Hetherington



Yüklə 180,15 Kb.
Pdf görüntüsü
səhifə3/3
tarix28.04.2017
ölçüsü180,15 Kb.
1   2   3

Fig. 6-12. Compressive and tension forces applied to the 

first metatarsal epiphysis as theorized by Luba and Rossman.

 

cally and radiographically. The growing foot, however, 



adds another dimension to this surgical correction. It 

appears that a slightly elevated intermetatarsal angle, 

at the time of examination in the child, may need 

greater reduction because of its tendency to increase 

with age. The timing of surgery should be related to 

the severity of symptoms, the estimation of progres- 

sion of deformity based on radiographic criteria, and 

the skeletal age of the child. Estimation of skeletal age 

is important especially with regards to procedures 

around or involving the epiphyseal plate. 

The goals of surgery in juvenile hallux valgus are 

primarily to correct the deformity, to reduce the inter- 

metatarsal angle, to reduce the hallux abductus angle, 

to obtain and maintain a congruous metatarsophalan- 

geal joint with realignment of the sesamoids, and to 

have a pain-free range of motion. All this is predicated 

on the choice of the correct procedure. 

A number of surgical procedures that may be used 

in the management of juvenile hallux valgus include 

soft tissue tendon-balancing procedures, whose main 

aim is to realign the osseous structures by correcting 

abnormality of soft tissue ligamentous and capsular 

structures. However, these procedures are infre - 

quently done in the patient with juvenile hallux valgus 

as the primary procedure but are often used in con- 

junction with distal or proximal osteotomies that cor- 

rect structural deformities. Distal metatarsal osteoto- 

mies can decrease the intermetatarsal angle and 

realign structural abnormalities in the transverse 

plane such as abnormal proximal articular set angles. 

They can shorten or maintain the length of the meta- 

tarsal. Distal osteotomies of use in juvenile hallux 

valgus include the Mitchell, Wilson, Austin, Reverdin, 

or Hohman types. Reduction of the intermetatarsal an- 

gle is accomplished by lateral displacement of those 

osteotomies. The degree of reduction will be less than 

that obtained with proximal osteotomies, and there- 

fore lateral displacement osteotomy is used with inter- 

metatarsal angles ranging from 12° to 16°. Proximal 

osteotomies inc lude osteotomies of the metatarsal 

base, of the metatarsocuneiform joint in combination 

with a fusion, or cuneiform osteotomies. These osteot- 

omies are used to correct  hallux valgus deformities 

with increased intermetatarsal angles greater than 16°. 

Phalangeal osteotomy is limited to those cases in 

which structural deformity of the phalanx exist such as 

a transverse plane clinodactyly. Epiphysiodesis has 

been reported to be successful in the management of 

juvenile hallux valgus, and is best used in the child that 

is approaching skeletal maturity.

49

 

Complications following surgery for juvenile hallux 



valgus include recurrence of the deformity, Scranton 

and Zuckerman

50

 reported a failure rate of 50 percent 



in patients with long first metatarsals and a 56 percent 

failure rate associated with collapsing pes valgo 

planus. Drennan,

51

 at an American Academy of Ortho- 



pedic Surgeons meeting in 1990, reported 30 to 50 

percent recurrence of deformity after an initial proce- 

dure requiring secondary intervention. Metatarsalgia 

may occur postoperatively with excessive elevation or 

shortening of distal or proximal osteotomies. Exces- 

sive dorsiflexion may also lead to joint stiffness and 

secondary hallux rigidus. Total or partial premature 


 

122    HALLUX VALGUS AND FOREFOOT SURGERY 

epiphyseal plate closure may occur and result in short- 

ening or angular deformity of the metatarsal, under- 

correction, or overcorrection. Epiphyseal plate clo- 

sure may result secondary to osteotomy or arthrodesis 

of the metatarsal cuneiform  articulation. 

Juvenile hallux valgus is a complex deformity that 

needs careful preoperative clinical and radiographic 

evaluation. Consideration should be given to the ap- 

propriate timing of the procedure relative to the skele- 

tal growth of the child. It  is important to remember 

that no one procedure is appropriate for all juvenile 

or adolescent hallux valgus deformities. 



REFERENCES

 

1.



 

Craigmile DA: Incidence, origin and prevention of cer- 

tain foot defects. Br Med J 2:749, 1953 

2.

 



Clough JG, Marshall HJ: The etiology of hallux abducto 

valgus. A review of the literature. J Am Podiatr Med As- 

soc 75:238, 1985 

3.

 



Root ML, Orien WP, Weed JH: Normal and Abnormal 

Function of the Foot. Los Angeles. Clinical Biomechanics 

Corp., 1977 

4.

 



Duke H, Newman LM, Bruskoff BL, et al: Relative meta- 

tarsal length patterns in hallux abducto valgus. J Am 

Podiatr Assoc 72:1, 1982 

5.

 



Gerbert J: Textbook of Bunion Surgery. 2nd Ed. Futura 

Publishing, New York, 1991 

6.

 

Harris RI, Beath T: The short first metatarsal: its inci- 



dence and clinical significance. J Bone Joint Surg Am 

31:553, 1949 

7.

 

Robinson HA: Bunion: its cause and cure. J Surg Gynecol 



Obstet 27:343, 1918 

8.

 



Kalen V, Brecher A: Relationship between adolescent 

bunions and flatfeet. Foot Ankle 8:331, 1988 

9.

 

Hardy RH, Clapham JCR: Observations on hallux valgus. 



J Bone Joint Surg 33B:376, 1951 

 

10.



 

D'Amico JC, Schuster RO: Motion of the first ray. J Am 

Podiatr Assoc 69:17, 1979 

11.


 

DeBritto  SR: The first metatarso-sesamoid joint.  Int 

Orthop 6:67, 1984 

12.


 

Jahss MH (ed): The sesamoids of the hallux. Clin Orthop 

157:88. 1981

 

13.



 

Durman DC: Metatarsus primus varus and hallux valgus. 

Arch Surg 74:128, 1957 

14.


 

Durman DC: Metatarsus primus varus and hallux valgus. 

J Bone Joint Surg 39A:221, 1957 

15.


 

Lapidus PW: Operative correction of metatarsus primus 

varus in hallux valgus. Surg Gynecol Obstet 58:183,1934 

 

16.



 

Kleinberg S: Operative care of hallux valgus and bun- 

ions. Am J Surg 15, 1932 

17.


 

Wheeler PH: Os intermetatarseum and hallux valgus. 

Am J Surg 18:341, 1932  

18.


 

LaPorta G, Melillo T, Olinsky D: X-ray evaluations of 

hallux abducto valgus deformity. J Am Podiatr Assoc 

64:544, 1974 

19.

 

Jiminez AJ, Corey SV: Hallux valgus, intractable plantar 



keraotsis   sub   second   metatarsal,   hammertoe.    In 

McGlamry ED (ed): Reconstructive Surgery of the Foot 

and  Leg,   Update   '87.   Podiatry  Institute   Publishing, 

Tucker, GA, 1987 

20.

 

Sage RA, Jugar DW: Hallux pinch calluses: some etio- 



logic considerations. J Foot Surg 19:148, 1980 

21.


 

McCrea JD, Lichty TK: The first metatarsocuneiform ar- 

ticulation and its  relationship to metatarsus primus 

varus. J Am Podiatr Assoc 69:700, 1979 

22.

 

Steel MW, Johnson KA, De Witz MA, et al: Radiographic 



measurements of the normal foot. Foot Ankle 1:151, 

1980 


23.

 

Southerland C, Spinner SM: Preoperative criteria for hal- 



lux valgus surgery and use of convergent angled base 

wedge osteotomy. J Foot Surg 26:475, 1987 

24.

 

Scott G, Wilson DW, Bently G: Roentgenographic assess- 



ment in hallux valgus. Clin Orthop Relat Res 267:143, 

1991 


25.

 

Schechter DZ, Doll PJ: Tangential angle to the second 



axis. J Am Podiatr Med Assoc 75:505, 1985 

26.


 

Balding MG, Sorto LA: Distal articular set angle. Etiology 

and x-ray evaluation. J Am Podiatr Med Assoc 75:648, 

1985 


27.

 

Barnett CH: Valgus deviation of the distal phalanx of the 



great toe. J Anat 96:171, 1962 

28.


 

Duke H, Newman LM, Bruskoff  BL. et al: Hallux abductus 

interphalangeus and its relationship to hallux valgus 

surgery. J Am Podiatr Med Assoc 72:625, 1982 

29.

 

McGlamry ED: Hallucal sesamoids. J Am Podiatry Assoc 



55:693. 1965 

30.


 

Smith RW, Reynolds JC, Stewart MJ: Hallux valgus assess- 

ment: report of research committee of the American 

Orthopedic Foot and Ankle Society. Foot Ankle 5:92, 

1984 

31.


 

Yu GV, DiNapoli R: Surgical management of hallux ab- 

ducto valgus with concomitant metatarsus adductus. In 

McGlamry ED (ed): Reconstructive surgery of the foot 

and   leg,   Update   '87.   Podiatry   Institute   Publishing, 

Tucker. GA, 1987 

32.

 

Jahss MH: Hallux valgus: further considerations, the first 



metatarsal head. Foot Ankle 2:1, 1981 

33.


 

Kilmartin TE, Wallace WA: First metatarsal head shape 

in juvenile hallux abducto valgus. J Foot Surg 30:506, 

1991 


 

PREOPERATIVE ASSESSMENT IN HALLUX VALGUS    123

 

34.


 

Cole AE: Foot inspection of the school child. J Am Po- 

diatr Med Assoc 49:446, 1959 

35.


 

Gould N, Schneider W, Ashikaga T: Epidemiological sur- 

vey of foot problems in the continental United States. 

1978-1979. Foot Ankle 1:8, 1980 

36.

 

Hardy RH, Clapman JCR: Hallux valgus; predisposing 



anatomical causes. Lancet ii:1180, 1952 

37.


 

Piggott H: The natural history of hallux valgus in adoles- 

cence and early adult life. J Bone Joint Surg 42:749, I960 

38.


 

Johnston O: Further studies on the inheritence of hand 

and foot anomalies. Clin Orthop Relat Res 

39.


 

Goldner JL, Gaines RW: Adult and juvenile hallux valgus: 

analysis and treatment. Orthop Clin North Am 7:863, 

1976 


40.

 

Lundberg BJ, Sulja T: Skeletal parameters on the hallux 



valgus foot. Acta Orthop Scand 43:749, 1960 

41.


 

Jones RA: Hallux valgus in the adolescent. Proc R Soc 

Med 41:391, 1948 

42.


 

Bohm M: The embryonic origin of clubfoot. J Bone Joint 

Surg 27:229, 1945 

43.


 

Hawkins FB, Mitchell CL, Hedrick DW: Correction of 

hallux valgus by metatarsal osteotomy. J Bone Joint Surg 

27:387, 1945

 

44.


 

Simmonds FA, Menelaus MB: Hallux valgus in adoles- 

cent. J Bone Joint Surg 42B:76l, I960 

45.


 

Bonney G, McNab, L: Hallux valgus and hallux rigidus— 

a critical survey. J Bone Joint Surg 34B:366, 1952 

46.


 

Truslow W: Metatarsus primus varus or hallux valgus. J 

Bone Joint Surg 7:98, 1925 

47.


 

Luba R, Rosman M: Bunions treatment with a modified 

Mitchell osteotomy. J Pediatr Orthop 4:44, 1984 

48.


 

Kilmartin TE, Barrington RL, Wallace WA: Metatarsus pri- 

mus varus. J Bone Joint Surg 736:937, 1991 

49.


 

Fox IM, Smith SD: Juvenile bunion correction by epiphy- 

siodesis of the first metatarsal. J Am Podiatr Med Assoc 

73(9):448, 1983 

50.

 

Scranton PE, Zuckerman JD: Bunion surgery in adoles- 



cents: results of surgical treatment. J Pediatr Orthop 

4:39, 1984 

51.

 

Drennan JC: Instructional Course Lectures, The Childs 



Foot I. In Proceedings, Annual Meeting AAOS, New Or- 

leans, LA, February 1990 




Yüklə 180,15 Kb.

Dostları ilə paylaş:
1   2   3




Verilənlər bazası müəlliflik hüququ ilə müdafiə olunur ©azkurs.org 2020
rəhbərliyinə müraciət

    Ana səhifə