Hallux valgus deformity treated with the extensor hallucis longus tendon transfer by dynamic correction

Recurrence of hallux valgus is considered to be the most common problem experienced postoperatively. We designed and carried out operations to correct hallux valgus by transferring the extensor hallucis longus (EHL) tendon to reduce the likelihood of recurrence.

Twenty-five patients (38 feet) with the average age of (46.3 ± 12.3) (range, 22 to 60) years underwent the operation. The American Orthopaedic Foot and Ankle Society score and weight-bearing radiographs of the foot were applied to assess the feet pre- and postoperatively with a mean duration of follow-up of (38.2 ± 3.2) months. The surgical procedure includes the release of the distal soft tissues, excision of the medial eminence, plication of the medial part of the capsule, and transfer of the EHL tendon, and reconstructing its insertion.

At follow-up, 35 feet (23 patients, 85%) were free from pain at the first metatarsophalangeal (MTP) joint. In three feet (two patients), the pain was alleviated but persisted. The mean hallux valgus angle decreased significantly from a preoperative 38.3° ± 8.0° to 7.3° ± 2.0° at the time of the most recent follow-up (P < 0.0001), and the mean intermetatarsal (IM) angle decreased significantly from preoperative 12.5° ± 3.4° to postoperative 6.5° ± 2.4° (P < 0.0001). The mean score according to the American Orthopaedic Foot and Ankle Society had increased from 46.5 to 84.8 points (P < 0.0001).

Hallux valgus can be corrected by transferring the EHL tendon medially and reconstructing its insertion. The technique can achieve stress balance of metatarsophalangeal joints and therefore prevent the recurrence of hallux valgus.