Long-term Result Of McBride Surgery For Treatment Of Adolescent Hallux Valgus

【Objective】Adolescent hallux valgus is a common skeletal-muscular deformity of the lower limbs, which is characterized by hallux abduct, bunion, pain and the first metatarsal adduct. Although it have been studied for many years, there are argument among researchers about the pathogenesis and effective treatment method. This paper summarizes McBride surgery for adolescent hallux valgus with more than five years follow-up, to evaluate the long -term result of McBride surgery. All the results will be used to improve the treatment methods of adolescent hallux valgus and to modify the operative procedure of hallux valgus.【Materials and Method】From September 1995 to July 2005, 18 young patients with hallux valgus were treated with McBride procedure in China Japan union hospital of Jilin University. There were 13(18 feet) patients gained more than 5 years follow-up. There are 5 male (7 feet) patients and 8 female (11 feet) patients in this group, 8 of them are unilateral, others are bilateral; the average age at the time of the operation was 14.3 years (range 12 to 18 years).The X-ray films of all patients were collected preoperatively, two weeks postopera- tively and 5-12 years postoperatively. The hallux valgus (HVA), intermetatars angle (IMA), Range of motion of the metatarso- phalangeal joint (ROM) were measured and analyzed on radiogra- phs based on the American Orthopedic Foot and Ankle Society (AOFAS)rating systems.Using the paired samples T test statistic method to analyze all of the above items : preoperative and follow-up state, P<0.05 is statistically significant different.【Results】1. The follow-up period of this group varied from 5 to 12 years (average 7.1 years).Based on hallux metatarsophalangea -interphalangeal scale of Maryland rating system,10 feet (55.6%) were excellent ,4 feet (22.2%) good,2 feet(11.1%) fair.The rate of excellent or good was 77.8%.2. The AOFAS scale had statistically significant differences between preoperative and follow up state (P<0.001). The average HVA of this group is 34.00±5.19°preoperatively, and17.17±5.43°at follow-up state; the average IMA of this group is 14.94±4.07°preoperatively, and 7.89±1.88°at follow-up state. The average correction of HVA was 16.83±6.62°, it was the same with the correction of IMA 7.06±2.90°, the HVA,IMA had statistically significant differences between preoperative and follow up (P<0.001), there is no statistically significant differences between postoperative and follow up state (P>0.05).3. Of all the complications the reduction of ROM of the metatarso-phalangeal joint is most common, 4 feet had moderate limitation, 3 feet had severe limitation .The average dorsiflexion of the metatarso-phalangeal joint was 29.44±5.26°preoperatively and 37.17±3.05°at follow-up state; the average plantar flexion was 28.22±8.70°preoperatively and 36.61±4.57°at follow-up state. There is no statistically significant differences (P>0.05) between preoperative and follow up state.【Conclusions】1. We now consider that the most satisfactory age for operation is between 11 and 15 years.2. The indications for operation are: (1) Hallux valgus deformity sufficiently severe to make the foot ugly, to cause difficulty in obtaining comfortable shoes, or to cause pain. (2) Hallux valgus deformity likely to become severe. If serial radiographs, taken at intervals of six months, show progressive increase in an initially mild deformity, it is likely to become severe. (3) A further indication that the valgus deformity is likely to increase is the presence of a family history.3. McBride surgery can diminish the increased HVA effectively,with the correction of hallux valgus, IMA will be smaller accordingly.4. The McBride surgery is a technically simple method. There is small damage to bone and joint structure, so it is better for the functional recovery postoperatively. Through balancing the soft tissue forces of foot, McBride surgery can effectively improve symptoms and foot function in young patients with hallux valgus deformities. It is a better and reliable method to treat the mild-to- moderate adolescent hallux valgus deformity.