Applications of the opening wedge cuneiform osteotomy in the surgical repair of juvenile hallux abducto valgus.

Juvenile hallux abducto valgus is a complex deformity of multifactoral etiology. The vast majority of cases, however, present as symptomatic or progressive misalignment of the first metatarsophalangeal joint with accompanying: 1) flexible flatfoot with anterior-medial imbalance, 2) medial column adductus, and 3) metatarsus primus adductus as a result of hyperobliquity of the first metatarsocuneiform joint (Lynch, F. R. Applications of the opening wedge cuneiform osteotomy in the surgical repair of juvenile hallux abducto valgus. Podiatry Tracts 5:173-187, 1987). Biplane cuneiform osteotomy, in conjunction with bicorrectional first metatarsal head osteotomy, was carried out a total of 48 times, in 44 patients, over a 5-year period of time. Patients averaged in age from 11 to 16 years old, with an average age of 13.2 years old. There were 44 females and no males, and the procedure was performed 18 times on the left foot, and 30 times on the right. Postoperative observations include decrease in the first intermetatarsal angle and hyperobliquity of the first metatarsocuneiform joint, decrease in medial column adductus, and stabilization of the anteromedial imbalance associated with the flexible flatfoot. Accordingly, the use of the biplane cuneiform osteotomy addresses the deformity at its apex and eliminates the primary contributory and etiologic factors responsible for its occurrence. It is thus invaluable in the surgical repair of juvenile hallux abducto valgus.