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Surgical correction of juvenile hallux valgus (JHV) by soft tissue balancing or skeletal realignment is associated with a high rate of recurrence of the deformity. An alternative treatment strategy for the management of symptomatic or progressive JHV, consisting of lateral hemiepiphyseodesis of the great toe metatarsal physis, has been used at our institution since 1996. A review of these cases was performed to determine the outcomes in the technical and patient satisfaction domains. Preoperative and follow-up radiographs of the foot were analyzed to measure the intermetatarsal angle (IMA), the hallux valgus angle (HVA), the proximal metatarsal articular angle (PMAA), and the metatarsal length ratio. Repeated measures of the radiographs were performed to determine intraobserver reliability. The medical records were reviewed to determine the children's age at presentation, chief complaints, age at surgery, tourniquet time of the surgical procedure, length of follow-up, the need for subsequent foot surgeries, and complications. Follow-up clinic or telephone interviews were performed to determine patient satisfaction. Seven children with 11 feet treated for JHV were available for study. Mean age at the time of the index surgery was 10 years 4 months (range, 9 years 7 months-11 years 1 month). Mean follow up after surgery was 4 years 2 months (range, 1 year 7 months-7 years 6 months). The mean improvement in the IMA was 2.32 degrees (range, 0-5 degrees; P < 0.0001). The mean improvement in the HVA was 3.45 degrees (range, 0-9 degrees; P = 0.027). Significant correction of both the IMA and the HVA was achieved in 6 (55%) of 11 of the feet. In no case did either of the measures worsen. The mean change in the PMAA in the anteroposterior plane was 5.09 degrees (range, 0-11 degrees; P = 0.001). The mean change in the PMAA in the lateral plane was 1.00 degree (range, 0-3 degrees; P = 0.008). The mean change in the metatarsal length ratio was 0.01 (range, 0.07-0.11), which was not statistically significant (P = 0.65). Lateral hemiepiphyseodesis of the great toe metatarsal was effective at halting the progression of the JHV deformity in all cases and achieved significant correction of both the IMA and the HVA in more than 50% of the feet. Lateral hemiepiphyseodesis of the great toe metatarsal is a reasonable alternative for the management of symptomatic or progressive JHV, given the high recurrence rate associated with other soft tissue and skeletal surgical procedures.
Re: Hemiepiphyseodesis of metatarsal in juvenile HAV
To properly plan this procedure, there are charts that will help you calculate the amount of growth left. Then using paper cut outs you can estimate the amount of correction you will obtain. The toughest part of the whole procedure is obtaining a staple of the correct size. I have had to make my own using a .062 K-wire and bending and cutting it to size and shape. The nice part of this procedure is how little pain the patient has and how quickly the patient heals.
Hemiepiphyseodesis of metatarsal in juvenile HAV
Linear Mode
