[Surgical treatment of recurrent hallux valgus]

Little work has been reported on the treatment of recurrent hallux valgus. We reviewed 64 cases after surgical treatment in order to ascertain the cause of recurrence, results of the treatment given, and deduce therapeutic options and indications.

Fifty-nine patients had 64 recurrent hallux valgus bunions. Mean age of the patients was 58 years, 54 women and 5 men. The clinical and radiographic preoperative work-up led to two categories of treatments. In 35 cases, conservative treatment was used to re-align the axis by procedures on the soft tissues either alone or in combination with MacBride tendon transfers, metatarsal osteotomies, or osteotomies to shorten the first phalange. In 29 cases, metatarsophalangeal arthrodesis was used. Patient satisfaction, pain, deformation, shoe wearing and activity were recorded at follow-up. The same radiological parameters were used postoperatively to assess anatomic results.

Mean follow-up was more than 6 years (range 2-18 years). The subjective result was good in 52 cases. The objective result was good in 50 cases and poor in 14 (including 7 cases with insufficient correction). The results were analyzed by type of treatment.

The preoperative analysis demonstrated that recurrence is due to insufficient initial treatment which must take into account all the components leading to the deformation. Arthrodesis gave a good result in 83% of the cases and conservative treatment gave a good result in 71%. Thus, in our opinion, no one type of treatment of recurrent hallux valgus can be applied for all patients. Nevertheless, conservative treatment should associate complementary procedures that can be deduced from the clinical and radiological analysis.