Is Hemiepiphysiodesis Enough? Evaluating Growth Modulation in Juvenile Hallux Valgus.

BACKGROUND

Juvenile hallux valgus (JHV) is a progressive forefoot deformity that is often managed nonoperatively, though surgery is required for persistent symptoms. Traditional osteotomies provide definitive correction but carry a recurrence risk in skeletally immature patients. Lateral first metatarsal hemiepiphysiodesis is a minimally invasive growth modulation technique intended to improve alignment and delay osteotomy; however, long-term outcomes remain unclear. This study evaluated radiographic correction, persistence of deformity, and need for revision following hemiepiphysiodesis for JHV.

METHODS

Institutional records (2006 to 2024) were reviewed to identify pediatric patients undergoing hemiepiphysiodesis with at least 1 year of radiographic follow-up. Demographics, radiographic parameters, complications, and secondary procedures were collected. Paired t tests assessed preoperative to postoperative changes and χ2 tests were used for comparisons of categorical variables.

RESULTS

Among 482 patients with radiographically confirmed JHV, 20 feet in 13 children met the inclusion criteria. Mean age at surgery was 10.0±1.8 years, with a mean follow-up of 57±45 months. Diagnoses included idiopathic (n=9), syndromic (n=3), and neuromuscular (n=1) etiologies. Preoperative symptoms were common, including pain (84.6%), shoe-wear difficulty, and activity avoidance. HVA improved from 33.3 to 27.4 degrees (-6.0 degrees, P=0.014), and IMA improved by -1.9 degrees (P=0.024). Annual correction rates were -3.0 degrees for HVA and -1.2 degrees for IMA. Despite these improvements, residual deformity (HVA ≥ 15 degrees) persisted in 80% of feet. Six reoperations (30% of feet; 38% of patients) were performed at a mean of 6.2 years postoperatively, frequently involving osteotomies.

CONCLUSIONS

Hemiepiphysiodesis yields modest radiographic correction in skeletally immature patients with JHV but rarely restores normal alignment, and at least one-third ultimately require corrective osteotomy. These findings support its use as a temporizing option that may delay but not necessarily avoid the need for revision.

LEVEL OF EVIDENCE: Level IV-retrospective case series.