Abstract
Introduction
The management of adolescent hallux valgus (AHV) remains controversial, with reservations about both conservative and surgical treatments. Non-operative management has a limited role in preventing progression. Surgical correction of AHV has, amongst other concerns, been associated with a high prevalence of recurrence of deformity after surgery. We conducted a systematic review to assess clinical and radiological outcomes following surgery for AHV.
Methods & Materials
A comprehensive literature search was performed in the Cochrane Library, CINAHL, EMBASE, Google Scholar, and Pubmed. The study was performed in accordance with the recommendations of the PRISMA guidelines. Demographic data, radiographic parameters, and results of validated clinical scoring system were analysed.
Results
Nine contemporary studies reporting on 201 osteotomies in 140 patients were included. The female to male ratio was 10:1. Mean age at operation was 14.5 years (10.5–22). Mean follow-up was 41.6 months (12–134). The mean post-operative AOFAS score was 85.8 (sd ±7.38). The mean AOFAS patient satisfaction showed that 86% (sd ± 11.27) of patients satisfied or very satisfied with their outcome. On the DuPont BRS, 90% rated their outcome as good or excellent. There was a statistically significant improvement in the IMA (p=0.0003), HVA (p<0.0001), and DMAA (p=0.019). The main complication was persistent pain (12%); others included infection (2%), scar hypersensitivity (4.5%), and non-union, metatarsalgia, and CRPS (each at 0.5%), and no reports of metatarsal head AVN.
Conclusion
Based on the most current published evidence, surgery for AHV shows excellent clinical and radiological outcomes, with high patient satisfaction. The rates of recurrence and other complications are lower than the historically reported figures. There is, however, a need for high level, multi-centre collaborative studies with prospective data to establish the long-term outcomes and optimal surgical procedure(s).
