Congenital Hallux Varus with Polydactyly and Syndactyly-Correction in an Adult - A Case Report

Abstract

Introduction: Congenital hallux varus of secondary type is associated with polydactyly, syndactyly or other congenital deformities of the foot. Such congenital deformities can be addressed in childhood with soft tissue reconstructive procedures. In adulthood, treatment of these deformities is challenging because of soft tissue contractures and rigid bony deformities. To our knowledge, this is the first case report demonstrating the management of neglected secondary congenital hallux varus in adults.

Case report: We present here a case of a 23 years old male patient who presented to us with untreated congenital hallux varus of secondary type. Patient had an extra great toe (polydactyly) with syndactyly. We have treated this patient in two stages. First stage consisted of excision of the extra great toe and gradual correction of medial great toe. In second stage, metatarsophalangeal joint fusion was done. We have follow up of this case for more than 2.5 years.

Conclusion: Severe neglected congenital deformities presenting in adulthood pose unique problems of soft tissue contractures and permanent bony deformities. Congenital neglected hallux varus with polydactyly and syndactyly is a rare deformity. Its correction was challenging as patient presented to us in adulthood. A staged approach of gradual soft tissue distraction and then metatarsophalangeal joint fusion has resulted in satisfactory aesthetic and functional outcome.

Keywords: Polydactyly with syndactyly; distraction with external fixator; metatarsophalangeal joint fusion; neglected hallux varus; secondary congenital hallux varus.

Figure 1

Preoperative Clinical Photograph: Preoperative Clinical Photograph of a 23 Year Old Male Showing Hallux Varus Deformity of Right Foot. Note Polydactyly and Syndactyly of Great Toe. The Great Toes are Deviated Medially at almost Right Angle to the First Metatarsal.

Figure 2A and 2B

Preoperative Deformity: Preoperative Clinical Photograph Showing Difficulty in Wearing Regular Footwear.

Figure 3A and 3B

Pre-operative Adiographs: Pre-operative Anteroposterior, Oblique and Lateral Radiographs Showing Short First Metatarsal with Deformed Head Articulating with Two Proximal Phalanges.

Figure 4

AIntraoperative Photographs, First Stage: 4A - Based on Vascularity, Lateral Great Toe was Excised. 4B and 4C- K-wires & Two Distractors were Applied to Distract Metatarsophalangeal and Tarsometatarsal Joints.

Figure 5A and 5B

Post-operative Radiographs: Post-operative Anteroposterior, Oblique and Lateral Radiographs at Four Weeks Follow-up Showing Distraction at Metatarsophalangeal and Tarsometatarsal Joints.

Figure 6

Intraoperative Photographs, Second Stage: 6A- Dorsomedial Incision for Approach to Metatarsophalangeal and Tarsometatarsal Joints. 6B to 6D- Tricortical Bone Fraft from Iliac Crest Inserted at Metatarsophalangeal Joint after. Joint Preparation

Figure 7A to 7C

Intraoperative Photographs, Second Stage: 2.7mm Dynamic Compression Plate Applied Medially across Metatarsophalangeal and Tarsometatarsal Joints with an Axial K-Wire in Situ.

Figure 8A and 8B

Post operative radiographs: Post-operative Radiographs at 2.5 Years Follow Up Showing Sound Fusion at Metatarsophalangeal Joint.

Figure 9

Clinical photograph at 2.5 Years Follow- up:Clinical Photograph of the same Patient at 2.5 Years Follow-up Showing Satisfactory Correction of the Deformity & Good Soft Tissue Healing.

Figure 10A and 10B

Comparative Clinical Photograph: 10A, Pre-operative and 10B Post-operative Clinical Photographs Showing Correction of the Deformity. Patient can Wear Regular Shoes & Trousers without Difficulty.