Application of bone graft to the medial side of the first metatarsal head in the treatment of hallux varus

Background: Hallux varus deformity is not frequent, is usually acquired, an d is poorly tolerated by patients. A common cause is the resection of an ex cessive amount of the head of the first metatarsal during an operation perf ormed to correct a hallux valgus deformity, The purpose of this study was t o evaluate the results of application of bone graft to the medal aspect of the first metatarsal head in order to restore missing bone after resection of an excessive amount of bone during a bunionectomy, Methods: Off thirty patients who had a hallux varus deformity that was trea ted operatively; eight (ten feet) had bone-grafting to the medial aspect of the first metatarsal head, Six patients (seven feet) were available for ev aluation at an average of 8.6 years (range, two to twenty-two years) postop eratively. The original reasons for the consultation for the hallux varus d eformity were pain in the great toe, discomfort with shoewear, and the cosm etic appearance of the deformity, The pain typically was located on the med ial aspect of the great toe and was caused by the pressure of the shoe; the pain usually was aggravated by walking. Preoperatively, the passive range of dorsiflexion averaged 72 degrees (range, 60 to 80 degrees); the passive range of plantar flexion, 12 degrees (range, 10 to 20 degrees); and the var us deformity 18 degrees. Results: Six of the seven feet had a satisfactory result, The pain associat ed with the varus deformity had disappeared in all patients. One patient wa s dissatisfied because of 20 degrees of valgus angulation, The passive rang e of dorsiflexion averaged 63 degrees (range, 60 to 70 degrees), and all pa tients had 10 degrees of plantar flexion. Overall, the valgus angulation of the metatarsophalangeal joint averaged 19 degrees (range, 16 to 22 degrees ). There was no recurrence or persistence of the varus deformity In three f eet, the joint space was reduced, but this did not jeopardize the clinical result. Conclusions: A bone graft screwed onto the medial aspect of the metatarsal head provided a good result. This technique is indicated when the varus def ormity is related to a previous resection of an excessive amount of bone du ring a bunionectomy and when the deformity is passively reducible to neutra l.