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Congenital hallux varus is uncommon as an isolated deformity. Many authors cite this deformity in conjunction with metatarsus varus or talipes equino varus deformities. An unusual case of bilateral congenital hallux varus is presented in a 9-month-old. A review of etiologies and treatment methods are given.
Hallux varus occurs most frequently as a result of excessive surgical correction of musculoligamentous imbalance around the metatarsophalangeal (MTP) joint of the great toe (lateral release and medial capsuloligamentous tensioning). If untreated, the condition may lead to motion loss and degenerative arthritis. In this series, 14 cases of hallux varus were treated. Medial arthrolysis was done in each case. In five cases, reconstruction of the lateral ligament (with a 1.5-mm Ligapro suture), using a new technique, accompanied the medial release. Arthrodesis of the MTP was done in nine cases treated when there was already stiffness and arthrosis. According to a 100-point scoring system, the results were excellent in 56% and good in 44% of the MTP joint arthrodesis cases. Results were excellent in 100% of the mobilizing technique cases using Ligapro suture.
The post operative iatrogenic hallux varus associates varus, big toe's dorsal flexion and supination. The pathogeny is dominated by musculo-tendinous lack of balance created by the initial operation and excessive exostosectomy. The authors have nineteen times surgically corrected this deformation. The procedure included in all cases, a medial arthrolysis; five times associated with a screwed capito-metatarsal osseous shelf (or graft) (when there was a metatarsal's head maiming); thirteen times associated with a metatarso-phalangeal arthrodesis (in cases of impaired joint surfaces). The authors analyse, besides, without excluding them the other surgical procedures for hallux varus, and particularly tendinous transfers. The results show the necessity of a perfect etiopathogenic analysis of the deformation.
Post-burn hallux varus is an extremely rare condition. A 22-year-old male, with a history of campfire burns in childhood, presented with secondary hallux varus of the left great toe. Surgical correction included medial soft tissue release, metatarsophalangeal joint arthrodesis, two-pin fixation of bones, metatarsophalangeal joint capsulorrhaphy, and coverage of the skin defect with a "Z" plasty of the skin and split thickness skin grafting. Follow up 20 months later showed satisfactory results.
Hallux varus is usually iatrogenic in nature; however, congenital and acquired etiologies have been described in the literature. The authors present a case of traumatic hallux varus secondary to rupture of the adductor tendon. Surgical correction was performed using a soft tissue anchor for maintenance of the soft tissues utilized for repair.
The authors describe radiographic results from nine patients in whom hallux varus was repaired by transferring the extensor hallucis longus tendon (EHLT) under the deep transverse intermetatarsal ligament into the proximal-lateral base of the proximal phalanx. X-ray films revealed clinically significant changes in biomechanical relations, specifically in the hallux abductus angle. No clinically significant changes were seen in the intermetatarsal angle. The EHLT transfer procedure described is a valuable surgical alternative for correction of iatrogenic hallux varus deformity when combined with the appropriate adjunctive procedures.
Hallux varus is a deformity, either congenital or acquired, of the first metatarsophalangeal joint. It presents as a medical deviation of the hallux in relation to the longitudinal axis of the first metatarsal shaft. The authors discuss the case history of a patient and the surgical technique--a split width tenodesis--which they used to correct the deformity.
In hallux varus, which may be either congenital or acquired, the great toe deviates tibialward at the metatarsophalangeal joint. Dr. Wood discusses the acquired type and its causes and treatment. A new technique involving the surgical detachment from bone of all structures located superficial to the periosteum that surrounds the distal half of the shaft of the first metatarsal has been developed. It may be used in conjunction with the available soft tissue procedures before bone surgery for correction of the deformity, and it may make bone surgery unnecessary or alter the extent and scope of any required bone surgery.
We have used an extensor hallucis brevis tenodesis procedure to treat symptomatic hallux varus in six patients (five women and one man). Indications for this procedure include the presence of flexible metatarsophalangeal and interphalangeal joints and the absence of arthritis. In this group (mean age, 47 years; range, 18-65 years), hallux varus followed correction of hallux valgus deformity in five patients and traumatic dislocation of the hallux in one patient. Excellent correction was noted and maintained in all patients at a mean interval of 28 months (range, 24-32 months) after surgery. Despite a slight decrease in dorsiflexion following surgery (average, 10 degrees), there were no additional complications noted, and the mean American Orthopaedic Foot and Ankle Society rating score improved from 61 to 85 after surgery.
A literature review of the etiologies and treatments of both hallux varus and brachymetatarsia is presented. An unusual case report of a young girl with bilateral congenital hallux varus and brachymetatarsia of the first metatarsal is then discussed. A detailed account of the surgical correction consisting of autogenous bone grafts from adjacent metatarsals proved to demonstrate excellent biomechanical and cosmetic results.
We reviewed 12 patients with congenital hallux varus who had had operations on 20 feet to enable them to wear normal shoes and to improve the appearance. After an average follow-up of 12.7 years the results of soft tissue procedures were satisfactory in 12 of 17 feet. Arthrodesis of the first metatarsophalangeal joint, performed primarily in one foot and secondarily in two others was also satisfactory, but metatarsal osteotomy in two feet gave unsatisfactory results leading to local amputation. The unsatisfactory results were generally due to the appearance of shortness of the first metatarsal and rarely because of symptoms or recurrent deformity.
Two brothers with hallux varus of both feet are reported. One brother also had duplication/triplication of the great toes. The parents had no skeletal abnormalities or abnormalities of dermatoglyphics.
Each of six below-the-knee amputation specimens were transfixed to a wooden block and mounted to a jig on an amputee testing device preloaded with 5 N applied to the proximal phalanx and displaced at a constant rate of 2 mm/min. Load displacement curves were generated for the intact joint and after sequential incisions of the lateral capsule, the adductor hallucis, and the lateral slip of the flexor hallucis brevis tendon, which caused varus dislocation of the hallux. An extensor hallucis brevis tenodesis was performed after the varus dislocation. Division of the lateral capsule, the adductor, and the flexor brevis reduced the force required to displace the hallux by 42.2%, an additional 25.2%, and a further 14.2%, respectively. Use of the extensor hallucis brevis tenodesis restored the load displacement curves to that of the normal joint. We conclude that the extensor hallucis brevis tendon may be useful as a tenodesis for reconstructing the deformity of acquired hallux varus.
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The split tendon transfer is introduced as an additional procedure for the correction of hallux varus. More clinical and statistical evaluations are required to fully appreciate its potential benefits.
Authors describe the congenital and acquired forms of the rarely occurring hallux varus on the basis of the material of 14 patients, treated in 1951-87 on the Orthopaedic Department of the Semmelweis University Budapest. In 11 cases the deformity was congenital and in the majority bilateral, multiple, together with other foot deformities.