Congenital hallux varus (CHV) – treatment option according to deformity type. Role of lengthening osteotomy of the 1st metatarsal with longitudinal epihyseal bracket (LEB)

Aim. Treatment option evaluation of different types of CHV. Materials and Methods. 11 feet (7 children) were treated operatively due to CHV. Deformities were divided into 3 groups. 1. Halux varus related to LEB involving the 1st metatarsal – 7 feet (4 children) 2. Idiopathic hallux varus with normal 1st metatarsal and contractured medial band of soft tissues which pulls a big toe into varus – 2 feet (2 children). 3. Hallux varus resulted from metatarsus primus varus – 2 feet (1 child). In all groups additional big toe or polydactyly was present. Technique. For all deformity types different surgical techniques were used. In the 1st group a described standard option was opening wedge osteotomy of the 1st metatarsal with separation of LEB combined with amputation of additional big toe, tenotomy of abductor hallucis, FHL lengthening and medial joints release with K wire stabilization of the first ray. In an own modification the one-staged lengthening osteotomy of the 1st metatarsal was done with bone graft from amputated phalanx using as spacer and growth stimulator. In the 2nd and 3rd group different technique variations based on this one described above were needed for deformity correction. In all feet the Farmer’s skin plasty was done as additional option. Age at operation ranged from 7 to 24 months. Follow-up ranged from 4 months to 11 years. All patients were examined clinically and radiologically. Results. In all feet proper shape was achieved. In the 1st group an elongation of the medial ray of the foot was sufficient and no foot required further surgery. Conclusion. Independently of surgical technique choice in the treatment of congenital hallux varus achieved results were satisfying.