Hallux Valgus Correction Using Transarticular Lateral Release With Distal Chevron Osteotomy
ABSTRACT Transarticular lateral release through a medial incision can avoid a dorsal incision. This study investigated outcomes following hallux valgus correction using transarticular lateral release, distal chevron metatarsal osteotomy and Akin phalangeal osteotomy through one medial incision.
Between June 2004 and May 2009, a single surgeon performed a transarticular lateral release, distal chevron metatarsal osteotomy and Akin phalangeal osteotomy through one medial incision for hallux valgus on a total of 103 feet of 68 patients. The average patient age at the time of surgery was 51 years, and the average followup was 27 months.
The average preoperative and final followup results were: 1) hallux valgus angle improvement from 29 degrees to 5 degrees, 2) intermetatarsal angle from 13 degrees to 5 degrees and 3) medial sesamoid bone position from 3 to 1 (p < 0.05 for each variable). The average AOFAS scores were improved from 49 to 92, and the VAS pain scores were improved from 7 to 1 (p < 0.05 for both variables). No patient had a serious complication such as infection, avascular necrosis, nonunion, transfer-metatarsalgia, or first metatarsophalangeal joint arthritis.
Hallux valgus correction using transarticular lateral release, distal chevron metatarsal osteotomy and Akin phalangeal osteotomy through one medial incision was found to be effective and safe. The advantages include that the procedure is simple, early ambulation is possible, and there is no dorsal scarring.
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ABSTRACT: The distal soft tissue procedure has evolved into an indispensable additional surgical procedure to increase the corrective effect in hallux valgus surgery. Considering the biomechanical development of hallux valgus deformity, degenerative changes of the soft tissues around the first metatarsophalangeal joint contribute much more to the deformity than changes in the bony structures which can rather be seen as degenerative changes secondary to the deformity. Thus the principles in hallux valgus correction should aim to reverse all pathogenetic steps leading to deformity: release of the contracted lateral soft tissue structures, tightening of the torn-out medial structures and reduction and rebalancing the first metatarsal head onto the sesamoid complex. The scientific discussion over the last decades has clarified the impact of different surgical steps and methods on the efficacy of the lateral release, the risk of creating overcorrection or instability of the joint and the risk of avascular necrosis of the first metatarsal head. According to anatomical and clinical data, a lateral soft tissue release can be combined with a distal metatarsal osteotomy, provided that the osteotomy is performed in a defined safe zone without increasing the risk for avascular necrosis of the first metatarsal head. Transecting the lateral metatarsosesamoid suspensory ligament is the key to a successful lateral release in hallux valgus surgery. Release of the deep transverse metatarsal ligament and the adductor hallucis muscle does not contribute to hallux valgus correction. The lateral short sesamophalangeal ligament and the plantar attachment of the articular capsule should be preserved to avoid possible joint instability. Thus today, the distal soft tissue procedure cannot be seen only as a supplementary surgical procedure in cases where the bony procedure needs additional correction, but rather is an indispensable procedure to restore the physiological situation and function of the first metatarsophalangeal joint.International Orthopaedics 07/2013; 37(9). DOI:10.1007/s00264-013-1959-5 · 2.02 Impact Factor
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ABSTRACT: The aim of this study was to investigate the difference in clinical and radiographic outcomes between conventional open lateral soft tissue release (OLSTR) and transarticular lateral soft tissue release (TLSTR) in patients undergoing distal chevron metatarsal osteotomy (DCMO) for hallux valgus (HV) correction. This study included weight-bearing anteroposterior radiographs of 138 patients (185 feet) with HV that underwent DCMO and Akin phalangeal osteotomy at a mean age of 51.7 years (21-74) with a mean 26 months of follow-up between June 2004 and June 2010. Patients were classified into two groups: OLSTR as group 1 (84 feet) and TLSTR as group 2 (101 feet). We evaluated clinical and radiographic outcomes between the two groups using the American Orthopaedic Foot and Ankle Society hallux score, visual analogue scale pain score, hallux valgus angle, intermetatarsal angle and complications, pre- and post-operatively. There were no significant differences between the two groups except for post-operative complications such as first metatarsophalangeal joint (MTPJ) stiffness (group 1) and post-operative hallux varus (group 2). Clinical and radiographic outcomes between OLSTR and TLSTR in HV correction using DCMO were not significantly different except for post-operative limitation of motion of the first MTPJ and hallux varus tendency. Different precautions should be taken into account when choosing the type of lateral soft tissue release due to possible complications associated with each technique.International Orthopaedics 08/2013; 37(9). DOI:10.1007/s00264-013-2023-1 · 2.02 Impact Factor