Abstract
Background
Surgical treatment of adolescent hallux valgus has been a challenging intervention because of high rates of postoperative recurrence. The purposes of this study were to describe a proximal abduction–supination osteotomy of the first metatarsal and prospectively review preliminary results of this procedure for correction of adolescent hallux valgus.
Methods
Eleven patients (12 feet) who had had a proximal abduction–supination osteotomy of the first metatarsal combined with a distal soft-tissue procedure to correct an adolescent hallux valgus deformity were prospectively reviewed clinically and radiologically. The average duration of follow-up was 22 months. The average age at the time of surgery was 17 years.
Results
The mean score on the Japanese Society for Surgery of the Foot standard rating system for hallux improved significantly, from 62.0 points preoperatively to 99.2 points postoperatively (p = 0.002). All patients were satisfied and would choose to have the same procedure again. The mean hallux valgus angle decreased significantly, from 32.3° preoperatively to 12.2° postoperatively (p = 0.002); mean intermetatarsal angle decreased significantly from 14.0° preoperatively to 6.2° postoperatively (p = 0.002). No feet had postoperative recurrence of hallux valgus (a hallux valgus angle ≥20°). There were no occurrences of nonunion or transfer lesions.
Conclusions
The clinical and radiological results of this study demonstrate that a proximal abduction–supination osteotomy with a distal soft-tissue procedure, which described in this study, achieved significant correction of an adolescent hallux valgus deformity, significant improvement in pain and function, and reduction in rate of recurrence.
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References
Scranton P. Adolescent bunion: diagnosis and management. Pediatr Ann. 1982;11:518–20.
Groiso JA. Juvenile hallux valgus. A conservative approach to treatment. J Bone Joint Surg Am. 1992;74:1367–74.
Das De S. Distal metatarsal osteotomy for adolescent hallux valgus. J Pediatr Orthop. 1984;4:32–8.
Luba R, Rosman M. Bunions in children: treatment with a modified Mitchell osteotomy. J Pediatr Orthop. 1984;4:44–7.
Scranton PE, Zuckerman JD. Bunion surgery in adolescents: results of surgical treatment. J Pediatr Orthop. 1984;4:39–43.
Ball J, Sullivan JA. Treatment of the juvenile bunion by Mitchell osteotomy. Orthopaedics. 1985;8:1249–52.
Zimmer TJ, Johnson KA, Klassen RA. Treatment of hallux valgus in adolescent by the chevron osteotomy. Foot Ankle. 1989;9:190–3.
Geissele CAE, Stanton RP. Surgical treatment of adolescent hallux valgus. J Pediatr Orthop. 1990;10:642–8.
Canale PB, Aronson DD, Lamont RL, Manoli JA. The Mitchell procedure for the treatment of adolescent hallux valgus. A long-term study. J Bone Joint Surg. 1993;74A:1610–8.
Peterson HA, Newman SR. Adolescent bunion deformity treated with double first ray osteotomy and longitudinal pin fixation of the first ray. J Pediatr Orthop. 1993;13:80–4.
Coughlin MJ. Juvenile hallux valgus: etiology and treatment. Foot Ankle Int. 1995;16:682–97.
Aronson J, Nguyen LL, Aronson E. Early results of the modified Peterson bunion procedure for adolescent hallux valgus. J Pediatr Orthop. 2001;21:65–9.
Johnson AE, Georgopoulos G, Erickson MA, Eliert R. Treatment of adolescent hallux valgus with the first metatarsal double osteotomy. J Pediatr Orthop. 2004;24:358–62.
Petratos DV, Anastasopoulos JN, Plakogiannis CV, Matosinos GS. Correction of adolescent hallux valgus by proximal crescentic osteotomy of the first metatarsal. Acta Orthop Belg. 2008;74:496–502.
Coughlin MJ, Robert EC. Treatment of hallux valgus with an increased distal metatarsal articular angle: evaluation of double and triple first ray osteotomies. Foot Ankle Int. 1999;20:762–70.
Okuda R, Kinoshita M, Yasuda T, Jotoku T, Kitano N, Shima H. The shape of the lateral edge of the first metatarsal head as a risk factor for recurrence of hallux valgus. J Bone Joint Surg Am. 2007;89:2163–72.
Okuda R, Kinoshita M, Yasuda T, Jotoku T, Kitano N, Shima H. Postoperative incomplete sesamoids reduction as a risk factor for recurrence of hallux valgus. J Bone Joint Surg Am. 2009;91:1637–45.
Akin OF. The treatment of hallux valgus—a new operative procedure and its results. Med Sentinel. 1925;33:678–9.
Okuda R, Kinoshita M, Morikawa J, Yasuda T, Jotoku T, Abe M. Distal soft tissue procedure and proximal metatarsal osteotomy in hallux valgus. Clin Orthop Relat Res. 2000;379:209–17.
Niki H, Aoki H, Inokuchi S, Ozeki S, Kinoshita M, Kura H, Tanaka Y, Noguchi M, Nomura S, Hatori M, Tatsunami S. Development and reliability of a standard rating system for outcome measurement of foot and ankle disorders II: interclinician and intraclinician reliability and validity of the newly established standard rating scales and Japanese Orthopaedic Association rating scale. J Orthop Sci. 2005;10:466–74.
Shima H, Okuda R, Yasuda T, Jotoku T, Kitano N, Kinoshita M. Radiographic measurement in patients with hallux valgus before and after proximal crescentic osteotomy. J Bone Joint Surg Am. 2009;91:1369–76.
Hardy RH, Clapham JCR. Observation on hallux valgus. Based on controlled series. J Bone Joint Surg Br. 1951;33:376–91.
Smith RW, Reynolds JC, Stewart MJ. Hallux valgus assessment: report of research committee of American Orthopaedic Foot and Ankle Society. Foot Ankle. 1984;5:92–103.
Richardson EG, Graves SC, McClure JT, Boone RT. First metatarsal head-shaft angle: a method of determination. Foot Ankle. 1993;14:181–5.
Vittetoe DA, Saltzman CL, Keieg JC, Brown TD. Validity and reliability of the first distal metatarsal articular angle. Foot Ankle Int. 1994;15:541–7.
Chi TD, Davitt J, Younger A, Holt S, Sangeorzan BJ. Intra- and inter-observer reliability of the distal metatarsal articular angle in adult hallux valgus. Foot Ankle Int. 2002;23:722–6.
Robinson B, Cullen B, Chhaya NC, Sri-Ram K, Lynch A. Variation of the distal metatarsal articular angle with axial rotation and inclination of the first metatarsal. Foot Ankle Int. 2006;27:1036–40.
Mizuno S, Sima Y, Yamazaki K. Detorsion osteotomy of the first metatarsal bone in hallux valgus. J Jpn Orthop Assoc. 1956;30:813–9.
Eustace S, O’byrne J, Stack J, Stephens MM. Radiographic features that enable assessment of first metatarsal rotation: the role of pronation in hallux valgus. Skeletal Radiol. 1993;22:153–6.
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All authors declare that no grants, funds or benefits of any kind were received in support of the study.
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Okuda, R., Yasuda, T., Jotoku, T. et al. Proximal abduction–supination osteotomy of the first metatarsal for adolescent hallux valgus: a preliminary report. J Orthop Sci 18, 419–425 (2013). https://doi.org/10.1007/s00776-013-0376-3
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DOI: https://doi.org/10.1007/s00776-013-0376-3