First clinical experience of a new surgical technique including correction of bony alignment of first foot ray combined with reconstruction of muscle balance in case of adolescent hallux valgus

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Abstract

BACKGROUND: Hallux valgus deformity of the big toe in adolescents accounts for 22%–44% of all relevant cases. Despite a relatively large number of surgical treatment methods proposed to correct this deformity, treatment results are not always satisfactory. The problem of imbalance between the external traction of the abductor hallucis muscle and the contracted adductor muscle in hallux valgus remains controversial and is not covered in the literature.

AIM: This study aimed to examine the results of hallux valgus deformity treatment, following the suggested combined technique.

MATERIALS AND METHODS: Eight teenage patients (10 feet), aged 15 years on average, were assessed. Patients were undergoing treatment in the department of pediatric orthopedics of the Dana Hospital, Tel Aviv, within the period from 2015 to 2019. The average postoperative observation period was 30 months. This study suggested a new combined technique, including (1) modified oblique Chevron osteotomy with a V-shaped cut in the distal aspect of the first metatarsal with the dorsal wedge excision performed at the apex of its angulation, (2) valgus osteotomy of the medial cuneiform bone with the insertion of the V-shaped bone allograft, and (3) transfer of the dorsal portion of the pre-split tendon of abductor hallucis muscle to the base of the triangular medial capsular flap of the first metatarsophalangeal joint (MPJ). The tendon received optimal tension to restore the muscular balance.

RESULTS: This surgical technique provided safe and stable correction of the hallux valgus deformity, restored muscular balance, avoided movement restriction of the first MPJ, and restored the function and strength of the abductor halluces muscle that prevented the recurrence of the deformity. The number of good and excellent results was much greater than those in published reports.

CONCLUSIONS: Despite a relatively small group of patients, the suggested technique has shown improvements in hallux valgus deformity in adolescents.

About the authors

Michael V. Fishkin

Dana Children’s Hospital, Medical Center

Email: mfishkin2003@yahoo.com
ORCID iD: 0000-0003-0719-9983
Israel, Tel-Aviv

Maxim V. Fomenko

Kaplan Medical Center

Author for correspondence.
Email: Fomenko_mv@mail.ru
ORCID iD: 0000-0001-7526-8296

MD, PhD

Israel, Rehovot

Haggai Schermann

Tel-Aviv Sourasky Medical Center

Email: sheralmi@bu.edu
ORCID iD: 0000-0002-9271-6932
Israel, Tel-Aviv

References

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2. Fig. 3. Original guide

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3. Fig. 7. Scheme of the influence of muscles (1, musculus abductor hallucis; 2, musculus abductor hallucis; 3, short flexor of the big toe) on the hallux valgus and varus deviation of the first metatarsal bone, accompanied by lateral displacement of the sesamoid bones, with an external plantar displacement of the musculus abductor hallucis tendon

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4. Fig. 1. Scheme for measuring the angles of deformity in hallux valgus: DMAA, distal metatarsal articular angle; HVA, hallux valgus angle; IMA, intermetatarsal angle

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5. Fig. 2. Stages of surgical intervention: a, capsulotomy with medial approach, bunion resection, guide wire insertion at the border of the neck and head of the first metatarsal bone at the level of the base of the sesamoid bones in the medial–lateral direction parallel to the base of the valgus main phalanx of the big toe; b, the guide is put on the guide wire at 30° angle between the longitudinal axis of the first metatarsal bone and the handle

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6. Fig. 4. Stages of surgery: a, osteotomy of the neck of the first metatarsal bone; b, separated distal segment of the first metatarsal bone, V-shaped osteotomy; c, resection of a wedge-shaped fragment from the proximal segment parallel to the orienting wire; d, alignment with correction and conduction of guide wire 2 before the insertion of the cannulated compression screw

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7. Fig. 5. Scheme of stages and levels of bone correction: a, places of planned corrective osteotomies of the first metatarsal bone and medial sphenoid bone in the frontal view; b, position of the segments after excision of the wedge from the neck of the first metatarsal bone, fixation with a compression screw, and insertion of the wedge-shaped allograft into the medial cuneiform bone in the frontal view; c, planned osteotomies in the lateral view; d, condition after removal of the wedge and fixation with a screw of the neck of the first metatarsal bone and insertion of the wedge-shaped allograft into the medial cuneiform bone in the lateral view (attention should be paid to the plantar translation of the head)

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8. Fig. 6. Patient, 13 years old. Hallux valgus deformity of the big toe of the left foot: a, X-ray image in frontal projection before surgery; b, stage of surgery with the transfer of the dorsal–distal part of the tendon of the musculus abductor hallucis, and it was sutured with tension to the base of the triangular medial capsular flap; c, frontal X-ray image 36 months after the surgery showing correction of the deformity and complete consolidation of osteotomies; d, lateral X-ray image

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Copyright (c) 2021 Fishkin M.V., Fomenko M.V., Schermann H.

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