[Hallux varus congenitus]

Primary Congenital Hallux Varus: A Step-Cut Surgical Approach

Hallux varus is a rare deformity of the forefoot, which is characterized by medial deviation of the proximal phalanx of the great toe at the metatarsophalangeal joint. It is usually acquired, secondary to failed hallux valgus surgery, trauma, neurologic or rheumatologic disease. Rarely, this deformity may be congenital, either isolated, or in the context of various underlying congenital malformations of the foot, such as poly-syndactyly or longitudinal epiphyseal bracket, or part of generalized skeletal malformations. We present a case of bilateral congenital hallux varus with concomitant short first metatarsal in a three-year-old girl. A step-cut soft-tissue surgical procedure to achieve proper alignment of the medial ray of the foot is described.

A rare combination of brachymetatarsia and congenital hallux varus: case report and review of the literature

Hallux varus is defined as a medial deviation of the phalanx at the first metatarsophalangeal joint and can be congenital or acquired. Brachymetatarsia is defined as shortening of the metatarsal bones. A combination of hallux varus and brachymetatarsia is rare. A 15-year-old girl presented to our outpatient clinic complaining of problems with her feet. A distinctive hallux varus was present bilaterally combined with a brachymetatarsia of the first metatarsals. The patient reported discomfort. She was restricted in her activities and had severe psychological strain owing to the deformity. We decided on surgery. First, a Pennig MiniFixator for callus distraction of the first metatarsal bone was applied. Owing to the increased plantar subluxation of the phalanx during distraction, an extension of the external fixator was administered so that the hallux could be repositioned to a physiologically satisfying position. After sufficient callus formation, the hardware was removed 14 weeks after surgery. Thereafter, the phalanx moved back to the subluxed position. Finally, an arthrodesis of the first metatarsophalangeal joint was performed with a locking plate. Surgery should not be made only for cosmesis and associated psychological aspects; but, discomfort should be the deciding factor. The postoperative clinical and cosmetic results in our case were good, and the patient was quite satisfied. There was no longer any preoperative discomfort and pain.