The Clinical Study Of The Procedure Of Reconstructing The Transverse Arch Of The Forefoot By Transfering And Anastomosing Abductor Hallucis And Adductor Haltucis Tendons On Correcting Hallux Valgus

Objective:To explore the curative effect of clinical application of the procedure ofreconstructing the transverse arch of the forefoot by anastomosing abductorhallucis and adductor hallucis tendons on correcting hallux valgus.Materials and Methods：We have retrospectively assessed18patients (26feet) treated with theprocedure of reconstructing the transverse arch of the forefoot by anastomosingabductor hallucis and adductor hallucis tendons from January2012to October2014.There are1male (1feet) patients and17female (25feet) patients in thisgroup,10of them are unilateral,others are bilateral.The average age at the timeof surgery was47.1years old (from19to66years).The mean preoperativesustaining period of complaints was5.3years (from1to17years).All the caseshad pain over the first MP joint;15feet have obviously collapsed transverse archof the forefoot,and combined callus in the plantar.there were3feet combinedhammer toe deformity.American Orthopaedic Foot and Ankle Society’s (AOFAS) scorewas (57.46±8.01).Preoperative weight-bearing anteropsterior X-ray displayed:hallux valgus angle (HVA) was (33.92±5.65)°,intermetatarsal angle (IMA) was(13.73±2.09)°,tibial sesamoid position (TSP) was (3.46±1.03).According toclassification of the HV proposed by Mann:6feet were mild;moderate15feet;severe5feet.Results:There was1patient (1foot) appeared superficial infections of incision aftersurgery,others were healing by first intention.Two cases (3feet) appeared numbness in the toes.All of18cases were followed up,and the follow-up periodfrom6months to31months,an average of10months.Based on the AOFAS score,therewere14feet excellent,9feet good,2feet medium and1feet poor.And the rate ofexcellent and good was88.4%.At the last follow up period,mean values of theHVA,IMA,TSP and AOFAS score was (13.50±3.52)°,(8.62±2.17)°,(2.00±0.85)and(87.85±8.03),respectively.There was statistically significant differencecompared with the preoperative ones (P=0.00).The collapsed transverse arch of theforefoot was recovered to some extent,callus under the heads of the seeond andthe third metatarsus disappeared (9feet),or decreased (6feet).One cases (1feet)appeared recurrence of hallux valgus deformity,and no case appeared halluxvarus.Conclusion:1.The procedure of reconstructing the transverse arch of the forefoot byanastomosing abductor hallucis and adductor hallucis tendons aimed at correctingthe main pathological changes of hallux valgus,and got well therapeutic effect.2.This procedure can not only effectively reduce hallux valgus angle and theangle between the1st and2nd metatarsal,meanwhile relocate the sesamoid system.3.The operation can reconstruct the collapsed transverse arch of the forefootto some extent,the pain of bunion and callus disappeared,and callus in the plantarwas shrinked or disappeared gradually.