Surgical treatment for bunions in adolescents

The results of three different surgical procedures for the correction of bunions on 25 adolescent feet (distal soft-tissue procedure, proximal closing-wedge osteotomy of the first metatarsal with distal soft-tissue procedure, and proximal phalangeal osteotomy) are reviewed. The results with an average follow-up of 3.5 years were excellent or good in 21 cases, and fair or poor in 4. The average correction of the metatarsophalangeal angle, the intermetatarsal angle, and the hallux valgus interphalangeus angle was, respectively, 9.88, 3.11, and 0.0 degrees for the first procedure, 21.0, 6.87, and 0.0 degrees for the second, and 11.0 0.9, and 22.5 degrees for the third. We conclude that distal soft-tissue reconstruction allows only mild to moderate correction of the metatarsophalangeal and intermetatarsal angles, and the association of a proximal osteotomy of the first metatarsal produces an statistically significant better correction (p < 0.05). Hallux valgus interphalangeus deformities are corrected only by proximal phalanx osteotomies. The selection of a particular procedure should therefore be based on an appropriate preoperative planification.