Operative treatment for hallux valgus in children with cerebral palsy

All patients with cerebral palsy who had hallux valgus and bunion deformities surgically corrected between 1986 and 1995 were reviewed to determine whether techniques other than arthrodesis of the first metatarsophalangeal joint would adequately correct these deformities. Twenty-six feet of 17 patients were surgically corrected for their bunions and/or their hallux valgus deformity. The mean hallux valgus angle for all children was 30 degrees, preoperatively, with 70% correction achieved. Four techniques of surgical correction were used. A first metatarsophalangeal joint arthrodesis on eight feet gave excellent outcomes for all using the duPont Bunion Rating Score and a mean of 89% correction of the hallux valgus angle. A proximal first metatarsal osteotomy, distal soft tissue release, and exostectomy of the bunion on five feet gave three excellent and two fair outcomes, with a mean of 83% correction of the hallux valgus angle. A distal soft tissue release and exostectomy on eight feet gave four excellent outcomes, two good outcomes, and two fair outcomes, with a mean of 53% correction of the hallux valgus angle. An osteotomy of the first proximal phalanx, metatarosphalageal soft tissue release, and exostectomy on five feet gave three excellent outcomes, one good outcome, and one fair outcome with a mean of 36% correction of the hallux valgus angle. All patients who met the criteria for the procedures were satisfied with the outcomes; however, the first metatarosphalageal joint arthrodesis gave the best results with the highest percent correction and bunion score.