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First clinical experience of a new surgical technique including correction of bony alignment of first foot ray combined with reconstruction of muscle balance in case of adolescent hallux valgus

BACKGROUND: Hallux valgus deformity of the big toe in adolescents accounts for 22%44% of all relevant cases. Despite a relatively large number of surgical treatment methods proposed to correct this deformity, treatment results are not always satisfactory. The problem of imbalance between the external traction of the abductor hallucis muscle and the contracted adductor muscle in hallux valgus remains controversial and is not covered in the literature. 
AIM: This study aimed to examine the results of hallux valgus deformity treatment, following the suggested combined technique. 
MATERIALS AND METHODS: Eight teenage patients (10 feet), aged 15 years on average, were assessed. Patients were undergoing treatment in the department of pediatric orthopedics of the Dana Hospital, Tel Aviv, within the period from 2015 to 2019. The average postoperative observation period was 30 months. This study suggested a new combined technique, including (1) modified oblique Chevron osteotomy with a V-shaped cut in the distal aspect of the first metatarsal with the dorsal wedge excision performed at the apex of its angulation, (2) valgus osteotomy of the medial cuneiform bone with the insertion of the V-shaped bone allograft, and (3) transfer of the dorsal portion of the pre-split tendon of abductor hallucis muscle to the base of the triangular medial capsular flap of the first metatarsophalangeal joint (MPJ). The tendon received optimal tension to restore the muscular balance. 
RESULTS: This surgical technique provided safe and stable correction of the hallux valgus deformity, restored muscular balance, avoided movement restriction of the first MPJ, and restored the function and strength of the abductor halluces muscle that prevented the recurrence of the deformity. The number of good and excellent results was much greater than those in published reports. 
CONCLUSIONS: Despite a relatively small group of patients, the suggested technique has shown improvements in hallux valgus deformity in adolescents.