PMC7775152_01
Photograph of the plantar (a) and dorsal (b) sides of the patient's feet as a child (2 years), as provided by the parents.
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The asymmetry of his feet, which has never been progressive, was first noticed at the time of his birth (Figure 1).
Preoperative anteroposterior radiograph.
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Radiographs in two planes (posteroanterior and lateral) confirmed the clinical presentation (Figure 2).
Sagittal (a) and coronal (b) MRI scans show hypertrophy of abductor hallucis (*), flexor digitorum brevis (x), abductor digiti minimi (#), and accessorius soleus muscle ( ).
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Moreover, an accessory musculus soleus, with muscular portions ventral to the Achilles tendon, was shown to reach up to the calcaneus (Figure 3).
Intraoperative photograph (a) displaying the medial approach: reduction-plasty of abductor hallucis brevis muscle (*); (b) shows the resected muscular portion), flexor digitorum brevis muscle in depth (x), and the delta-shaped neurovascular bundle (framed with white dots).
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Below this muscle, the neurovascular bundle appeared flattened in a delta-shaped manner in the intermuscular fascia (Figure 4).
Intraoperative photograph demonstrating the lateral approach: reduction-plasty of the abductor digiti minimi muscle (#) and nervus suralis retracted with a vessel loop.
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The next step included a lateral, straight, and approximately 6-centimeter-long approach to the hypertrophic abductor digiti minimi muscle, which was also freed and decreased in volume (Figure 5).
Postoperative posteroanterior radiograph, including plate and K-wire osteosynthesis.
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For osteosynthesis, we chose an ankle-stable plate system and a temporary K-wire fixation (Figure 6).
Postoperative photographs of the medial (a) and dorsal (b) side of the foot, displaying the wound with skin staples, a drain, a K-wire, fatty gauze covering the hallux metatarsophalangeal joint approach, and laterally abducted fifth toe.
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Following hemostasis, a drain was placed both in the medial and lateral wound cavity, and dermal closure was performed with skin staples (Figure 7).
Photographs of the medial (a) and dorsal (b) side of the foot nine weeks postoperatively, displaying healed wounds, and corrected hallux valgus deformity, as well as an already significant decrease in volume of the plantar aspect of the foot.
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Postoperatively, the foot was immobilized with a below-knee cast for six weeks, after which the K-wire was removed (Figure 8).