Acta chirurgiae orthopaedicae
et traumatologiae Čechoslovaca

Acta Chir Orthop Traumatol Cech. 2026; 93(4):235-240 | DOI: 10.55095/achot2026/019

Mid-Term Follow-Up Results of Surgical Reconstruction for Congenital Hallux Varus with Polysyndactyly in Children

BOYAN BOYANOV HRISTOV, SOFIA VALENTINOVA NIKOLOVA, ALEXANDAR IVANOV GERCHEV, STEFAN STEFANOV TSEROVSKI, HRISTO DIMITROV GEORGIEV

Department of Pediatric Orthopaedics, University Hospital for Active Treatment in Orthopaedics (UHATO) "Prof. B. Boychev", Sofia, Bulgaria

Purpose of the study:
Congenital hallux varus associated with preaxial polysyndactyly of the foot is a rare deformity for which standardized treatment protocols and outcome data remain limited. The purpose of this study was to evaluate the mid-term clinical and radiographic outcomes of early surgical reconstruction in a consecutive pediatric series.

Material and methods:
Between 2015 and 2023, eight affected feet in seven children with congenital preaxial polysyndactyly and hallux varus were surgically treated at a single tertiary pediatric orthopedic center. The diagnosis was established at birth. The mean age at surgery was 31.62 ± 36.64 months. All patients exhibited varus deviation of the first ray, duplication of the distal phalanx, complete or partial duplication of the proximal phalanx, soft-tissue syndactyly, duplicated or shared nail plates, and a hypoplastic medial ray. Surgical treatment consisted of resection of the hypoplastic medial hallux, abductor hallucis tenotomy, excision of chondrofibrous bands when present, subtotal periosteal stripping of the first metatarsal, and medial open-wedge osteotomy of the first metatarsal or proximal phalanx in selected cases. Outcomes were assessed clinically and radiographically, and graded using the Phelps and Grogan classification.

Results:
At a mean follow-up of 45.14 ± 18.79 months (range, 24 to 82 months), satisfactory outcomes were achieved in 87.5% of the treated feet. Significant correction of the hallux varus deformity was obtained, with preservation of motion of the first metatarsophalangeal and interphalangeal joints. No patient required secondary surgical procedures. One patient who did not undergo initial metatarsal osteotomy demonstrated progressive recurrent varus during follow-up.

Conclusions:
Early surgical correction of congenital hallux varus polysyndactyly (between 12 and 18 months of age) yields favorable mid-term outcomes. Medial open-wedge osteotomy of the first metatarsal represents a critical component for durable correction and should be considered even in low-grade deformities.

Keywords: congenital hallux varus, preaxial polysyndactyly, pediatric foot deformity, McElvenny procedure, first metatarsal osteotomy.

Received: January 25, 2026; Revised: January 25, 2026; Accepted: April 16, 2026; Published: August 1, 2026  Show citation