Bilateral congenital hallux varus with metatarsus adductus in a 6-year-old girl: A case report

Table 1 A summary of other cases of congenital hallux varus

Ref.	Patient (number)	Age, sex of patient	Chief complaint	History	Clinical examination findings	X-ray findings	Surgical procedures	Fixator removal timing	Hospitalization duration	Progression post-surgery	F/u
Bajuri et al[1], 2021	-	16 years, male	Limiting of physical activities Pain and difficulty with footwear fitting	No history of surgery or trauma	HV in the left foot	Shifting of proximal phalanx at MTP joint	Removal of the polyp and the accessory bone	Sutures removed after 2 weeks	Discharge day after 5 (day)	Non weight bearing for 8 weeks	Minimal callus formation after 6 weeks
					Polyp over the medial border of the left foot	An accessory bone over the medial cuneiform	Tenotomy and lengthening of abductor hallucis, flexor hallucis longus and extensor hallucis longus	K-wires removed after 8 weeks		Partial weight bearing for 1 month	Full union was formed after 3 months
					Widening 1st web space-1st MTP joint dorsiflexion and plantarflexion = 30°	Hallux angel = 20.4°	Osteotomy of proximal phalanx			Full weight-bearing after 3 months
						Intermetatarsal angle (normal) = 10.3°	Capsulotomyear of 1st MTP joint			Running after 4 months
							Stabilizing the big and 2nd toe with K-wires
Samelis et al[2], 2022	-	3 years, female	Difficulty with footwear fitting	No history of surgery or trauma	Bilateral HV at 1st MTP joint-Inversion of both feet	Short 1st metatarsal	Right foot: capsulotomyear of 1st MTP joint; tenotomy of extensor hallucis longus; correcting foot inversion	Splint removed after 6 weeks	NA	Gradual weight bearing was recommended	NA
			Affecting walking	No family history	Mild clawing in all toes	Normal IMA	Left foot was planned
Sulaiman et al[3], 2019	1	7 months, NA	NA	NA	HV and polysyndactyly of the right big toe	Split distal phalanx of the right hallux	Medial release and realignment of big toe, Farmer’s procedure	K-wire removed after 6 weeks	NA	NA	Good results after 8 years
							K-wire was reinserted back after 2 weeks
	2	2 years, NA	NA	NA	HV and polysyndactyly of the left big toe	Polysyndactyly and congenital HV of the left big toe	Medial release and realignment of big toe and resection of the phalanx with the usage of excess of plantar skin	Non used	NA	NA	Good/4 years
	3	3 years, NA	NA	NA	Short 1st metatarsal			1.6 mm K-wire used not mentioned when removed	NA	NA	Good/1 years
	4	2 years, NA	NA	NA	HV and polydactyly of the right big toe	HV and well separated polydactyly	Medial release and realignment of big toe + excision of phalanx + proximal based flap	External fixator removed 6 weeks after 1st surgery	NA	NA	Good/6 years
					Short 1st metatarsal + polydactyly			K-wire removed 4 weeks after 2nd surgery
Patil et al[9], 2014	-	23 years, male	Difficulty with footwear fitting and pants	No history of surgery or trauma	HV, polydactyly and syndactyly of the right big toe	Short 1st metatarsal with deformed head	Removal of lateral great toe since it was smaller and showed less vascularity	K-wire removed after 6 weeks (in both surgeries)	Discharged after 7 (day)	Non weight bearing for 6 weeks after 1st surgery	Satisfying results in a f/u X-ray after 3 years
					1st MTP joint dorsiflexion and plantarflexion = 20°	2 phalanges in the both big toes	Correction of medial big toe After 7 weeks	Splint removed 6 weeks after 1st surgery and continued for protection after the 2nd		Non weight bearing for 2 months after 2nd surgery
						Distal phalanx of lateral big toe was trapezoidal	MTP joint fusion a week after taking out the external fixator
						1 sesamoid at MTP joint
						IMA = 27°
Vlaić et al[10], 2018	1	19 years, male	Difficulty with footwear fitting	1 year of physical therapy for a metatarsus varus deformity in the left foot	HV and LEB in the 1st metatarsal of the left foot	Same results as clinical examination	At 26 months: Tenotomy of abductor hallucis; correction of 1st metatarsal bone and LEB	K-wire removed after 6 weeks	NA	Gradual weight bearing was recommended	Satisfying results clinicallyear although X-ray wasn’t as desired 24 months after 2nd surgery
							4.5 years after the 1st surgery: Correction of 1st MTP joint alignment by an osteotomy of 1st metatarsal with a fibular autologous graft and releasing soft tissues
	2	4 years, male	Difficulty with footwear fitting	Hypospadias surgery at 1.5 years conservative treatment for 1 years for flatfoot and HV deformities in the right foot	HV in the right foot	Wide and short 1st metatarsal pointing to LEB deformity in the right foot	At the age of 5.5 years: Resection of the LEB; correction of 1st metatarsal	K-wire removed after 5 weeks	NA	Gradual weight bearing was recommended	F/u for 32 months after surgery: Excellent results
	3	1 month, female	NA	NA	HV, polydactyly and LEB in the 1st metatarsal of the left foot	Same results as clinical examination	At 1 year: Removal of the accessory toe; capsulotomy of medial cuneiform metatarsal and 1st MTP joints; resection of bracket (no interposition graft); correction of 1st metatarsal with a K-wire	Fixator removed after 14 weeks	NA	NA	F/u for 31 months after surgery: Satisfactory results
Froehlich et al[11], 2014	-	15 years, female	Limiting of physical activities	No family history, syndromes or metabolic disorders	Bilateral HV	Radiographs showed shortening and bulging of the 1st metatarsal bilaterally along with a varus aligned joint surface of the 1st metatarsal. The epiphyses were closed, and the 1st metatarsal bone was approximately 24 mm shorter than the 2nd metatarsal (Figure 1B)	External fixator to reposition 1st metatarsal bone and hallux	Fixator removal timing	NA	1st surgery postoperative shoe and after the arthrodesis, the patient again used a postoperative shoe and was fully weightbearing for 6 weeks	Good results
			Psychological pressure		Bilateral brachymetatasia of 1st metatarsals		Arthrodesis of 1st MTP joint

NA: Not available; MTP: Metatarsophalangeal; IMA: Intermetatarsal angle; MRI: Magnetic resonance imaging; HV: Hallux varus; LEB: Longitudinal epiphyseal bracket; K-wires: Kirschner wires; F/u: Follow up.