Der hälftige Transfer der Extensor-hallucis-longus-Sehne zur Behandlung des Hallux varus

摘要

ObjectivenRealignment of a flexible hallux varus deformity through nsplit transfer of the extensor hallucis longus tendon.nIndicationsnFlexible hallux varus deformity without any osseous defor-nmity in patients with painful calluses, worsening of the nvarus position, or imminent lesser toe deformities.nContraindicationsnContract hallux varus deformity, bony malalignment, pain-nful arthritic first metatarsophalangeal joint, neuropathy, ninfection.nSurgical TechniquenMedial release with VY-lengthening of the capsule. Tenoto-nmy of the abductor hallucis tendon. Lateral reefing of the nmetatarsophalangeal joint capsule. Transfer of the split ex-ntensor hallucis longus tendon beneath the intermetatarsal nligament to the lateral aspect of the phalanx.nPostoperative ManagementnDressing with the great toe in an appropriate position. nImmediate weight bearing in a forefoot relief orthosis for 4 weeks. Comfortable shoes for the next 2 weeks. Physio-ntherapy (muscular strengthening, standing on tiptoes, naquajogging) after 6 weeks.nResultsnTwelve patients were followed up clinically and radiologi-ncally after a mean of 18 months. Four patients complained nof pain during weight bearing (barefoot walking and wear-ning soft-soled shoes). Another seven patients presented nwith a limited range of motion in the first metatarsopha-nlangeal joint. Overall, the range of motion has decreased nsignificantly (p < 0.05). In five patients, an average varus po-nsition of 14° was found on plain radiographs. Clinically, this nmalalignment was obvious in only two patients. All pa-ntients presented with sufficient ground contact of the great ntoe. As arthritic changes have not been detected radiologi-ncally, the limited range of motion in the first metatarsopha-nlangeal joints has to be attributed to the tenodesis effect of nthe transferred tendon slip.