Distal Soft Tissue Release Using Direct and Indirect Approaches: An Anatomic Study

Two surgical approaches for distal soft tissue release in the correction of hallux valgus, one using a dorsal first web space incision and the other a longitudinal medial capsulotomy incision (used also for medial eminence resection), were studied to compare and delineate the structures actually incised. Anatomic dissections were performed on six fresh-frozen amputation specimens using each of the approaches. The adequacy of release of the adductor hallucis, transverse and oblique heads, first metatarsophalangeal lateral capsule, and suspensory ligament was reviewed. Any inadvertent damage to the first metatarsal head cartilage, second metatarsophalangeal capsule, and lateral head of the flexor hallucis brevis tendon was also noted. Distal soft tissue release is thought to be an important part of hallux valgus surgery. Based on our anatomic dissections, the actual extent of the release may be inconsistent and unpredictable, and may have implications for the predictability of results after hallux valgus surgery.

Download Full-text

PO 18236 - Assessment of hallux valgus reduction using a modified version of the McBride test

Scientific Journal of the Foot & Ankle ◽

10.30795/scijfootankle.2019.v13.1048 ◽

2019 ◽

Vol 13 (Supl 1) ◽

pp. 53S

Author(s):

Bruno Rodrigues de Miranda ◽

Rui Dos Santos Barroco ◽

Leticia Zaccaria Prates de Oliveira ◽

Mahmoud Beerens Abdul Ghani Abdul Ghani ◽

Antonio Candido de Paula Neto ◽

...

Keyword(s):

Soft Tissue ◽

Hallux Valgus ◽

Metatarsophalangeal Joint ◽

Preoperative Assessment ◽

Metatarsal Head ◽

Soft Tissue Release ◽

First Metatarsal ◽

Lateral Tension ◽

Reduction Methods ◽

Manual Correction

Introduction: The McBride test was created to assess hallux valgus reduction and is also used to assess capsular and lateral soft-tissue tension indicating the need for lateral capsular release after the bone procedure in the first metatarsal bone. The flowcharts for lateral soft-tissue release remain unclear and lack consensus among surgeons. Objective: To propose a modified version of the test for the complementary preoperative assessment of hallux valgus reduction. Methods: We describe a method in which the examiner supinates the first metatarsal head medially to manually correct the pronation of the first metatarsal and then applies varus force to the hallux to test the lateral capsular tension of the metatarsophalangeal joint. Results: A significant reduction in lateral capsular tension was observed in the metatarsal head lifting and rotating maneuver compared with the conventional McBride test. Discussion: Hallux valgus reduction is greater with manual correction of the deformity than with the classic McBride test, most likely because of the resulting rotational bone repositioning and soft-tissue balancing. These changes seem to decrease the lateral tension that limits the correction of the deformity in the metatarsophalangeal angular plane. Conclusion: We believe that this modified version of the McBride test can be used as a more reliable predictor of the need for lateral metatarsophalangeal release after the metatarsal position is corrected through osteotomy or cuneometatarsal arthrodesis.

Download Full-text

The Role of Lateral Soft Tissue Release for the Treatment of Hallux Valgus with Distal Chevron Osteotomy

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00511 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0051

Author(s):

Zhijian Wang ◽

Tao Zhong

Keyword(s):

Soft Tissue ◽

Hallux Valgus ◽

Metatarsal Head ◽

Soft Tissue Release ◽

Aofas Score ◽

Chevron Osteotomy ◽

Valgus Angle ◽

Group A ◽

Group B

Category: Bunion Introduction/Purpose: To define the effect of distal chevron osteotomy with and without lateral soft tissue release for the correction of mild and moderate hallux valgus. Methods: 24 consecutive patients were enrolled in this prospective study. In Group A, 12 patients underwent a chevron osteotomy only. In Group B, 12 patients underwent a chevron osteotomy with lateral soft tissue release. The hallux valgus angle (HVA) and intermetatarsalangle (IMA), and AOFAS score were measured preoperatively, and 6-month follow up postoperatively and complications were evaluated. Results and complications were evaluated. Results: The change in HVA, IMA and AOFAS score were insignificant (p > 0.05) between Group A and Group B. Complications of digital neuritis and cosmetically dissatisfied scarring of the dorsal web space were seen only in Group B. No cases had avascular necrosis of the metatarsal head, malunion or nonunion. Conclusion: Lateral soft tissue release may not be needed for mild or moderate hallux valgus deformities which may prevent neuritis of dorsal or plantar lateral digital nerve and cosmetic dissatisfaction of adorsal scar.

Download Full-text

Effect on Foot Width With Triplanar Tarsometatarsal Arthrodesis for Hallux Valgus

Foot & Ankle Orthopaedics ◽

10.1177/2473011420934804 ◽

2020 ◽

Vol 5 (3) ◽

pp. 247301142093480

Author(s):

Justin Vaida ◽

Justin J. Ray ◽

Taylor L. Shackleford ◽

William T. DeCarbo ◽

Daniel J. Hatch ◽

...

Keyword(s):

Soft Tissue ◽

Functional Outcome ◽

Hallux Valgus ◽

Metatarsal Head ◽

Level Of Evidence ◽

3 Dimensional ◽

First Metatarsal ◽

Institutional Review ◽

Retrospective Comparative Study ◽

Width Reduction

Background: Foot width reduction is a desirable cosmetic and functional outcome for patients with hallux valgus. Triplanar first tarsometatarsal (TMT) arthrodesis could achieve this goal by 3-dimensional correction of the deformity. The aim of this study was to evaluate changes in bony and soft tissue width in patients undergoing triplanar first TMT arthrodesis. Methods: After receiving Institutional Review Board approval, charts were retrospectively reviewed for patients undergoing triplanar first TMT arthrodesis for hallux valgus at 4 institutions between 2016 and 2019. Patients who underwent concomitant first metatarsal head osteotomies (eg, Silver or Chevron) or fifth metatarsal osteotomies were excluded. Preoperative and postoperative anteroposterior weightbearing radiographs were compared to evaluate for changes in bony and soft tissue width. One hundred forty-eight feet from 144 patients (48.1 ± 15.7 years, 92.5% female) met inclusion criteria. Results: Preoperative osseous foot width was 96.2 mm, compared to 85.8 mm postoperatively ( P < .001). Preoperative soft tissue width was 106.6 mm, compared to 99.3 mm postoperatively ( P < .001). Postoperatively, patients had an average 10.4 ± 4.0 mm reduction (10.8% reduction) in osseous width and average 7.3 ± 4.0 mm reduction (6.8% reduction) in soft tissue width. Conclusions: Triplanar first TMT arthrodesis reduced both osseous and soft tissue foot width, providing a desirable cosmetic and functional outcome for patients with hallux valgus. Future studies are needed to determine if patient satisfaction and outcome measures correlate with reductions in foot width. Level of evidence: Level III, retrospective comparative study

Download Full-text

First Metatarsal Head and Medial Eminence Widths with and Without Hallux Valgus

Journal of the American Podiatric Medical Association ◽

10.7547/15-038 ◽

2016 ◽

Vol 106 (5) ◽

pp. 323-327 ◽

Cited By ~ 3

Author(s):

Robin C. Lenz ◽

Darshan Nagesh ◽

Hannah K. Park ◽

John Grady

Keyword(s):

Hallux Valgus ◽

Frontal Plane ◽

Metatarsal Head ◽

Head Width ◽

Plane Rotation ◽

First Metatarsal ◽

Significant Difference ◽

Medial Eminence ◽

And Control

Background: Resection of the medial eminence in hallux valgus surgery is common. True hypertrophy of the medial eminence in hallux valgus is debated. No studies have compared metatarsal head width in patients with hallux valgus and control patients. Methods: We reviewed 43 radiographs with hallux valgus and 27 without hallux valgus. We measured medial eminence width, first metatarsal head width, and first metatarsal shaft width in patients with and without radiographic hallux valgus. Results: Medial eminence width was 1.12 mm larger in patients with hallux valgus (P < .0001). Metatarsal head width was 2.81 mm larger in patients with hallux valgus (P < .001). Metatarsal shaft width showed no significant difference (P = .63). Conclusions: Metatarsal head width and medial eminence width are significantly larger on anteroposterior weightbearing radiographs in patients with hallux valgus. However, frontal plane rotation of the first metatarsal likely accounts for this difference.

Download Full-text

First Tarsometatarsal Joint Loading After Sequential Correction of Hallux Valgus Using a Proximal Opening Wedge Metatarsal Osteotomy and Distal Soft Tissue Procedure

Foot & Ankle Orthopaedics ◽

10.1177/24730114211026934 ◽

2021 ◽

Vol 6 (3) ◽

pp. 247301142110269

Author(s):

Jonathan Kraus ◽

Michael J. Ziegele ◽

Mei Wang ◽

Brian Law

Keyword(s):

Soft Tissue ◽

Hallux Valgus ◽

Contact Force ◽

Contact Stress ◽

Soft Tissue Release ◽

Wedge Osteotomy ◽

Opening Wedge ◽

First Metatarsal ◽

Joint Contact ◽

The Mean

Background: The proximal opening wedge osteotomy (POWO) of the first metatarsal (TMT-1) is commonly performed in the operative treatment of hallux valgus. Limited work has been dedicated to study POWO’s effect on the TMT-1 joint, however. The purpose of this study is to evaluate the changes in TMT-1 joint contact stress following POWO of the first metatarsal. Methods: Five fresh-frozen cadaveric below-knee specimens (mean age: 73 years) with hallux valgus deformities (mean hallux valgus angle [HVA]: 37.4 ± 8.5 degrees) were studied. The specimens were loaded to 400 N on an MTS servohydraulic load frame. Joint contact characteristics at TMT-1 joint were measured with a Tekscan pressure sensor (Model 6900, 1100 psi; Tekscan Inc, Boston, MA) with various opening wedge sizes of 3, 5, and 7 mm both without and with a distal soft tissue release (DSTR). The contact force, area, and peak contact stress were compared among groups using analysis of variance and post hoc multiple comparisons over the untreated (Dunnett test, P < .05). Results: The mean contact force was 47.7 ± 33.5 N for untreated specimens. This increased sequentially with opening wedge size and reached statistical significance for 7-mm opening wedge (129.7 ± 62.3 N, P = .01) and 7-mm wedge + DSTR (134.8 ± 60.5 N, P = .008). The mean peak contact stress was 2.8 ± 1.3 MPa for the untreated specimens and increased incrementally with wedge size to 5.7 ± 3.0 MPa for 7-mm wedge only ( P = .03) and 5.6 ± 2.5 MPa for 7-mm wedge + DSTR ( P = .05). The contact area increased with corrections, but none reached significance. Conclusion: With increasing opening wedge size, loading of the TMT-1 joint increases. Joint stresses higher than 4.7 MPa have been shown to be chondrotoxic, potentially predisposing patients to arthritic joint changes following POWO. Level of Evidence: XXXXXX

Download Full-text

Technique Tip: Lateral Soft-Tissue Release für Correction of Hallux Valgus Through a Medial Incision Using a Dorsal Flap Over the First Metatarsal

Fuß & Sprunggelenk ◽

10.1016/j.fuspru.2007.12.008 ◽

2008 ◽

Vol 6 (1) ◽

pp. 46

Keyword(s):

Soft Tissue ◽

Hallux Valgus ◽

Soft Tissue Release ◽

First Metatarsal

Download Full-text

Reduction of Foot Width with Triplanar Tarsometatarsal Arthrodesis for Hallux Valgus Deformity: A Multicenter Study

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00474 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0047

Author(s):

Justin Vaida ◽

Justin J. Ray ◽

Taylor L. Shackleford ◽

William T. DeCarbo ◽

Daniel J. Hatch ◽

...

Keyword(s):

Soft Tissue ◽

Functional Outcome ◽

Hallux Valgus ◽

Three Dimensional ◽

Metatarsal Head ◽

Valgus Deformity ◽

Inclusion Criteria ◽

First Metatarsal ◽

Hallux Valgus Deformity ◽

Width Reduction

Category: Bunion; Hindfoot Introduction/Purpose: Foot width reduction is a desirable cosmetic and functional outcome for patients with hallux valgus. Triplanar tarsometatarsal (TMT) arthrodesis achieves this by three-dimensional correction of the deformity. The aim of this study was to evaluate changes in bony and soft tissue width in patients undergoing triplanar TMT arthrodesis. Methods: After receiving IRB approval, charts were retrospectively reviewed for patients undergoing triplanar TMT arthrodesis for hallux valgus deformity at four institutions between 2016 and 2019. Patients who underwent concomitant first metatarsal head osteotomies (e.g., Silver or Chevron) or fifth metatarsal osteotomies were excluded. Preoperative and postoperative anteroposterior weightbearing radiographs were compared to evaluate for changes in bony and soft tissue width. Bony width was defined as the distance from the most medial aspect of the first metatarsal head to the most lateral aspect of the fifth metatarsal head. Soft tissue width was defined as the distance from the most medial soft tissue overlying the first metatarsal head to the most lateral soft tissue overlying the fifth metatarsal head. Results: 148 feet from 144 patients (48.1 +- 15.7 years, 92.5% male) met inclusion criteria. Preoperative osseous foot width was 96.2 mm, compared to 85.8 mm postoperative (p < 0.001). Preoperative soft tissue width was 106.6 mm, compared to 99.3 mm postoperative (p < 0.001). Postoperatively, patients had an average 10.4 +- 0.33 mm reduction (10.8% reduction) in osseous width and average 7.3 +- 0.33 mm reduction (6.8% reduction) in soft tissue width. Conclusion: Triplanar TMT arthrodesis reduces both osseous and soft tissue foot width providing a desirable cosmetic and functional outcome for patients with hallux valgus. Future studies are needed to determine if patient satisfaction and outcome measures correlate with reductions in foot width.

Download Full-text

Avascular Necrosis of the First Metatarsal Head: Incidence in Distal Osteotomy Combined with Lateral Soft Tissue Release

Foot & Ankle International ◽

10.1177/107110079401500201 ◽

1994 ◽

Vol 15 (2) ◽

pp. 59-63 ◽

Cited By ~ 74

Author(s):

Drew A. Peterson ◽

Jeffrey L. Zilberfarb ◽

Marie A. Greene ◽

Robert C. Colgrove

Keyword(s):

Soft Tissue ◽

Avascular Necrosis ◽

Metatarsal Head ◽

Soft Tissue Release ◽

Radiographic Examination ◽

Metatarsal Osteotomy ◽

First Metatarsal ◽

Valgus Angle ◽

Adductor Tenotomy

The incidence of avascular necrosis of the metatarsal head following distal first metatarsal osteotomy combined with adductor tendon release has not been documented in a large series of patients. Of 82 consecutive procedures in 64 patients performed between 1986 and 1988, 42 patients (58 procedures) were available for clinical and radiographic examination. Average follow-up was 2.5 years (range 1.0–4.2 years). There were 35 L-shaped and 23 chevron osteotomies which were combined with a lateral soft tissue release that included adductor tenotomy. preoperative hallux valgus angle averaged 25° (range 15–40°), and intermetatarsal angle averaged 12° (range 5–24°). Follow-up amount of correction averaged 13° and 5°, respectively. Eighty-four percent of patients were satisfied with their result. There was one case of avascular necrosis. The patient was asymptomatic at 4.2 years' follow-up, and the remaining patients included two with infections, one hallux varus, and no nonunions.

Download Full-text

Foot Width Changes Following Hallux Valgus Surgery

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00481 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0048

Author(s):

Shay Tenenbaum ◽

Jason Bariteau ◽

Amir Herman ◽

Oded Coifman

Keyword(s):

Soft Tissue ◽

Hallux Valgus ◽

Metatarsal Head ◽

Soft Tissue Release ◽

X Rays ◽

Maximal Distance ◽

Bone Width ◽

Radiographic Measurements ◽

Valgus Angle ◽

The Impact

Category: Midfoot/Forefoot Introduction/Purpose: Hallux valgus is one of the most common deformities of the adult foot, and can adversely affect quality of life, with common complaints including pain, footwear restrictions and cosmesis. Every clinician is familiar with the patients’ concerns regarding the postoperative foot appearance and footwear anticipations. Surprisingly, although patients are concerned with postoperative foot width, there are only scarce reports on this issue. This study was undertaken to evaluate the impact of hallux valgus surgical treatment on foot width. Methods: Study included 71 consecutive cases with moderate to severe hallux valgus treated with Scarf osteotomy, distal soft tissue release and Akin osteotomy as needed. Patients were included only if pre- and postoperative weightbearing X-rays at minimum 6 months followup were available. The average age was 55.7 years (range, 20 to 76), with average follow-up of 20.7 months (range, 6 to 96). Patients’ medical records were reviewed for clinical data, surgical technique and radiographic measurements. The radiographic measurements included hallux valgus angle (HVA), intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA), and foot width. Foot width was assessed by measuring both the bony width (BW: maximal distance between the medial cortex of 1st metatarsal head and lateral cortex of the 5th metatarsal head) and the soft tissue width (STW: maximal distance between most medial soft tissue outline and the most lateral soft tissue outline at the level of metatarsal heads). Results: Preoperative HV deformity (mean HVA 35.8, IMA 14.1 and DMAA 15.2) was successfully corrected (postoperative mean HVA 13.7, IMA 6.9 and DMAA 7.7). Overall bony foot width was reduced by 5% and soft tissue foot width by 2% postoperatively. Further analysis showed there were 13 feet (18.3%) with increased (>5%) bone width, 26 feet (36.6%) with no change (±5%) and 32 feet (45.1%) for which width decreased in more than 5% postoperatively. Patients with the widest foot before surgery, had a decrease in foot width following surgery whereas, patients with the narrowest foot width, had an increase in foot width. Magnitude of preoperative deformity (as assessed by HVA, IMA and DMMA measurements) or amount of correction had low correlation (<0.2) with postoperative foot width. Conclusion: While the ability of surgery to correct HV deformity is well established and reported in the literature, its effect on foot width is less understood or predictable. Overall, the postoperative reduction of foot with was modest. Furthermore, while postoperative foot width (both bony and soft tissue) decreases or does not change in 4 out of 5 patients, there are cases in which foot width actually increases.

Download Full-text