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Bard T, Pesenti S, Roy A, Afonso D, Couvreur A, Glard Y, Guillaume JM, Choufani É, Launay F, Jouve JL. Juvenile hallux valgus: Comparison of three types of osteotomy and medium-term postoperative results. Arch Pediatr 2024:S0929-693X(24)00088-5. [PMID: 39030123 DOI: 10.1016/j.arcped.2024.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 04/08/2024] [Accepted: 04/16/2024] [Indexed: 07/21/2024]
Abstract
BACKGROUND There is no consensus on the treatment of juvenile hallux valgus (JHV). Numerous surgical techniques have been described, none of which has been proven to be superior and the mid-term results of these methods are not well known. Our objective was to compare the mid-term clinical, radiographic, and functional results of three metatarsal osteotomy techniques. METHODS Patients under 18 years of age operated on for JHV between January 2010 and December 2019 were included in this multicenter retrospective study. Patients were excluded if they had non-idiopathic hallux valgus or if their postoperative follow-up was less than 3 years. The surgical techniques used were metatarsal osteotomies: basimetatarsal, scarf, or distal. During follow-up visits, we collected HMIS-AOFAS (Hallux Metatarsophalangeal Interphalangeal Scale-American Orthopedic Foot and Ankle Society) and Visual Analogue Scale (VAS) scores, acquired radiographs, and recorded complications and recurrences. Secondarily, the study population was stratified according to physis status (open vs. closed). RESULTS During the study period, 18 patients (26 feet) met the inclusion criteria. The median postoperative follow-up was 6.5 (4.1) years. At the end of follow-up, the median HMIS score was 79.0 (20.0), the mean hallux valgus angle (HVA) improvement was 13.2° (16.8), and the complication and recurrence rates were 31 % and 23 %, respectively. There was no significant difference in the outcome measures between the three techniques or any difference according to physis status at the time of surgery. DISCUSSION AND CONCLUSION The functional and radiographic results of metatarsal osteotomies are good in the medium term, regardless of the osteotomy site. Our results are comparable to those published in the literature. As our sample size was limited, it did not lead to the identification of statistically significant differences.
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Affiliation(s)
- Thomas Bard
- Pediatric Orthopedic Surgery Department, Hôpital de la Timone Enfants, Aix Marseille Université, 264 rue Saint Pierre, 13005 Marseille, France.
| | - Sébastien Pesenti
- Pediatric Orthopedic Surgery Department, Hôpital de la Timone Enfants, Aix Marseille Université, 264 rue Saint Pierre, 13005 Marseille, France.
| | - Adrien Roy
- Pediatric Orthopedic Surgery Department, Hôpital de la Timone Enfants, Aix Marseille Université, 264 rue Saint Pierre, 13005 Marseille, France
| | - David Afonso
- Pediatric Orthopedic Surgery Department, Hôpital de la Timone Enfants, Aix Marseille Université, 264 rue Saint Pierre, 13005 Marseille, France; Pediatric Surgery Department, Hôpital Saint Joseph, 26 boulevard de Louvain, 13008 Marseille, France
| | - Antoine Couvreur
- Pediatric Orthopedic Surgery Department, Hôpital de la Timone Enfants, Aix Marseille Université, 264 rue Saint Pierre, 13005 Marseille, France
| | - Yann Glard
- Pediatric Surgery Department, Hôpital Saint Joseph, 26 boulevard de Louvain, 13008 Marseille, France
| | - Jean-Marc Guillaume
- Pediatric Orthopedic Surgery Department, Hôpital de la Timone Enfants, Aix Marseille Université, 264 rue Saint Pierre, 13005 Marseille, France
| | - Élie Choufani
- Pediatric Orthopedic Surgery Department, Hôpital de la Timone Enfants, Aix Marseille Université, 264 rue Saint Pierre, 13005 Marseille, France
| | - Franck Launay
- Pediatric Orthopedic Surgery Department, Hôpital de la Timone Enfants, Aix Marseille Université, 264 rue Saint Pierre, 13005 Marseille, France
| | - Jean-Luc Jouve
- Pediatric Orthopedic Surgery Department, Hôpital de la Timone Enfants, Aix Marseille Université, 264 rue Saint Pierre, 13005 Marseille, France
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Artioli E, Mazzotti A, Langone L, Zielli SO, Arceri A, Bonelli S, Faldini C. First Metatarsal Hemiepiphysiodesis for the Treatment of Juvenile Hallux Valgus: A Systematic Review. J Pediatr Orthop 2023; 43:584-589. [PMID: 37526093 DOI: 10.1097/bpo.0000000000002485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Abstract
INTRODUCTION Juvenile hallux valgus (JHV) is a pediatric deformity characterized by the varus deviation of the first metatarsal and valgus deviation of the proximal phalanx. Among the several surgical techniques available, hemiepiphysiodesis consists of the unilateral growth arrest of the first metatarsal physis. Despite this technique has been proposed over 70 years ago, only a few studies including clinical and radiological outcomes have been published, making the procedure unclear in terms of results. This systematic review aimed to evaluate the outcomes of hemiepiphysiodesis of the first metatarsal in the treatment of JHV. METHODS Google Scholar, Embase, PubMed, and Cochrane databases were searched for all the articles reporting on clinical and radiological results of hemiepiphysiodesis of the first metatarsal in the treatment of JHV. The selected articles were reviewed to extract demographic data, surgical techniques, complications, clinical outcomes, and radiological parameters. RESULTS Six articles were included in the qualitative analysis. A total of 85 patients with 144 halluces valgus were treated through hemiepiphysiodesis of the first metatarsal. The mean age at surgery was 10.7 years (range 5 to 15). The mean follow-up was 2.7 years (range 1 to 7.5). Hemiepiphysiodesis was performed through 2 different techniques. Eighteen (12.5%) complications occurred. The mean American Orthopaedic Foot and Ankle Society (AOFAS) score increased from 70.6 (range 49 to 93) preoperatively to 89.4 (range 72 to 100) postoperatively. The mean HVA improved from 28.3 (range 14 to 46) to 24.03 degrees (range 0 to 54), and the mean IMA improved from 13 (range 8 to 33) to 10.9 degrees (range 8 to 33). CONCLUSIONS This review showed that hemiepiphysiodesis of the first metatarsal is a safe treatment for JHV. Improvement in both clinical and radiological results has been observed in all the studies, sometimes being statistically significant. Despite the improvement, mean postoperative radiological angles remained altered and consistent with mild-moderate hallux valgus. This suggests that hemiepiphysiodesis plays a bigger role in preventing the worsening of the deformity rather than correcting it. Randomized controlled trials with longer follow-up and a larger number of patients are needed to further investigate the efficacy and safety of this treatment.
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Affiliation(s)
- Elena Artioli
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli
| | - Antonio Mazzotti
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Laura Langone
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli
| | | | - Alberto Arceri
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli
| | - Simone Bonelli
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli
| | - Cesare Faldini
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
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Al-Mohrej OA, Ade-Conde AM, Ade-Conde OS, Argan M, Khan M, Bouchard M, Al-Asiri J. Hemiepiphysiodesis for juvenile hallux valgus deformity: A systematic review. Foot Ankle Surg 2023; 29:448-454. [PMID: 37419765 DOI: 10.1016/j.fas.2023.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 05/27/2023] [Accepted: 06/24/2023] [Indexed: 07/09/2023]
Abstract
BACKGROUND Among the numerous surgical interventions for correcting hallux valgus deformity in skeletally immature patients, hemiepiphysiodesis is a simple technique with a low complication rate yet its effectiveness remains unclear. This systematic review evaluates hemiepiphysiodesis of the first metatarsal for treating juvenile hallux valgus (JHV) deformities with respect to radiological outcomes, postoperative clinical outcomes, and postoperative complications. METHODS EMBASE, MEDLINE, PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), and Cumulative Index to Nursing and Allied Health Literature (CINAHL) database were searched from inception to September 15th, 2022, for studies investigating hemiepephysiodesis for JHV and its effect on clinical and radiological outcomes. The search, data extraction and methodologic assessment were performed in duplicate for all included studies. RESULTS Six studies out of 488 with a total of 147 feet in 85 patients were included in the final qualitative synthesis. The American Orthopaedic Foot & Ankle Society hallux metatarsophalangeal interphalangeal scale (AOFAS Hallux MTP-IP scale) was used in two studies. The mean pooled preoperative score was 62.2 ± 8.9 and improved to 88.6 ± 4.8 postoperatively in 33 patients. All six studies reported significant improvement in the hallux valgus angle (HVA) from mean preoperative angle of 29.2° ± 3.7-23.8° ± 4.5° postoperatively, while the intermetatarsal angle (IMA) preoperative and postoperative means corrected from 13.9° ± 1.1-11.4° ± 1.2°, respectively. Out of 147 feet, 21 (14.2%) had reported complications including recurrence and need for revision surgery. CONCLUSION This systematic review confirms that hemiepiphysiodesis of the first metatarsal in patients with JHV has improved clinical and radiological outcomes. LEVEL OF EVIDENCE Level IV, Systematic review.
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Affiliation(s)
- Omar A Al-Mohrej
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada; Section of Orthopedic Surgery, Department of Surgery, King Abdullah Bin Abdulaziz University Hospital, Princess Nourah Bint Abdul Rahman University, Riyadh, Saudi Arabia.
| | | | | | - Mohaned Argan
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Moin Khan
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada; Division of Orthopaedic Surgery, Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Maryse Bouchard
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Canada; Division of Orthopaedics, The Hospital for Sick Children, Toronto, Canada
| | - Jamal Al-Asiri
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
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AlZeedi M, Park JP, Marwan Y, Abu-Dalu KM, Hamdy R, Janelle C. Growth Modulation for the Treatment of Juvenile Hallux Valgus: A Systematic Review of Literature. Strategies Trauma Limb Reconstr 2023; 18:51-55. [PMID: 38033921 PMCID: PMC10682558 DOI: 10.5005/jp-journals-10080-1579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 04/20/2023] [Indexed: 12/02/2023] Open
Abstract
Background Juvenile hallux valgus (JHV) is a forefoot deformity that causes pain and functional limitation. Treatment poses a challenge in terms of the optimal technique and timing of intervention. A systematic review of the literature on the use of growth modulation in treating JHV was conducted. Materials and methods The literature review was performed using PubMed and EMBASE searches for articles investigating growth modulation in the treatment of JHV published before December 1st, 2021. Seven articles were included in the final review that matched the inclusion and exclusion criteria. The primary outcomes included the degree of correction of hallux valgus angle and intermetatarsal angle. A qualitative assessment of the articles was done due to the heterogeneity of the growth modulation methods used in these articles. Results A total of 135 feet from 78 patients were included from the reviewed articles. Growth modulation methods included temporary screw lateral hemiepiphysiodesis of the first metatarsal, lateral drilling hemiepiphysiodesis of the first metatarsal, and a trephine plug removal of the lateral epiphysis followed by cancellous bone graft insertion. The degree of correction of the hallux valgus and intermetatarsal angles were found to be statistically significant in all studies, regardless of the technique. Conclusion Growth modulation for JHV by lateral hemiepiphysiodesis using minimally invasive techniques produced favourable radiologic outcomes with some evidence of clinical improvement. Larger, prospective and comparative studies with objective clinical outcome measures may further consolidate this surgical approach as a mean to treating this deformity. How to cite this article AlZeedi M, Park JP, Marwan Y, et al. Growth Modulation for the Treatment of Juvenile Hallux Valgus: A Systematic Review of Literature. Strategies Trauma Limb Reconstr 2023;18(1):51-55.
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Affiliation(s)
- Muadh AlZeedi
- Department of Pediatric Orthopaedic Surgery, Shriners Hospital for Children; Division of Pediatric Orthopaedic Surgery, Department of Pediatric Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - J Patrick Park
- Department of Pediatric Orthopaedic Surgery, Shriners Hospital for Children; Division of Pediatric Orthopaedic Surgery, Department of Pediatric Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Yousef Marwan
- Department of Surgery, College of Medicine, Health Sciences Centre, Kuwait University, Kuwait City, Kuwait
| | - Khaled Mousa Abu-Dalu
- Department of Pediatric Orthopaedic Surgery, Shriners Hospital for Children; Division of Pediatric Orthopaedic Surgery, Department of Pediatric Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Reggie Hamdy
- Department of Pediatric Orthopaedic Surgery, Shriners Hospital for Children; Division of Pediatric Orthopaedic Surgery, Department of Pediatric Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Chantal Janelle
- Department of Pediatric Orthopaedic Surgery, Shriners Hospital for Children; Division of Pediatric Orthopaedic Surgery, Department of Pediatric Surgery, McGill University Health Centre, Montreal, Quebec, Canada
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Caravelli S, Vocale E, Di Ponte M, Fuiano M, Massimi S, Zannoni F, Zaffagnini S, Mosca M. SERI Technique for Isolated Juvenile Hallux Valgus Patients: A Retrospective Evaluation With Mid-term to Long-term Follow-up. Foot Ankle Spec 2022:19386400221121409. [PMID: 36113025 DOI: 10.1177/19386400221121409] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Many different operative procedures have been described to treat hallux valgus, but many of them are inappropriate for active, skeletally immature patients. This retrospective evaluation aimed to show the efficacy of SERI (Simple, Effective, Rapid, Inexpensive) technique in young patients affected by mild to moderate hallux valgus deformity at a mid-term to long-term follow-up. METHODS All patients were clinically and radiographically evaluated, independently by 2 researchers, by American Orthopaedic Foot and Ankle Society (AOFAS) Hallux-Metatarsophalangeal-Interphalangeal score and radiographic examination. RESULTS Twenty-nine feet, undergone SERI procedure, have been reviewed at a mean follow-up of 5 years. The mean AOFAS score was significantly improved from 59.7 preoperatively to a mean value of 90.7 at last follow-up. Mean correction degrees have been recorded for both angles (hallux valgus angle [HVA] -13.7° and intermetatarsal angle [IMA] -6.7°). CONCLUSIONS The SERI technique represents a powerful surgical procedure for the treatment of painful, mild to moderate, juvenile hallux valgus. Recurrence and complication rate make this surgical approach effective, repeatable, and safe. LEVEL OF EVIDENCE Level IV, Retrospective case series.
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Affiliation(s)
- Silvio Caravelli
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Emanuele Vocale
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Marco Di Ponte
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Mario Fuiano
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Simone Massimi
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Francesca Zannoni
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Stefano Zaffagnini
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Massimiliano Mosca
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Meyr AJ, Doyle MD, King CM, Kwaadu KY, Nasser EM, Ramdass R, Theodoulou MH, Zarick CS. The American College of Foot and Ankle Surgeons® Clinical Consensus Statement: Hallux Valgus. J Foot Ankle Surg 2022; 61:369-383. [PMID: 34706857 DOI: 10.1053/j.jfas.2021.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 08/24/2021] [Indexed: 02/07/2023]
Affiliation(s)
- Andrew J Meyr
- Clinical Professor, Department of Surgery, Temple University School of Podiatric Medicine, Philadelphia, PA.
| | - Matthew D Doyle
- Silicon Valley Reconstructive Foot and Ankle Fellowship - Palo Alto Medical Foundation, Mountain View, CA
| | - Christy M King
- Residency Director, Kaiser San Francisco Bay Area Foot & Ankle Residency Program and Attending Surgeon, Kaiser Foundation Hospital, Oakland, CA
| | - Kwasi Y Kwaadu
- Clinical Associate Professor, Department of Surgery, Temple University School of Podiatric Medicine, Philadelphia, PA
| | | | - Roland Ramdass
- Residency Training Committee, INOVA Fairfax Medical Campus, Fairfax, VA
| | - Michael H Theodoulou
- Chief Division of Podiatric Surgery, Cambridge Health Alliance, and Instructor of Surgery, Harvard Medical School, Boston, MA
| | - Caitlin S Zarick
- Assistant Professor, Department of Plastic Surgery, MedStar Georgetown University Hospital, Washington, DC
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AlFarii H, Marwan Y, Algarni N, Addar A, Hamdy R, Janelle C. Temporary Screw Lateral Hemiepiphysiodesis of the First Metatarsal for Juvenile Hallux Valgus Deformity: A Case Series of 23 Feet. J Foot Ankle Surg 2022; 61:88-92. [PMID: 34266723 DOI: 10.1053/j.jfas.2021.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Revised: 03/13/2021] [Accepted: 06/08/2021] [Indexed: 02/03/2023]
Abstract
Juvenile hallux valgus (JHV) can limit the quality of life of the affected children. This study aims to evaluate the outcomes of temporary screw lateral hemiepiphysiodesis of the base of the first metatarsal. A chart review of patients who underwent temporary screw lateral hemiepiphysiodesis of the first metatarsal at a tertiary care pediatric orthopedic center was done. A total of 23 feet of 14 patients were included. The mean age of the patients was 10.6 ± 1.8 years, while the bone age was 11.1 ± 1.8 years. The mean follow-up duration was 24.7 ± 13.4 months (range: 12-60 months). The hallux valgus angle (HVA) improved from a mean of 30.9° ± 6.7° to a mean of 27.6° ± 8.2° (p = .001), while the intermetatarsal angle (IMA) improved from a mean of 14.6° ± 2.3° to a mean of 12.5° ± 3.0° (p < .001). Revision surgery was done for 5 (21.7%) feet of 3 patients for symptomatic uncorrected deformity (4 feet) or screw migration due to bone growth (1 foot). The mean HVA correction was 5.00° ± 3.7° in patients with bone age of 12 years or less compared to 1.50° ± 4.6° in patients with bone age of more than 12 years (p = .060). The radiological outcomes of temporary screw lateral hemiepiphysiodesis of the first metatarsal for JHV deformity correction are promising, especially in children with lesser bone age. The procedure was technically simple to perform and had minor complications.
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Affiliation(s)
- Humaid AlFarii
- Division of Orthopaedic Surgery, Shriners Hospital for Children, McGill University Health Centre, Montreal, Quebec, Canada.
| | - Yousef Marwan
- Division of Orthopaedic Surgery, Shriners Hospital for Children, McGill University Health Centre, Montreal, Quebec, Canada
| | - Nizar Algarni
- Division of Orthopaedic Surgery, Shriners Hospital for Children, McGill University Health Centre, Montreal, Quebec, Canada
| | - Abdullah Addar
- Division of Orthopaedic Surgery, Shriners Hospital for Children, McGill University Health Centre, Montreal, Quebec, Canada
| | - ReggieC Hamdy
- Division of Orthopaedic Surgery, Shriners Hospital for Children, McGill University Health Centre, Montreal, Quebec, Canada
| | - Chantal Janelle
- Division of Orthopaedic Surgery, Shriners Hospital for Children, McGill University Health Centre, Montreal, Quebec, Canada
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