- Discussion:
- adolescent bunion is present if IM angle > 10 deg & HV angle > 20 deg;
- moderate deformity: HV of 25 - 40 deg,
- severe deformity: HV of more than 40 deg;
- in children, the finding of short thumbs and juvenile bunions may suggest
fibrodysplasia ossificans:
- Pathologic Findings:
- basis for juvenile hallux valgus is believed to be metatarsus primus varus;
- metatarsus primus varus & hallux valgus is most common combination of foot deformities encountered in adolescent;
- oblique 1st metatarsal - medial cuneiform articulation:
- another possible cause is increase lateral deviation of the distal articular surface of the MTP joint;
- obliquity of this joint may affect degree of metatarsus primus varus
- a flat joint will have minimal mobility where as a curved joint will have increased mobility;
- presence of long 1st metatarsal is also associated w/ juvenile bunion;
- approximately 50% of patients will have
flexible flat feet, and many will have generalized ligamentous laxity;
- spasm/contracture of the
abductor hallucis (which can occur in
cerebral palsy);
- Radiographs: 
- Non Operative Treatment:
- shoe modification can be extremely beneficial;
- Operative Treatment:
- surgical indications: severe deformity which is accompanied by pain;
- any proposed operation should address the metatarsus primus varus deformity (if it is present);
- w/ excessive lateral deviation of the distal metatarsal articular surface, consider distal metatarsal osteotomy (such as a
Chevron);
-
hypermobile first ray:
- consider
Lapidus procedure:
- shortening of the metatarsal will occur if a large biplanar wedge is resected from the joint;
- therefore, minimal cartilage resection is optimal technique;
- the incidence of pseudoarthrosis is approximately 15%;
-
long first metatarsal:
- is associated w/ high rate of recurrence;
- avoid opening wedge osteotomy;
- Complications:
- bunion recurrence in > 60%;
- due to the high recurrance rate, most surgeons will attempt to delay surgery until after skeletal maturity;
The pathophysiology of the juvenile bunion.
Juvenile hallux valgus. Etiology and treatment. MJ Coughlin. Foot Ankle Int. Vol 16. 1995. p 682-697.
Bunion surgery in adolescents: results of surgical treatment.
Adolescent bunions treated by the modified lapidus procedure. Clark HR, Veith RG, Hansen ST: Bull Hosp Jt Dis Orthop Inst 1987;47:109-122.
Bunions and Deformities of the Toes in Children and Adolescents. George Thompson MD. JBJS. Vol 77-A. No. 12. Dec 1995.
Treatment of hallux valgus in adolescents by the chevron osteotomy. TJ Zimmer et al. Foot Ankle. Vol 9. 1989. 190-193.
Adolescent bunion treated with double osteotomy and longitudinal pin fixation of the first ray. J Pediatr Orthop 1993;13:80-84.
Early results of the modified Peterson bunion procedure for adolescent hallux valgus.
Adolescent bunion deformity treated with double osteotomy and longitudinal pin fixation of the first ray.
