Is Hemiepiphysiodesis Enough? Evaluating Growth Modulation in Juvenile Hallux Valgus.

BACKGROUND: Juvenile hallux valgus (JHV) is a progressive forefoot deformity that is often managed nonoperatively, though surgery is required for persistent symptoms. Traditional osteotomies provide definitive correction but carry a recurrence risk in skeletally immature patients. Lateral first metatarsal hemiepiphysiodesis is a minimally invasive growth modulation technique intended to improve alignment and delay osteotomy; however, long-term outcomes remain unclear. This study evaluated radiographic correction, persistence of deformity, and need for revision following hemiepiphysiodesis for JHV.

METHODS: Institutional records (2006 to 2024) were reviewed to identify pediatric patients undergoing hemiepiphysiodesis with at least 1 year of radiographic follow-up. Demographics, radiographic parameters, complications, and secondary procedures were collected. Paired t tests assessed preoperative to postoperative changes and χ2 tests were used for comparisons of categorical variables.

RESULTS: Among 482 patients with radiographically confirmed JHV, 20 feet in 13 children met the inclusion criteria. Mean age at surgery was 10.0±1.8 years, with a mean follow-up of 57±45 months. Diagnoses included idiopathic (n=9), syndromic (n=3), and neuromuscular (n=1) etiologies. Preoperative symptoms were common, including pain (84.6%), shoe-wear difficulty, and activity avoidance. HVA improved from 33.3 to 27.4 degrees (-6.0 degrees, P=0.014), and IMA improved by -1.9 degrees (P=0.024). Annual correction rates were -3.0 degrees for HVA and -1.2 degrees for IMA. Despite these improvements, residual deformity (HVA ≥ 15 degrees) persisted in 80% of feet. Six reoperations (30% of feet; 38% of patients) were performed at a mean of 6.2 years postoperatively, frequently involving osteotomies.

CONCLUSIONS: Hemiepiphysiodesis yields modest radiographic correction in skeletally immature patients with JHV but rarely restores normal alignment, and at least one-third ultimately require corrective osteotomy. These findings support its use as a temporizing option that may delay but not necessarily avoid the need for revision.

LEVEL OF EVIDENCE: Level IV-retrospective case series.