[Treatment of hallux valgus by varus osteotomy of the first phalanx associated with adductor plasty]

Sixty two hallux valgus treated by first phalanx varus osteotomy associated to adductor hallux plasty were reviewed with a minimum follow-up of 4 years.48 females and 2 males were operated. Average age was 46 years. The forefoot was grecian 40 times. The pre-operative metatarsus varus was at an average of 14.2 degrees when the metatarso-phalangeal valgus was 33.3 degrees. The interphalangeal valgus was 8.25 degrees. The first phalanx base lateral translation measured an average of 5.8 mm. Sesamoids were always dislocated. 36 patients were treated in the same operative time, using this associated approach at different level.Results were evaluated according to 3 Groulier's criteria. In 10 cases, a post-operative pain persisted. Shoe wearing continually improved. The great toe valgus was corrected in 31 cases (50 per cent). The correction was partial in 20 cases (32.3 per cent) but on radiographs, only 34 cases (54.8 per cent) conserved a normal joint space. The first phalanx base lateral translation only improved partially. It measured an average of 408 mm. The global result was good in and very good, 67 per cent, while patients subjective estimation was good or very good in 90.3 per cent.The study of this series of first phalanx varus osteotomy associated to adductor plasty shows lateral subluxation partial correction, factor of long term modification on articular metatarso-phalangeal joint space. The adductor plasty associated to abductor disinsertion showed a results improvement compared with other published series.The first phalanx varus osteotomy associated to adductor plasty should be limited to moderate hallux valgus deformity with interphalangeal valgus and without any major articular incongruity.