Folie 1

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Hallux Valgus in Children and Adolescents Treated
by First Metatarsal SCARF Osteotomy.
Kehayov R , Mednikarov E ,Stefanov S ,Efremov E
. Dept. Of Pediatric Orthopaedics, University
Hospital of Orthopaedics, Sofia.
Hallux valgus deformity occurs in about 12 of
the children and adolescents, approximately 5
of the cases in general necessitating surgical
management. A great number of techniques have
been described for correction of hallux valgus
deformity. The combination of a double chevron
Z-shaped SCARF redirectional osteotomy of the
first metatarsal bone and a capsuloplasty of the
first MTFJ shows good results in adults. The same
surgery can be applied in children without any
risk of growth disturbances.

• Method and Material
• Forty-two (42) children, 38 girls and 4 boys were
  followed up in this study.
• The etiology was identified in 10 of the cases
  and 90 were considered idiopathic.
• The mean age at the time of the surgery was 14
  years (range 9 18 years).
• All the patients were operated on by means of a
  SCARF osteotomy and capsuloplasty of the first
  MTFJ, and medial release of the soft tissues by
  McBrides technique.
• Postoperatively the patients were protected by a
  shoe of Barouk for 30 days.
• The postoperative clinical results were estimated
  according to the questionnaire of AFAS.
• The postoperative radiographic results were
  estimated according to the classification of
  Bonney and Macnab, Piggot, AFAS.

• Clinical Results
• They were appreciated with a minimal follow-up of
  two years, according to the 3 Groulier's
  criteria correction of deformation, statics
  complaints, functional activity.
• The results were accepted as good or satisfactory
  if 1 to 3 functional disorders of the initial
  deformation were present., and as bad if the
  latter were gt3 or there was a complication.
• In 80 of the patients the pain had been absent
  to minimal six months following the surgery.
• In 5 cases there were complications superficial
  infections or reccurrence of the deformity.

• Radiographic evolution
• The correction of the metatarsal varus and the
  metatarsophalangial valgus was obtained without
  disturbance of the growth plate of the first
  metatarsal bone..
• The preoperative metatarsus varus was of 158.
  Mean alignment of metatarsal bar was 314.
• The cuneo-metatarsal joint was twenty two times
  spheric and twenty eight times plane. The average
  metatarso-phalangeal great toe valgus was 398.
• Patients with metatarsus varus gt 10 or normal
  distal metatarsal angle had good results.
• According to Piggots criteria, postoperatively
  35 (70) of the feet were grade I and 15 (30)
  grade II.

Results Hallux valgus deformation in children
and adolescents is often underestimated
operative treatment should be considered in
certain cases. They were appreciated with a
minimal follow-up of two years, according to the
3 Groulier's criteria correction of deformation,
statics troubles, functional activity. Overall
results were excellent or good in 70,
satisfactory in 22, and bad in 8 of cases.
Discussion Scarf Osteotomy of the first
metatarsal allows complete correction of
metatarsus varus. The surgical approach can be
proposed at every age. There are no vascular
trouble or arthrosis worsening. It must be
completed with an adductor and I MTFJ plasty.