Treatment of Adolescent Hallux Valgus with Percutaneous Distal Metatarsal Osteotomy

Background: A significant amount of adolescents develop a hallux valgus deformity. Many surgical procedures have been described to treat hallux valgus, but there is no compelling evidence to prefer one method over another. Minimal incision osteotomies has been proposed as an alternative to open surgery, and reported to be an effective and cheaper treatment leading to high patient satisfaction. The objective of this study was to describe the clinical course of adolescent patients treated with minimally invasive hallux valgus technique using a specialized guide and Kirschner Wire fixation.

Methods: Included all patients under the age 18 years, which had a percutaneous hallux valgus correction during the years 2008-2015. The following measurements were compared before surgery to last follow-up: AOFAS hallux-metatarsophalangeal-interphalangeal questionnaire; and radiologic measurements (hallux valgus angle, intermetatarsal angle, distal metatarsal articular angle). Any postoperative complications were extracted from medical records. The surgery was performed using the technique described by Magnan B.

Results: The procedure was performed on 32 feet (27 patients, 10 male and 17 female). The average age during operation was 15.8 years with standard deviation (SD) 1.6 (range 13-18 years). The average follow up time was 43 months with SD 22 months (range 24-94 months). The average AOFAS score before operation was 66 (median 64, SD 11), and after operation on last follow on average 96 (median 100, SD 6). This difference was significant (p-value < 0.0001). Most of the patients were painless after the procedure and returned to full age appropriate function. A significant improvement was noted in all radiologic criteria (HVA, IMA, DMAA).

Conclusions: Based on our experience with minimally invasive distal metatarsal osteotomy in the treatment of hallux valgus in adolescents, the technique described by Magnan is safe, reliable and effective for the correction of mild to moderate symptomatic hallux valgus.