What are the treatment options for Intertarsal and Phalangeal Joint (IPJ) valgus deformity of the foot in pediatric patients?

From the Guidelines

Treatment options for Intertarsal and Phalangeal Joint (IPJ) valgus deformity of the foot in pediatric patients should prioritize non-surgical interventions, including weight-bearing exercise, maintenance of joint range, and maximizing strength and endurance, as recommended by recent guidelines 1. The primary goal of treatment is to improve function, prevent progression of the deformity, and reduce the risk of long-term complications.

• Conservative measures, such as physical therapy exercises, can help strengthen the intrinsic foot muscles and improve flexibility.
• Guided growth techniques, which involve the use of a small metal plate to tether growth near the physis, can be considered for children with persistent deformity despite maximized medical therapy 1.
• Surgical options, including osteotomies, may be considered in cases of severe deformity or when conservative measures fail, but should be performed by a surgeon with expertise in metabolic bone diseases and only after medical treatment has been maximized for at least 12 months 1.
• The age of the child should be considered an important factor in the decision-making process, with guided growth techniques typically performed at least 2-3 years before skeletal maturity 1.
• Regular follow-ups with a pediatric orthopedist or podiatrist are essential to monitor progress and adjust treatment as needed, with postoperative assessment of the axis correction documented at 12 months and functional assessment performed according to the World Health Organization (WHO) International Classification of Function 1.

From the Research

Treatment Options for Intertarsal and Phalangeal Joint (IPJ) Valgus Deformity

• Surgical treatment options:
  • Excision of the exostosis and soft-tissue realignment for symptom relief in patients with painful symptomatic hallux valgus interphalangeus deformity 2
  • Medial closing wedge osteotomy and fixation with a double compression headless bone screw for treatment of juvenile hallux valgus interphalangeus 3
• Non-surgical treatment options:
  • Conservative measures such as kinesitherapy, application of certain agents (thermotherapy, electrotherapy, ultrasound), and orthosis for maintaining corrections 4
  • Combination of exercise and toe separator, night splints, and dry needling for reducing the hallux valgus angle and intermetatarsal angle 5
  • Toe separators (with or without exercise), dry needling, and manipulation (with or without ice treatment) for improving the subjective feeling of patients 5

Considerations for Treatment

• The risk of degenerative changes following spur removal must be considered prior to surgical procedure 2
• A pain-free deformity that does not impact functionality of the toe or impair shoe wear may be treated successfully with conservative measures 2
• Physical therapy may yield acceptable results in specific treatment phases, and can contribute to more rapid recovery and decrease possible complications after surgical correction 4