[Split transfer of the extensor hallucis longus tendon in flexible hallux varus deformity].

OBJECTIVE

Realignment of a flexible hallux varus deformity through split transfer of the extensor hallucis longus tendon.

INDICATIONS: Flexible hallux varus deformity without any osseous deformity in patients with painful calluses, worsening of the varus position, or imminent lesser toe deformities.

CONTRAINDICATIONS: Contract hallux varus deformity, bony malalignment, painful arthritic first metatarsophalangeal joint, neuropathy, infection.

SURGICAL TECHNIQUE: Medial release with VY-lengthening of the capsule. Tenotomy of the abductor hallucis tendon. Lateral reefing of the metatarsophalangeal joint capsule. Transfer of the split extensor hallucis longus tendon beneath the intermetatarsal ligament to the lateral aspect of the phalanx.

POSTOPERATIVE MANAGEMENT: Dressing with the great toe in an appropriate position. Immediate weight bearing in a forefoot relief orthosis for 4 weeks. Comfortable shoes for the next 2 weeks. Physiotherapy (muscular strengthening, standing on tiptoes, aquajogging) after 6 weeks.

RESULTS

Twelve patients were followed up clinically and radiologically after a mean of 18 months. Four patients complained of pain during weight bearing (barefoot walking and wearing soft-soled shoes). Another seven patients presented with a limited range of motion in the first metatarsophalangeal joint. Overall, the range of motion has decreased significantly (p < 0.05). In five patients, an average varus position of 14 degrees was found on plain radiographs. Clinically, this malalignment was obvious in only two patients. All patients presented with sufficient ground contact of the great toe. As arthritic changes have not been detected radiologically, the limited range of motion in the first metatarsophalangeal joints has to be attributed to the tenodesis effect of the transferred tendon slip.