From the Guidelines
Treatment for Intertarsal and Phalangeal Joint (IPJ) valgus deformity of the foot in children should prioritize guided growth surgery, as it has shown to be a less invasive and effective technique in improving limb deformity. This approach, as described in the study by 1, involves the placement of a small metal plate on the medial or lateral surface of the bone to act as a tether to growth, allowing for differential growth and improvement in alignment over time.
The use of casts, insoles, and physiotherapy, as mentioned in 1, may not be effective in improving lower limb deformity associated with IPJ valgus deformity. Insoles, in particular, cannot improve the position of a flat foot if it is distal to a valgus knee. However, physiotherapy, in terms of a general strengthening and/or a gait education programme, might be helpful, especially after surgery.
Key considerations in the treatment of IPJ valgus deformity in children include:
- Early intervention to address the condition and prevent gait abnormalities and pain
- Regular follow-ups with a pediatric orthopedist or podiatrist to monitor progress and adjust treatment as the child grows
- Avoidance of complex osteotomies until the patient is skeletally mature, due to the high recurrence rate and complications associated with these procedures, as noted in 1
- The potential benefits of guided growth surgery, including its less invasive nature and ability to improve alignment over time, making it a preferred option for treating IPJ valgus deformity in children.
From the Research
Treatment Options for Intertarsal and Phalangeal Joint (IPJ) Valgus Deformity
- Surgical correction of the deformity is an option for patients who have failed conservative treatment or have a significantly symptomatic deformity 2
- Excision of the exostosis and soft-tissue realignment appears to be a reliable option for symptom relief for patients who present with a painful symptomatic hallux valgus interphalangeus deformity 2
- Medial closing wedge osteotomy and fixation with a double compression headless bone screw (DCHBS) is another surgical option for treating IPJ valgus deformity in children 3
- Conservative measures such as exercise, toe separators, night splints, and dry needling may be effective in treating hallux valgus deformity in children 4
- Double osteotomy of the first metatarsal is a surgical option for treating juvenile hallux valgus deformity, which can correct all three components of the deformity while maintaining functional first metatarsal length 5
Non-Surgical Treatment Options
- Conservative treatment may be successful in treating pain-free deformities that do not impact functionality of the toe or impair shoe wear 2
- A combination of exercise and toe separator, night splints, and dry needling may be effective in reducing the hallux valgus angle and intermetatarsal angle 4
- Toe separators (with or without exercise), dry needling, and manipulation (with or without ice treatment) may have advantages in improving the subjective feeling of patients with hallux valgus deformity 4
Surgical Considerations
- Epiphysiodesis using a transphyseal medial malleolar screw is a simple, efficient, and safe procedure to correct a significant or symptomatic ankle valgus deformity in children before skeletal maturity 6
- Double first metatarsal osteotomy can correct all three components of the deformity while maintaining functional first metatarsal length, but may be associated with post-operative complications such as restricted motion in the first metatarsophalangeal joint 5