درمان هالوكس والگوس در نوجوانان با استئوتومي دوگانه متاتارس

Double Osteotomy of First Metatarsus for Adolescent Hallux Valgus Deformity

Background: Double osteotomy of first metatarsal has been advocated as a procedure of choice for severe hallux valgus in adolescent age group. We would like to report our experience with such an osteotomy in Meshhad. Methods: Over a five year period (1999-2004), 26 feet in 17 adolescents - mean age of 15.5 years - with moderate to severe hallux valgus underwent double first metatarsal osteotomies. With a mean follow-up of 26 months. the cases were evaluated by American Orthopaedics Foot & Ankle Society Hallux Metatarsophalangeal- interphalangeal scale (AOFASIHMI). In this study pre and post hallux valgus (HVA), intermctatarsal (lMA). and distal metatarsal articular (DMAA) angles, and the relation between the angles and patient satisfaction were evaluated. Results: The mean angular corrections for hallux valgus (HVA), intermetatarsal (lMA) and distal metatarsal articualr (DMAA) angles were 26.65, 6.20 and 5.55 degrees respectively. Four cases could not be reached and from the remaining 13 patients, 2 cases had required second surgery for non-union and 3 cases had stillness in MTP (metatarsophalangeal) joints. Sixteen cases reported good to excellent results. Conclusions: Double first metatarsal osteotomy for severe hallux valgus is a reasonable procedure in adolescents which maintains the correction. Non-union and first MTP joint contractures are the two main side effects