IATROGENIC HALLUX VARUS: TECHNIQUES AND INDICATIONS. A REPORT OF 65 CASES

Abstract

Introduction: Hallux varus deformity leads to a major esthetic and shoe wearing discomfort with a severe functional disability. Surgical procedures for correction must be adapted to the degenerative changings in the first MTP joint, to the joints stiffness and the IP joint claw.

Material and Methods: 80 patients have been operated on from 1981 to 2004

An enlarged debridment of the first MTP joint was mandatory before any reconstructive procedure.

The collateral lateral ligament reconstruction has been achieved with a synthetic suture (LigaproÒ or LigasticÒ of 1.5 mm diameter) according to flexible joint with no arthritis (regimen 1 (25 cases), youngpopulation (44 years) with an average varus of −12°).

The first MTP joint arthrodesis was performed for osteoarthritis combined with stiffness. (regimen 2 (40 cases), older (64 years) with an average varus of −16°.

Results: 15 patients were lost for FU.65 patients were clinically and radiologically reviewed with a medium FU of 10 years(2 to 25 years).

In series 1 (ligament reconstruction),24/25 patients were totally painless with an artificial device well tolerated. The joint motion, the gait and the shoe-wearing were normal in 24/25 of cases. The medium post-operative valgus was of 12°.

In series 2 (MTP arthrodesis), arthrodesis healed in 39 cases with an average time of 60 days. Valgus positionning was always restaured.Degenerative changings occured in the IP joint in 4 cases without any complain. Shoe- wearing was classical in all the cases.

Conclusions: The first MTP joint arthrodesis must be the referred procedure for hallux varus deformity according to OA and stiffness in the joint site.

Among the procedures for the first MTP joint preservation, enabled to restore valgus strength, the synthetic reconstruction of the collateral lateral ligament is a reliable and reproducible technique, without any damages for the active tendons nor for the joint function.