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Acquired hallux varus deformity secondary to postburn contracture is a rare condition. It causes cosmetic disfigurement, pain, and inability to wear a shoe. Soft-tissue procedures and tendon transfers have been described for correction; however, these may require multiple operations and the outcome may be poor. We report a 6-year-old neglected case of hallux varus deformity secondary to burn contracture successfully managed by contracture release with pivotless distraction technique using a biplanar distractor and skin grafting with Z-plasty in the same procedure. The deformity was corrected to a lesser extent and with good functional outcomes. The scar was excised and Z-plasty was performed. The medial joint capsule was released. We used gradual differential distraction with monitoring on sequential radiographs. Pain-free flexion of 45° and extension of 40° were achieved and the patient was able to wear shoes after 4 weeks postoperatively. Hallux varus is a multidimensional deformity. A severe and rigid deformity might not respond well to tendon transfers in a single stage. Our described technique can be used to correct rigid hallux varus deformity with preservation of joint function.

Longitudinal epiphyseal bracket is a rare ossification disorder of the short tubular bones. The affected bone becomes deformed as a result of the bracket. The normal growth pattern cannot occur, and when it affects the first metatarsal bone, hallux varus may develop with the abnormal growth pattern. We present such a 6-year-old patient who had undergone surgery at 6 months of age for hallux varus and polydactyly. The deformity had worsened gradually after the initial operation because of the overlooked longitudinal epiphyseal bracket. The patient was treated with surgical excision of the epiphyseal bracket, with corrective medial open wedge osteotomy and split transfer of the extensor hallucis longus tendon. The result was excellent at the 20-month follow-up. At an early age, patients who present with hallux varus must be checked for the epiphyseal bracket, which can be invisible on radiographs because of the chondral structure. Untreated or overlooked patients with epiphyseal bracket will need revision operations for recurrent deformities.

Hallux varus is most commonly seen iatrogenically following overaggressive lateral release, removal of the fibular sesamoid, or overaggressive removal of the medial eminence. There are several reported cases of traumatic hallux varus, although this is much less common. We present a case of traumatic hallux varus in a patient who was later found to have bilateral absence of her fibular sesamoids. We postulated that lack of her fibular sesamoid led to weakness of her lateral capsular ligaments, thereby making her more susceptible to this injury. We performed a repair using a split extensor hallucis longus tendon transfer that was transected proximally, rerouted the tendon under the deep transverse intermetatarsal ligament, and secured it to the first metatarsal with a Bio-Tenodesis (Arthrex, Inc, Naples, Florida) screw. At 22 months postoperatively, she has demonstrated maintenance of correction and has resumed use of normal shoe gear and participation in activities. Our goal was to demonstrate a repair for this condition that successfully maintained correction over time while still allowing for functionality of the first metatarsophalangeal joint.