SLR - January 2024 - Wijesinghe
Title: First Metatarsal Hemiepiphysiodesis for the Treatment of Juvenile Hallux Valgus: A Systematic ReviewReference: Artioli E, Mazzotti A, Langone L, Zielli SO, Arceri A, Bonelli S, Faldini C. First Metatarsal Hemiepiphysiodesis for the Treatment of Juvenile Hallux Valgus: A Systematic Review. J Pediatr Orthop. 2023 Oct 1;43(9):584-589.
Level of Evidence: Level IV
Scientific Literature Review
Reviewed By: Wathmi Sajika Wijesinghe, DPM, PGY2
Residency Program: Scripps Mercy Podiatry Residency Program in San Diego, California
Podiatric Relevance: Hallux Valgus (HV) is one of the most common structural deformities of forefoot treated by foot and ankle surgeons. Juvenile hallux valgus (JHV) can be challenging to treat given the open physeal plates. This can be debilitating condition as these younger patients have difficulty with cosmesis, inability to fit into shoes, and difficulty participating in sports. This is the first systematic review of this topic who aim to evaluate the efficacy of hemi-epiphysiodesis in the treatment of JHV by evaluating both clinical and radiological outcomes
Methods: Google Scholar, Embase, PubMed, and Cochrane data bases was used to pool case series, cohort studies, and clinical trials reporting surgical outcomes, with radiographical and clinical findings, until February 28th, 2023. Six studies were included with 85 patients, with 144 hallux valgus deformities, who underwent hemiepiphysiodesis. Data collection included specific type of procedure, post op cares, complications, AOFAS scores, and radiographic measurements including hallux valgus and intermetatarsal angle (IMA) along with proximal metatarsal articular angle in anteroposterior plane (PMAA-AP) and proximal metatarsal articular angle in the lateral plane ( PMAA-L).
Results: Different approaches were used to perform hemiepiphysiodesis whether its drilling and curettage or medial or lateral hemiepiphysiodesis. Post op care included immediate WBAT. Complications occurred in 12.5% of cases with most common being persistent pain in 4% of cases. Mean pre op AOFAS scores improved from 70.6 to 89.4. Mean pre op HV angle was 28.3 degrees which improved to 24.03 degrees post operatively. Mean pre op IM angle of 13 degrees decreased to 10.9 post operatively. Mean pre op PMAA-AP angle of 89.57 increased to 91.51 post operatively. Minor change noted in the mean pre op PMAA-L with decrease from 91.32 degrees to post op value of 91.28.
Conclusions: Authors concluded that hemi-epiphysiodesis can be safe surgical treatment for JHV with improved clinical and radiological outcomes. Post op HV and IM angles after hemiepiphysiodesis were compared to recent study that showed HV angle of 13.2 degrees and IM angle of 9.5 degrees after distal metatarsal osteotomy. This illustrate that hemi-epiphysiodesis was not able to completely correct the deformity where the post op angles after hemi-epiphysiodesis still represented mild to moderate HV deformity. Some of the limitations of the study included retrospective nature of the studies and concurrent implementation of first proximal phalanx hemiepiphysiodesis on certain patients. Based on the results of the study, it is unclear superiority of one technique vs the other.