[Treatment of a Progressive Collapsing Foot Deformity]. / Behandlung des Plattfusses.

Treatment of a Progressive Collapsing Foot Deformity Abstract. The so-called "flat foot" can be more accurately described in German as "Knick-Senkfuss" or "kinking-flatfoot". The "kink" refers to the hindfoot axis as such, which can be identified by the intersection of the longitudinal axes of the Achilles tendon and the tuber calcanei. The designation "flat foot" marks the appearance of the longitudinal axis, that is, the medial longitudinal arch, which is easy to determine clinically. Nowadays, a new terminology has been added: Progressive collapsing foot deformity (PCFD). The forms of a PCFD are manifold, as are the possible causes. For this reason, the forms of therapy to be used are often not very simple and must be carefully considered and applied. Not always are PCFD in need of treatment. That means that there are people who have always had such deformities but never develop symptoms. For this reason, only symptomatic patients suffering from a PCFD need treatment. The degree of treatment and its success depends on the careful examination and interpretation of the findings by the orthopedic surgeon. This article deals with treatment of PCFD and attempts to provide a logical overview.

Incidence of thyroid disease in patients with forefoot deformity.

BACKGROUND: Hallux valgus and lesser toe deformities are common foot disorders with substantial functional consequences. While the exact etiologies are multi-factorial, it is unknown if certain endocrine abnormalities, such as thyroid dysfunction, may be associated with these pathologies. The current study sought to investigate the prevalence of thyroid disease in patients with hallux valgus or lesser toe deformities. METHODS: Every new patient who presented to our institution's foot and ankle clinic during a three-month time period was given a survey to determine the presence of a known thyroid disorder. The diagnosis for each visit was then recorded. Additionally, a national, publicly available database was queried for patients diagnosed with thyroid disease and concomitant hallux valgus or specific forefoot pathology. Odds ratios for the presence of thyroid dysfunction were then calculated for each patient group. RESULTS: Three-hundred and fifty initial visit patient surveys were collected, and 74 (21.1%) patients had a known diagnosis of thyroid disease. The most common diagnoses were primary hypothyroidism (n = 61, 17.4%), secondary hypothyroidism (n = 6, 1.7%), thyroiditis (n = 4, 1.1%), and hyperthyroidism (n = 3, 0.9%). Thyroid disease was present in 16 of 26 patients (61.5%) with a diagnosis of hallux valgus (OR 7.3, CI[3.16-16.99], p < 0.0001). Lesser toe deformities, including hammertoes, mallet toes, bunionettes and crossover toes, were also significantly associated with thyroid disease (OR 5.45, CI[1.83-16.26], p < 0.002). The national database revealed 905,924 patients with a diagnosis of a specific forefoot deformity, and 321,656 of these patients (35.5%) had a concomitant diagnosis of a thyroid condition (OR 2.11, CI[2.10-2.12], p < 0.0001). CONCLUSIONS: The current study suggests a significant association between forefoot pathology and thyroid dysfunction, especially hallux valgus and lesser toe deformities. Increased understanding of these correlations may offer an important opportunity in population health management, both in diagnosis and treatment. While further studies with long-term outcomes are necessary, the early diagnosis of thyroid disease may provide an opportunity to predict and potentially alter the course of forefoot pathology.

Radiographic changes of the mid-tarsal joint after calcaneal lengthening for planovalgus foot deformity.

BACKGROUND: This study evaluate the radiographic changes in the mid-tarsal joint, including the calcaneocuboid and talonavicular (TN) joints after calcaneal lengthening for planovalgus deformity in children. METHODS: This study included 38 patients (68 feet) who underwent calcaneal lengthening for planovalgus deformity. Radiographic osteoarthritic changes at the CC or TN joint were defined as modified Kellgren-Lawrence grade of ≥1. RESULTS: Among the 68 feet, 31 feet (45.6%) showed radiographic osteoarthritic changes at the CC joint and 20 (29.4%) showed changes at the TN joint. Risk of radiographic osteoarthritic changes at the CC joint was associated with increased age at surgery (OR = 1.2, p = 0.038). Risk of radiographic osteoarthritic changes at the TN joint was associated with increased age at surgery (OR = 2.2; p = 0.002), preoperative AP talus-1st metatarsal angle (OR = 1.1; p = 0.044), and degree of CC subluxation (OR = 2.1; p = 0.007). CONCLUSIONS: Surgeons should consider the risk factors in the surgical correction of planovalgus deformity to prevent mid-tarsal arthritis.

Müller-Weiss Disease: Three- to Eight-Year Follow-Up Outcomes of Isolated Talonavicular Arthrodesis.

Numerous surgical techniques for the treatment of Müller-Weiss disease (MWD) have been reported. However, no extensive clinical and radiographic studies of isolated talonavicular arthrodesis and MWD have been reported. The present retrospective cohort study examined the outcomes of isolated talonavicular arthrodesis at 3 to 8 years of follow-up in 16 MWD patients with a collapsed longitudinal arch and at least Maceira stage III. Demographic data, pre- and postoperative visual analog scale (VAS) scores for pain on walking and walking disability, foot and ankle outcome scores (FAOSs), and radiographic parameters were analyzed, with statistical significance at p < .05. A survival analysis was used to determine the median time to union. The mean ± standard deviation pre- and postoperative VAS scores for pain on walking were 7.69 ± 1.62 and 2.19 ± 1.52 and the walking disability scores were 7.06 ± 2.11 and 2.31 ± 1.92, respectively. The pre- and postoperative FAOSs were 48.07 ± 21.50 and 82.27 ± 13.86 for activities of daily living, 30.86 ± 19.70 and 76.17 ± 22.39 for quality of life, and 20.93 ± 22.89 and 51.88 ± 23.66 for sports/recreation, respectively. The median pre- and postoperative FAOSs for the symptoms subscale were 73.22 (range 42.88 to 100.00) and 87.50 (35.71 to 100.00) and for pain were 34.72 (range 8.33 to 72.22) and 88.89 (54.41 to 100.00), respectively. Significant improvements occurred from preoperatively to postoperatively for VAS scores and FAOSs (p < .05). The mean pre- and postoperative calcaneal pitch angles were 11.31° ± 4.35° and 13.81o ± 5.60o, significant improvement (p = .016). Improvement was also seen midfoot abduction, with a mean pre- and postoperative anteroposterior Meary's angle of 14.38° ± 10.07° and 9.38° ± 12.21°. The survival analysis showed union was achieved in all patients, with a median time to union of 2 (95% confidence interval 1.03 to 3.00) months. Our data indicate that talonavicular arthrodesis provides satisfactory functional outcomes for MWD patients with a collapsed longitudinal arch.

Spectrum of Diagnosis and Disposition of Patients Referred to a Pediatric Orthopaedic Center for a Diagnosis of Intoeing.

BACKGROUND: Orthopaedic surgeons frequently evaluate otherwise healthy children for concern of intoed gait. Intoeing in otherwise healthy young children due to metatarsus adductus, internal tibial torsion, and increased femoral anteversion do not typically require orthopaedic treatment. This study reviewed the actual diagnosis, management, and disposition of patients referred to a pediatric orthopaedic specialty hospital for a diagnosis of intoeing; the efficacy of an Advanced Practice Provider (APP) assessment program to screen and triage patients with a primary complaint of intoeing; and parental satisfaction with that program. METHODS: We established an "Intoeing Clinic" conducted by APPs to conduct initial evaluations of patients referred for a diagnosis of intoeing meeting-specific criteria, including (1) a referring provider's diagnosis of "intoeing"; (2) the patient was under the age of 9 years; and (3) there was no suggestion of comorbidity in the information provided by the referring provider to imply a diagnosis other than "benign" intoeing. Under pediatric orthopaedic surgeon "on-call" supervision, APPs were authorized to perform clinical assessments supplemented by radiographs and laboratory investigations as deemed necessary. We performed an Institutional Review Board-approved, retrospective medical record review of all patients appointed to our Intoeing Clinic over a 30-month period (March 2010 to September 2013). RESULTS: About 95% of 926 patients appointed to APP Intoeing Clinic were confirmed to have a diagnosis of "benign" intoeing or a similar "benign" diagnosis; 5% of these patients requested a reevaluation for the same concern. Approximately 5% were determined to have a nonbenign diagnosis, either known to the family/provider, but not conveyed at the time of referral (4%), or identified at our institution (1%). Two patients (0.2%) were determined at follow-up examination to have a neurological abnormality at the subsequent examination. CONCLUSIONS: An "Intoeing Clinic" staffed by experienced Advanced Pediatric Practitioners or equivalent, with appropriate orthopaedic surgeon availability for consultation can be an effective and efficient method of evaluating patients referred for a diagnosis of "intoeing." LEVEL OF EVIDENCE: Level IV-case series.

The Failed Cavovarus Foot: What Went Wrong and Why?

The adult cavovarus foot exists on a spectrum and, therefore, requires a thorough evaluation to determine the extent of the deformity and then choose from a multitude of surgical procedures to achieve correction. Regardless of the severity of the deformity, treatment should include an algorithmic approach to adequately achieve a stable, balanced, and plantigrade foot. To prevent failure, the surgeon should evaluate whether the deformity is flexible or rigid, determine the location of the apex or apices of the deformity, evaluate any muscle imbalances occurring about the foot and ankle, and determine the need for additional procedures. A failure to consider these principles and, subsequently, the extent of the deformity often results in recurrence and progression of the deformity.

[Orthopedic shoe treatment: Inserts]. / Orthopädische Schuhversorgung: Einlagen.

The use of inserts and orthopedic shoe adjustment represents an essential component of the conservative therapy of degenerative diseases and deformities of the musculoskeletal system. Inserts can have supportive, bedding and corrective effects and are used in particular for complaints of the feet and ankles. The combination of diverse materials allows a high level of cushioning and supporting features and corresponding longevity to be accomplished. The production is carried out on an individual basis and if necessary computer-assisted in order to achieve an optimal fit. For severe and rigid deformities the formation of pressure ulcers can be prevented by orthopedic shoe adjustment and by the use of orthopedic tailor-made shoes.

Idiopathic pes cavus in adults is not associated with neurophysiological impairment in the lower limbs.

The nerve conduction characteristics of adults with idiopathic pes cavus/hammer toes have not been studied extensively. Among 2048 out-patients (59.5 ± 13.9 years) referring to a laboratory of Neurophysiology in Rome, we recruited 18 patients with idiopathic pes cavus (61.3 ± 12.5 years). Fifty-four age/sex-matched controls were also studied. No nerve conduction differences were observed between patients with and without cavus foot (p > 0.05). The absence of deep tendon reflexes and slight muscle weakness and hypotrophy in the lower limbs were more common in subjects with cavus foot deformity than in controls (p < 0.001). Adult patients with idiopathic pes cavus/hammer toes do not differ from healthy controls from a neurophysiological standpoint, but they could show minor signs of clinical impairment, such as lower limb weakness, hypotrophy and areflexia.

Osteodesis for hallux valgus correction: is it effective?

BACKGROUND: Although the etiology of hallux valgus is contested, in some patients it may be failure of the stabilizing soft tissue structures around the first ray of the foot. Because there is lack of effective soft tissue techniques, osteotomies have become the mainstream surgical approach to compensate for the underlying soft tissue deficiency; osteodesis, a soft tissue nonosteotomy technique, may be a third alternative, but its efficacy is unknown. QUESTIONS/PURPOSES: We asked: (1) Can an osteodesis, a distal soft tissue technique, correct hallux valgus satisfactorily in terms of deformity correction and improvement in American Orthopaedic Foot and Ankle Society (AOFAS) score? (2) Is the effectiveness of an osteodesis affected by the patient's age or deformity severity? (3) What complications are associated with this procedure? METHODS: Between February and October 2010, we performed 126 operations to correct hallux valgus, of which 126 (100%) were osteodeses. Sixty-one patients (110 procedures) (87% of the total number of hallux valgus procedures) were available for followup at a minimum of 12 months (mean, 23 months; range, 12-38 months). This group formed our study cohort. During the study period, the general indications for this approach included failed conservative measures for pain relief and metatarsophalangeal angle greater than 20° or intermetatarsal angle greater than 9°. Intermetatarsal cerclage sutures were used to realign the first metatarsal and postoperative fibrosis was induced surgically between the first and second metatarsals to maintain its alignment. The radiologic first intermetatarsal angle, metatarsophalangeal angle, and medial sesamoid position were measured by Hardy and Clapham's methods for deformity and correction evaluation. Clinical results were assessed by the AOFAS score. RESULTS: The intermetatarsal angle was improved from a preoperative mean of 14° to 7° (p<0.001; Cohen's d=1.8) at followup, the metatarsophalangeal angle from 31° to 18° (p<0.001; Cohen's d=3.1), the medial sesamoid position from position 6 to 3 (p<0.001; Cohen's d=2.4), and AOFAS hallux score from 68 to 96 points (p<0.001). Neither patient age nor deformity severity affected the effectiveness of the osteodesis in correcting all three radiologic parameters; however, the deformities treated in this series generally were mild to moderate (mean intermetatarsal angle, 14°; range, 9°-22°). There were six stress fractures of the second metatarsal (5%), five temporary metatarsophalangeal joint medial subluxations all resolved in one month by the taping-reduction method without surgery, and six metatarsophalangeal joints with reduced dorsiflexion less than 60°. CONCLUSIONS: The osteodesis is a soft tissue nonosteotomy technique, and provided adequate deformity correction and improvement in AOFAS scores for patients with mild to moderate hallux valgus deformities, although a small number of the patients had postoperative stress fractures of the second ray develop. Future prospective studies should compare this technique with osteotomy techniques in terms of effectiveness of the correction, restoration of hallux function, complications, and long-term recurrence. LEVEL OF EVIDENCE: Level IV, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.

Clinical correlates of Charcot-Marie-Tooth disease in patients with pes cavus deformities.

INTRODUCTION: Given its association with Charcot-Marie-Tooth disease (CMT), pes cavus is a common reason for referral to a neurologist. We investigated clinical features that may predict CMT in children with pes cavus. METHODS: In this study we retrospectively reviewed pes cavus patients referred to Boston Children's Hospital in the past 20 years. Patients were categorized as idiopathic or CMT, based on EMG/genetic testing, and their clinical features were compared. RESULTS: Of the 70 patients studied, 33 had idiopathic pes cavus, and 37 had genetically confirmed CMT. Symptoms of weakness, unsteady gait, family history of pes cavus and CMT, and signs of sensory deficits, distal atrophy and weakness, absent ankle jerks, and gait abnormalities were associated with CMT. CONCLUSIONS: In children with pes cavus, certain clinical features can predict CMT and assist in selection of patients for further, potentially uncomfortable (EMG) and expensive (genetic) confirmatory investigations.

Clinical examination of plantar plate abnormality: a diagnostic perspective.

BACKGROUND: Plantar plate tears can cause pain and deformity in the forefoot but are frequently missed on initial examination. The purpose of this article was to evaluate the diagnostic statistics of common clinical examination parameters using observed intraoperative abnormality as the referenced standard. METHODS: Medical records of 90 patients (109 feet) who underwent a plantar plate repair were reviewed for the presence and onset of pain, plantar edema, instability of the second metatarsophalangeal (MTP) joint (drawer sign), pain with range of motion of the lesser MTP joint, first MTP joint range of motion, crossover toes, previous first ray surgery, and previous corticosteroid injections. Clinical examination findings were compared with intraoperative findings. Diagnostic statistics were calculated. RESULTS: Parameters with a high sensitivity (greater than 80%) were gradual onset of pain (93%), previous first ray surgery (100%), pain at the second metatarsal head (98%), edema at the second metatarsal head (95.8%), and a positive drawer sign (80.6%). High specificity (greater than 80%) was found for a positive drawer test (99.8%) and crossover toes (88.9%). Parameters with odds ratios greater than 1 were gradual onset of pain (1.104), pain at the second metatarsal head (6.125), edema at the second metatarsal head (2.875), and a positive drawer sign (1.389). CONCLUSION: Ninety-five percent of patients with a plantar plate tear presented with a gradual onset of forefoot pain, edema, and a positive drawer sign. A comprehensive clinical examination can heighten the suspicion for plantar plate tears when the data are interpreted correctly. LEVEL OF EVIDENCE: Level III, retrospective, diagnostic.

Pediatric Forefoot Deformities.

This article explores different pediatric forefoot deformities including syndactyly, polydactyly, macrodactyly, curly toe, and congenital hallux varus. The epidemiology and genetic background are reviewed for each condition. Preferred treatment options and recommended surgical techniques are discussed with review of the current literature.

Lesser Metatarsophalangeal Plantar Plate Repair.

Lesser toe plantar plate injuries at the metatarsophalangeal (MTP) joint are a common source of metatarsalgia. Chronic pain with weight-bearing is the common presentation of lesser toe instability. Deformity occurs when the plantar plate is torn or attenuated. Crossover toe and MTP instability often occur with multiplane deformity, most commonly with dorsal contracture of the second toe and medial drift over the Hallux. In this article, the authors present a comprehensive stepwise approach to diagnosing and treating plantar plate injuries using both dorsal and plantar approach techniques.

Diagnostic Accuracy of the Progressive Collapsing Foot Deformity (PCFD) Classification.

BACKGROUND: A consensus group recently proposed the term progressive collapsing foot deformity (PCFD) and a new classification with 2 stages plus 5 classes to describe the complex array of flatfoot deformities. This study aimed to validate different diagnostic accuracy rates of the PCFD classification. METHODS: This was a survey-based study distributed among 13 foot and ankle fellowship programs for 3 groups of participants with varied experience in practice (group 1: fellows in training, group 2: surgeons in practice for 1-4 years, and group 3: surgeons in practice for ≥5 years). Each participant was asked to assign 20 different cases of flatfoot deformity to the appropriate classes and stages using the PCFD classification. The overall diagnostic accuracy, class, and stage diagnostic accuracy rates for the 20 cases were calculated first for the entire cohort and then compared among the 3 groups. The misdiagnosis rate for each class of deformity (the sum of overdiagnosis and underdiagnosis rates) of the entire cohort was calculated and compared with the other classes. Mean and standard evidence were used to describe numerical data. One-way analysis of variance was used to compare values among the 3 groups and the 5 classes. P <.05 was considered statistically significant. RESULTS: For the whole cohort, the overall diagnostic accuracy, class diagnostic accuracy, and stage diagnostic accuracy rates were 71.0%, 78.3%, and 81.7%, respectively There was a statistically significant difference between group 1 and 2, and group 1 and 3, in overall diagnostic accuracy and class diagnostic accuracy, with no significant difference among the 3 groups regarding stage diagnostic accuracy. Class B had a significantly higher overdiagnosis rate than the rest of the classes, whereas class D was significantly underdiagnosed than others. The misdiagnosis rates for classes A to E were 3.3%, 17.5%, 11.1%, 26.0%, and 3.7%, respectively. CONCLUSION: The PCFD classification showed overall fair diagnostic accuracy rates. The highest diagnostic accuracy was for "hindfoot valgus deformity" and "ankle instability." Further content validation of the PCFD classification is needed to examine the terminology and interpretation of those classes with low diagnostic accuracy including "midfoot/forefoot abduction deformity," "forefoot varus deformity/medial column instability," and "peritalar subluxation/dislocation."Level of Evidence: Level II, prospective comparative study.

Supramalleolar osteotomy using circular external fixation with six-axis deformity correction of the distal tibia.

BACKGROUND: Supramalleolar osteotomy using circular external fixation with six-axis deformity correction is a rarely reported treatment method particularly well-suited for complex multidimensional deformities of the adult ankle. The purpose of this study was to assess the accuracy of deformity correction and change in functional status using this technique. METHODS: We present a retrospective review of 52 patients who underwent supramalleolar osteotomy with application of the Taylor Spatial Frame (Smith & Nephew, Memphis, TN). Mean age was 44 (range, 18 to 79) years. The primary outcome was change in preoperative to postoperative distal tibial joint orientation angles. Coronal and sagittal plane joint orientation angles were measured for all 52 enrolled patients. The secondary outcome was change in AOFAS scores which were available for 31 patients. RESULTS: Twenty-two patients had oblique plane deformities. The mean time in frame was 4 (range, 2 to 11) months, and patients were followed for a mean of 14 months after frame removal. All aggregate postoperative distal tibial angles underwent a significant improvement (p < 0.05) and were within 0 degrees to 4 degrees of normal in the various deformity groups. Average preoperative AOFAS score was 40 (range, 12 to 67) and average postoperative AOFAS score was 71 (range, 34 to 97; p < 0.001). Complications included two patients with nonunions at the osteotomy site that healed with further treatment. Three patients went on to have ankle fusion. CONCLUSION: We feel that supramalleolar osteotomy using circular external fixation with six-axis deformity correction was an effective method for correction of distal tibial deformities in the adult population, particularly for those patients with complex oblique-plane deformities, associated rotational deformity, a compromised soft tissue envelope, or a prior history of infection.

Validation of the American College of Foot and Ankle Surgeons Scoring Scales.

The American College of Foot and Ankle Surgeons (ACFAS) assembled a task force to develop a scoring scale that could be used by the membership and practitioners-at-large. The original publication that introduced the scale focused primarily on use of the scale and provided only brief background on the development of the health measurement instrument. Concerns regarding the validity and reliability of the scale were raised within the professional community, and ACFAS assembled a task force to address these concerns. The purpose of this article is to address the issues raised by reporting the detailed methods used in the development of the ACFAS Scoring Scales. The authors who constitute this task force reviewed the body of work previously conducted and applied standards that serve to evaluate the scoring scale for: 1) validity, 2) reliability, and 3) sensitivity to change. The results showed that a systematic and comprehensive approach was used in the development of the scoring scales, and the task force concluded that the statistical methods and instrument development process for all 4 modules of the scoring scales were conducted in an appropriate manner. Furthermore, modules 1 and 2 have been rigorously assessed and the elements of these modules have been shown to meet standards for validity, reliability, and sensitivity to change.

Second MTP joint instability: grading of the deformity and description of surgical repair of capsular insufficiency.

A crossover second toe is a commonly seen forefoot problem, usually occurring in women aged > 50 years, and often in association with a bunion deformity. The plantar plate is the principal static stabilizer of the second metatarsophalangeal (MTP) joint. Different authors have proposed classifications to define instability of the second MTP joint, but only describe clinical progression of the deformity. Once a plantar plate tear has developed, conservative treatment can eliminate the symptoms and prevent progression of the deformity but cannot achieve correction or realignment of the deformity. The proposed clinical staging and anatomic grading classification combines clinical findings and anatomic aspects of the plantar plate tears. The surgical treatment described herein reconstructs the anatomic structures that lead to the instability of the second MTP joint. A plantar plate tear repair and lateral soft tissue reefing can restore the normal alignment of the joint with an anatomic repair.

Vulnerability of the foot's morphological structure to deformities caused by foot loading paradigm in school-aged children: a cross-sectional study.

The study aimed to assess the association between the key predictive foot structure variables and its loading paradigm in 625 school-aged children. Clinical appraisal relied primarily on having the plantar parts of their feet comprehensively assessed with Podoscan 2D Foot CAD, and a dynamometer platform, the research tools of choice widely acknowledged for their overall accuracy and reliability, with a view to determining the distribution of respective foot loads, as well as addressing both balance and gait issues. The Clarke's angle, Wejsflog index, length and width of the feet, regardless of gender, proved the key predictive variables for the foot-loading paradigm. Notably the Clarke's angle, construed the most sensitive variable in assessing flat-footedness, offered an extra added value in overall investigative effort. The actual design of the study protocol effectively complements a standard clinical assessment procedure, whereas by comprehensively addressing those variables, it is also believed to aid clinicians in gaining an extra, hands-on, diagnostic potential, so that any teenagers exposed to the highest risk of developing foot deformities could effectively be identified through pertinent screening tests, and consequently offered a task-oriented, therapeutic management, specifically aimed at preventing potential postural complaints in later life.

Correction of coronal plane deformities around knee in children with two-hole tension band plates.

OBJECTIVES: This study aims to present the 10-year results and complications of two-hole tension band plate hemiepiphysiodesis for coronal deformities around knee in a large population from a single center. PATIENTS AND METHODS: Seventy-seven patients (46 boys, 31 girls; mean age 93±36 months; range, 22 to 181 months) who underwent temporary hemiepiphysiodesis around knee between January 2009 and January 2019 with two-hole tension band plates were retrospectively evaluated. Improvement of joint orientation angles and mechanical axis deviations, deformity correction rates, etiology groups, and complications were noted. RESULTS: A total of 166 bone segments (93 femurs, 73 tibias) were included in the study. Mean follow-up duration after the implantation was 36±17 (range, 12 to 88) months. Plates were removed at mean 18±8 (range, 7 to 47) months of implantation. Of the bone segments, 95.2% (n=158) responded successfully to the plates. Mean correction rate of mechanical lateral distal femoral angle in femoral valgum deformity was 0.94±0.43° (range, 0.17 to 2.22)/month and mean correction rate of mechanical medial proximal tibial angle in tibial valgum deformity was 0.62±0.36° (range, 0.11 to 1.55)/month. Mean correction rate of mechanical lateral distal femoral angle in femoral varum deformity was 1.3±0.8° (range, 0.48 to 2.92)/month and mean correction rate of mechanical medial proximal tibial angle in tibial varum deformity was 0.94±0.49° (range, 0.26 to 1.67)/month. The most common complication observed was rebound deformity seen in 41.2% (n=70) of the bone segments. Nine bone segments had persistent hemiepiphysiodesis despite plate removal. Four screw breakages (three metaphysial and one epiphysial) were observed. CONCLUSION: Two-hole tension band plate hemiepiphysiodesis appears to be an effective and safe method for the correction of coronal deformities around knee.