Surgical approaches and efficacy analysis of hallux valgus deformity in children and adolescents
Objective: To analyze the clinical results of different surgical approaches in treating hallux valgus deformity in children and adolescents.
Methods: From April 2000 to April 2007, 18 cases of hallux valgus deformity (30 feet) were treated. According to different ages, they were divided into children group (< or = 10 years) and adolescent group (11-18 years). In children group, 4 female patients included 2 bilateral and 2 unilateral hallux valgus deformity (2 left feet, 4 right feet). Each patient underwent a combination of Austin osteotomy and McBride procedure. The American Orthopaedic Foot and Ankle Society-Hallux Metatarsophalangeal Interphalangeal (AOFAS-HMI) score was 55.0 +/- 15.0, and the visual analogue scale (VAS) score was 6.0 +/- 2.0. The hallux valgus angle (HVA) and 1st-2nd intermetatarsal-phalangeal angle (IMA) were (35.0 +/- 4.0) degrees and (14.4 +/- 2.0) degrees. In adolescent group, 14 patients included 3 males (4 feet) and 11 females (20 feet), 10 bilateral and 4 unilateral hallux valgus deformity (10 left feet, 14 right feet). Each patient underwent the modified Mitchell osteotomy. The AOFAS-HMI score was 55.6 +/- 14.0, and the VAS score was 7.0 +/- 1.0. The HVA and IMA were (38.5 +/- 5.0) degrees and (15.0 +/- 3.0) degrees.
Results: All incisions healed primarily. The patients of two groups were followed up 12-32 months (21 months on average). In adolescent group, pain of metatarsophalangeal joint occurred in 1 case and the symptom disappeared after 3-month physical therapy; 1 case recurred after 21 months of operation and achieved satisfactory results after Lapidus operation. In children group, the AOFAS-HMI score was 92.1 +/- 5.0, the VAS score was 1.0 +/- 0.6, HVA was (14.7 +/- 3.0) degrees, and IMA was (5.5 +/- 2.0) degrees; showing significant differences (P < 0.05) when compared with those before operation. In adolescent group, the AOFAS-HMI score was 90.0 +/- 6.0, the VAS score was 1.0 +/- 0.6, HVA was (13.7 +/- 3.0) degrees, and IMA was (6.8 +/- 2.0) degrees; showing significant differences (P < 0.05) when compared with those before operation.
Conclusions: It has the advantages of rapid bone healing, short course of treatment, and less complication to treat hallux valgus deformity in children with a combination of Austin osteotomy and McBride procedure and in adolescent with the modified Mitchell osteotomy.