Adolescent hallux valgus: A systematic review of outcomes following surgery

Abstract

PurposeThe management of adolescent hallux valgus (AHV) remains controversial, with reservations about both conservative and surgical treatments. Non-operative management has a limited role in preventing progression. Surgical correction of AHV has, amongst other concerns, been associated with a high prevalence of recurrence of deformity after surgery. We conducted a systematic review to assess clinical and radiological outcomes following surgery for AHV.MethodsA comprehensive literature search was performed in the Cochrane Library, CINAHL, EMBASE, Google Scholar and PubMed. The study was performed in accordance with the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Demographic data, radiographic parameters and results of validated clinical scoring systems were analysed.ResultsThe published literature on AHV is largely heterogeneous and retrospective. Nine contemporary studies reporting on 140 patients (201 osteotomies) were included. The female to male ratio was 10:1. The mean age at operation was 14.5 years (range 10.5–22). The mean follow-up was 41.6 months (range 12–134). The mean post-operative American Orthopaedic Foot and Ankle Society (AOFAS) score was 85.8 (standard deviation, SD ±7.38). The mean AOFAS patient satisfaction showed that 86 % (SD ±11.27) of patients were satisfied or very satisfied with their outcome. On the duPont Bunion Rating Score (BRS), 90 % rated their outcome as good or excellent. There was a statistically significant improvement in the inter-metatarsal angle (IMA, p = 0.0003), hallux valgus angle (HVA, p < 0.0001) and distal metatarsal articular angle (DMAA, p = 0.019).ConclusionBased on the most current published evidence, contemporary surgical interventions for AHV show excellent clinical and radiological outcomes, with high patient satisfaction. The rates of recurrence and other complications are lower than the historically reported figures. There is a need for high-level, multi-centre collaborative studies with prospective data to establish the long-term outcomes and optimal surgical procedure(s).

Resultados radiográficos del tratamiento del <i>hallux valgus</i> juvenil con osteotomía <i>scarf </i>y técnica de McBride

“…Sin embargo, cabe mencionar que existen investigaciones que refieren buenos resultados radiográficos sin llegar a los rangos normales de corrección postquirúrgica. 8 Es evidente que existen alrededor de 130 procedimientos quirúrgicos descritos para la corrección del hallux valgus. Sin embargo, la osteotomía de scarf es una osteotomía sencilla, en la que la presencia de una placa de crecimiento metatarsiano no afecta ni limita el grado de corrección de la deformidad angular.…”

Management of Juvenile Hallux Valgus Deformity: the role of combined Hemiepiphysiodesis

“…An open metatarsal physis has been believed as a predisposing factor to the recurrence risk. Despite innovated technique and methods of fixation have improved the operative outcomes and lowered recurrence rate to 8% based on a recent systematic review article, most of the series included were focused on the adolescent rather than juvenile population [2, 15]. Temporary maintenance with orthotics and postponing surgery until mid- to late teens is usually preferred for skeletally immature HV.…”

“…Although the potential for correction is not as powerful as osteotomies based on prior studies, ranging from 7.3 degrees to 21.54 degrees change in HVA, and 0.87 to 9.25 degrees change in IMA [7, 15, 18–24], osteotomy procedures also carry higher complication rates (22.9%), such as metatarsal shortening, first metatarsal-phalangeal (MTP) joint stiffness, and recurrent HV deformity [2]. Shortening or dorsiflexion of the first ray are common complications of HV osteotomy and may result in transfer metatarsalgia [25].…”

“…Juvenile or adolescent hallux valgus (HV), also known as bunions, is a forefoot deformity commonly seen in the skeletally immature population [1, 2]. The deformity initially consists of lateral deviation of the great toe with the apex at the first metatarsophalangeal (MTP) joint, but as the condition progresses it involves the entire forefoot.…”

“…The management of HV deformities in skeletally immature patients remain controversial, either conservative or operative treatments. With uncertainty of halting progression in conservative management, operative intervention is often required in symptomatic skeletally immature HV [2, 4]. However, traditional operative options, such as proximal or distal first metatarsal osteotomy, the recurrence rates have been reported at a range of 20–40% in young patients with open physis, leading to an undesirable outcome [5–7].…”