CONGENITAL HALLUX VARUS DUPLEX: RECONSRUCTIVE SURGERY FOR CORRECTION OF THE DEFORMITY
Keywords:congenital hallux varus duplex, additional medial ossification center of the first metatarsal bone, McElvenny and Farmer operative techniques
Materials and methods: A case of a child at the age of 1 year and 8 months with a secondary single-sided hallux varus has been treated at the University Hospital of Active Treatment in Orthopaedics “Prof. B. Boytchev.” The deformity if caused by two anomalies: polysyndactyly and the presence of a medially located, additional secondary ossification center of the first metatarsal bone. The diagnosis is clinical at time of birth and radiologic at the age of 1 year, when the ossification center is already visible. The operative treatment is a combined technique of the reconstructive methods of McElvenny and Farmer, with modification of the same accordingly to the specific case. The assessment of the postoperative results is on the basis of changes in the angle, formed by the longitudinal axes of the first proximal phalanx and the fifth metatarsal bone, and with a scale from 1 to 10 for grading the aesthetic and functional effect of the operation (according to the parents of the child).
Results: The follow-up of the patient was carried out during the stay at the clinic, on the 2nd and 3rd week, on the 6th and 12th months post-operatively. A correction of the medial deviation of the toe was achieved. The angle between the proximal phalanx and the fifth metatarsal bone decreased from 66.7° to 12.5° on the 12th post-operative month.
Conclusion: In the case described, the combined techniques of reconstruction of the toe are effective in correcting the angle of the deformation caused by the preaxial polysyndactyly. Our end result is similar to the results of other authors using the same operative techniques in different combinations and/or alone. We recommend that the operation should be performed at the age between 9 and 12 months with the combined techniques of McElvenny and Farmer.