescent bunions: diagnosis and management. Pediatr Ann 11:518–520

    Article  PubMed  Google Scholar 

  16. Zimmer TJ, Johnson KA, Klassen RA (1989) Treatment of hallux valgus in adolescents by the chevron osteotomy. Foot Ankle 9:190–193

    Article  CAS  PubMed  Google Scholar 

  17. Nelson SC, Haycock DM, Little ER (2004) Flexible flatfoot treatment with arthroereisis: radiographic improvement and child health survey analysis. J Foot Ankle Surg 43:144–155. doi:10.1053/j.jfas.2004.03.012

    Article  PubMed  Google Scholar 

  18. Shibuya N, Kitterman RT, LaFontaine J, Jupiter DC (2014) Demographic, physical, and radiographic factors associated with functional flatfoot deformity. J Foot Ankle Surg 53:168–172. doi:10.1053/j.jfas.2013.11.002

    Article  PubMed  Google Scholar 

  19. Kernozek TW, Elfessi A, Sterriker S (2003) Clinical and biomechanical risk factors of patients diagnosed with hallux valgus. J Am Podiatr Med Assoc 93:97–103

    Article  PubMed  Google Scholar 

  20. Kilmartin TE, Wallace WA (1992) The significance of pes planus in juvenile hallux valgus. Foot Ankle 13:53–56. doi:10.1097/01241398-199207000-00047

    Article  CAS  PubMed  Google Scholar 

  21. Metcalfe SA, Bowling FL, Reeves ND (2011) Subtalar joint arthroereisis in the management of pediatric flexible flatfoot: a critical review of the literature. Foot Ankle Int 32:1127–1139. doi:10.3113/FAI.2011.1127

    Article  PubMed  Google Scholar 

  22. Staheli LT (1999) Planovalgus foot deformity. Current status. J Am Podiatr Med Assoc 89:94–99

    Article  CAS  PubMed  Google Scholar 

  23. Bouchard M, Mosca VS (2014) Flatfoot deformity in children and adolescents: surgical indication and management. JAAOS 22:623–632

    Google Scholar 

  24. Mosca VS (2010) Flexible flatfoot in children and adolescents. J Child Orthop 4:1–15. doi:10.1007/s11832-010-0239-9

    Article  Google Scholar 

  25. Mosca VS (1995) Calcaneal lengthening for valgus deformity of the hindfoot. Results in children who had severe, symptomatic flatfoot and skewfoot. J Bone Joint Surg Am 77:500–512

    CAS  PubMed  Google Scholar 

  26. Evans D (1975) Calcaneo-valgus deformity. J Bone Joint Surg (Br) 57:270–278

    CAS  Google Scholar 

  27. Giannini BS, Ceccarelli F, Benedetti MG et al (2001) Surgical treatment of flexible flatfoot in children a four-year follow-up study. J Bone Joint Surg Am 83-A(Suppl):73–79

    PubMed  Google Scholar 

  28. Saxena A, Nguyen A (2007) Preliminary radiographic findings and sizing implications on patients undergoing bioabsorbable subtalar arthroereisis. J Foot Ankle Surg 46:175–180. doi:10.1053/j.jfas.2007.01.009

    Article  PubMed  Google Scholar 

  29. Baker J, Klein E, Weil L (2012) Retrospective analysis of the survivability of absorbable versus nonabsorbable subtalar joint arthroereisis implants. Foot Ankle Spec 6(1):36–44. doi:10.1177/1938640012470712

    Article  PubMed  Google Scholar 

  30. Ruozi B, Belletti D, Manfredini G et al (2013) Biodegradable device applied in flatfoot surgery: comparative studies between clinical and technological aspects of removed screws. Mater Sci Eng C 33:1773–1782. doi:10.1016/j.msec.2012.12.093

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Istituto Ortopedico Rizzoli, via G.C. Pupilli 1, 40136, Bologna, Italy

    Cesare Faldini, Daniele Fabbri, Raffaele Borghi & Sandro Giannini

  2. Istituto Ortopedico Rizzoli, Strada Statale 113 Km 246, 90011, Bagheria, PA, Italy

    Cesare Faldini, Matteo Nanni & Francesco Traina

Authors
  1. Cesare Faldini
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  2. Matteo Nanni
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  3. Francesco Traina
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  4. Daniele Fabbri
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  5. Raffaele Borghi
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  6. Sandro Giannini
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Correspondence to Matteo Nanni.

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All authors declare that they have no competing interests.

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Faldini, C., Nanni, M., Traina, F. et al. Surgical treatment of hallux valgus associated with flexible flatfoot during growing age. International Orthopaedics (SICOT) 40, 737–743 (2016). https://doi.org/10.1007/s00264-015-3019-9

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  • DOI: https://doi.org/10.1007/s00264-015-3019-9

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