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Marek Napiontek, Michal Walczak Treatment of
the adolescent hallux valgus (AHV) by double
osteotomy of the first metatarsal
Department of Paediatric Orthopaedics and
Traumatology, University of Medical Sciences,
Poznan, Poland
Introduction. There is only 1 study assessing
clinical and radiological outcome of the 1st
metatarsal double osteotomy in the
treatment of AHV (Johnson AE et al. J Pediatr
Orthop. 1994 358-662). Material
presented there was comparable to ours but
follow-up period was shorter.
Purpose. Evaluation of the clinical and
radiological results after double level osteotomy
of the 1st metatarsal in AHV at the bone
maturity time.
Materials There were 13 females (22 feet)
operated at our institution in 1993-1998 by
different surgeons because of AHV. Double
level osteotomy of the 1st metatarsal bone
(distal closing wedge and proximal opening
wedge) was the basic surgical technique. Mean
age at operation was 14.3 ys (9.2-18.4). For the
follow- up examination arrived 8 patients (13
feet). Mean follow-up was 7.8 ys (5.3-10.3).
OP Technique
Methods Clinical examination (Kitaoka HB, AOFAS
1994 Hallux Metatarsophalangeal-Interphalangeal
Scale) and radiographic standing examination.
Results Good results were achieved in 7 feet,
poor in 6 feet. The angle between 1st and
2nd metatarsal diminished from 16º (10º-20º) to
8º (0º-28º). In 12 feet this angle was lower
than 9º. Hallux matatarsalphalangeal valgus
deformity on X-rays diminished from 38º
(23º-25º) before OP to 14º (2º-21º) in 11 feet
post OP. In 5 feet it was lower than 15º. 2
feet presented overcorrection ( varus deformity
23º and 28 º )
10-y-old girl before OP
Immediately after OP
Final result at age 20ys. Shortened
1st metatarsal

• Conclusions
• The 1st metatarsal double osteotomy was an
  effective technique for the treatment of AHV
• Poor results was caused by technical errors
  during surgery (different skill level of
  orthopaedic teams)