First metatarsophalangeal joint lateral release in hallux valgus surgery

NewsBot · May 9, 2013

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Efficacy of first metatarsophalangeal joint lateral release in hallux valgus surgery.
Augoyard R, Largey A, Munoz MA, Canovas F.
Orthop Traumatol Surg Res. 2013 May 3

INTRODUCTION:
Lateral release of the sesamoid ligament complex is one of the key step to the surgical treatment of hallux valgus. Although numerous techniques are available to perform this procedure, there is no accepted consensus on the method of choice. The goal of this study was to evaluate the efficacy of sequential release of lateral soft tissue structures for correction of hallux valgus deformity.

PATIENTS AND METHODS:
This study included 40 patients, mean age 50.9 years old (±17.4), with 49 hallux valgus deformities from mechanical causes. The first metatarsophalangeal angle (M1P1), the intermetatarsal angle (M1M2) and the position of the sesamoids in relation to mechanical axis of M (according to the Research Committee of the American Orthopedic Foot and Ankle Society) were determined on preoperative X-rays. During the procedure, lateral release was performed in several steps: sectioning the metatarsosesamoid suspensory ligament then sectioning the phalangeal insertional band (PIB) and complete detachment of the adductor on the fibular sesamoid ligament. We measured the changes in the M1P1 and M1M2 angles during this step-by-step release.

RESULTS:
The M1P1angle decreased during each step of release and went from 29.9° to 11.1° (P<0.001). The M1M2 decreased by 1.70° following medial capusolorrhaphy. Simple capsulorrhaphy reduced the hallux valgus deformity by 8.2° (44%). Release of the metatarsosesamoid suspensory ligament resulted in a decrease of 3.9° (or 21% of total release), release of the PIB in a decrease of 5.1° (27%) and complete detachment of the adductor in a decrease of 1.5° (8%). Thirty six percent of the sesamoids were reduced after metatarsosesamoid ligament resection, 56% after PIB release, and 60% after adductor release.

DISCUSSION:
Lateral soft tissue release is ensured in most cases by sectioning the metatarsosesamoid suspensory ligament and the PIB. Release of the adductor from the fibular sesamoid has a limited effect.

CONCLUSION:
Lateral soft tissue release should include sectioning the metatarsosesamoid suspensory ligament and detaching the PIB. This release should be enough to correct the deformity without performing any osteotomy in hallux valgus with M1P1<27° and M1M2<10°, as long as a stable medial plane can be obtained.
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NewsBot · Jul 25, 2015

Effect of Lateral Soft Tissue Release on Sesamoid Position in Hallux Valgus Surgery
Kyungjei Woo; In-Sang Yu, MD; Jun-Ho Kim, MD; Ki-Sun Sung, MD, PhD
Foot & Ankle International July 24, 2015

Background: The effect of lateral soft tissue release (LSTR) regarding the position of the sesamoid is not clear. The purpose of this study was to evaluate the effect of LSTR by comparing the radiologic and clinical outcomes of operative treatment for hallux valgus with or without LSTR.
Methods: This study included a consecutive series of chevron osteotomy of 119 feet of 90 patients with symptomatic hallux valgus with incongruent first metatarsophalangeal (MTP) joints. Fifty-one feet underwent an operation with the LSTR procedure (LSTR group), and the remaining 68 feet underwent treatment without LSTR (control non-LSTR group). We evaluated the differences regarding the distance of the fibular sesamoid from the second metatarsal bone between these 2 groups to evaluate the effect of LSTR on sesamoid position. The tibial sesamoid position was also investigated to evaluate the degree of reduction of the metatarsal head to the sesamoids. The hallux valgus angle, intermetatarsal angle, and distal metatarsal articulation angle were analyzed as radiologic outcomes. Additionally, the preoperative and final follow-up American Orthopaedic Foot & Ankle Society hallux MTP-IP scores and complications were evaluated as clinical assessments. The mean follow-up period was 43.3 weeks (range = 12-144).
Results: There were no significant differences in the amount and direction of movement of the fibular sesamoid between the LSTR group and non-LSTR group (1.9 mm and 1.6 mm, respectively) (P = .23). The direction was close to the second metatarsal bone in both groups. The complication rate in the LSTR group was 7.8% (n = 4) and 2.9% (n = 2) in the non-LSTR group (P = .40).
Conclusions: Although there were significantly improved clinical and radiologic outcomes after surgery, the LSTR procedure did not result in medial shift or reduction of the sesamoid position.
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NewsBot · Oct 12, 2017

A cadaveric study of a new capsulorrhaphy for the surgical treatment of hallux valgus
Orozco-Villaseñor SL, Monzó-Planella M, Martín-Oliva X, Vázquez-Escamilla J, Mayagoitia-Vázquez JJ, Frías-Chimal JE
Acta Ortop Mex 2017; 31 (3)

Background: There are many surgical options for the treatment of hallux valgus in combination with capsular repairs for the correction of hallux valgus. Material and methods: This report corresponds to a descriptive study where a new capsulorrhaphy technique in hallux valgus is proposed. Six dissections were performed on cadavers with hallux valgus deformity using the following surgical technique: medial approach on the first toe longitudinally, dissecting by planes and locating the metatarsophalangeal joint capsule; it was incised longitudinally. The capsule was separated and an exostectomy of the first metatarsal head was done, the edges were regularized and a release of the abductor hallucis was performed. Later, the capsular remnant was resected and repaired. Results: Six cadaveric feet with hallux valgus were studied, five with mild deformity, one with moderate deformity, one foot with the 2nd finger on supraductus. Discussion: Many capsular repairs have been reported in the literature, including «L», triangular, «V-Y», rectangular, with satisfactory results, along with osteotomy of the first metatarsal. In this report, a new capsular repair was described. Conclusion: Applying this new capsular repair, we reduced the metatarsophalangeal and intermetatarsal angles and achieved a capsular closure with suitable tension; the metatarsophalangeal joint mobility was preserved.
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NewsBot · May 6, 2018

Single Incision Lateral Release for Hallux Valgus Using A Cervical Biopsy Blade: A Cadaveric Study
James Kennedy et al
The Foot; 1 May 2018

What is already known:
•Lateral release is considered an important part of some hallux valgus corrections
•Despite controversy in the literature most authors agree that the lateral metatarsosesamoid suspensory ligament, lateral collateral ligament and lateral capsule should be divided to achieve lateral release.
•There is no gold standard to the approach of lateral release with a number of techniques having been described.
What this study adds:
•Lateral release can be achieved safely and reproducibly using a curved blade placed inferior to the metatarsal head and neck through a medial incision.
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The role of lateral release is widely accepted and regarded as a key step in management of hallux valgus. There remains however debate in literature in regards to which structures should be divided and the method of approach. We therefore developed a technique of lateral release using a curved blade placed inferior to the metatarsal head to divide the lateral metatarsosesamoid suspensory ligament and incise the lateral joint capsule. This technique was performed on fourteen fresh frozen cadaveric specimens which were then dissected. In all cases the lateral metatarsosesamoid suspensory ligament was divided and the lateral capsule incised to the joint line. One case of iatrogenic injury to the oblique head of adductor hallucis tendon was noted. No cases of neurovascular injury were noted. We conclude this method of lateral release to be safe and reproducible in a cadaveric model in achieving lateral release for the management of hallux valgus.
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NewsBot · Jun 19, 2019

Comparison of longitudinal and inverted L-type capsulorrhaphy in hallux valgus correction surgery.
Sever GB et al
Medicine [01 Jun 2019, 98(24):e15969]

The purpose of this study is to investigate clinical and radiographic differences between longitudinal capsulorrhaphy and inverted L-type capsulorrhaphy in patients diagnosed with hallux valgus (HV) to whom distal chevron osteotomy and HV distal soft-tissue procedure combination surgery was implemented.A total of 36 patients and 48 feet on whom distal chevron osteotomy and HV distal soft-tissue procedure combination surgery was implemented upon diagnosis of HV were included in the study. The patients were separated into 2 groups according to capsulorrhaphy technique, as group 1 (24 feet) wherein longitudinal capsulorrhaphy was implemented and group 2 (24 feet) wherein inverted-L type capsulorrhaphy was implemented. Both groups were compared preoperatively and postoperatively in terms of American Orthopedic Foot and Ankle Society HV score, visual analogue scale (VAS) pain score, HV angle (HVA), intermetatarsal angle and complications.Comparing the radiological data of both groups, the decrease in terms of HVA was significant in Group 2; however, no significant difference was detected in terms of other data. Postoperative hallux varus was observed 1 one patient in Group 2; however, this case was not statistically significant.In the distal chevron osteotomy and distal soft-tissue procedure combination, applied as a HV correction surgery technique, comparing inverted L-type capsulorrhaphy with longitudinal capsulorrhaphy techniques, it was observed that inverted L-type capsulorrhaphy was more effective in correcting the HVA. However, it should be kept in mind that L-type capsulorrhaphy is also the technique wherein hallux varus complication occurred. As a result, the conclusion was reached that both techniques are applicable and effective in HV correction surgery and the choice should be made by considering the command of the surgeon on the technique.
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NewsBot · May 1, 2023

Comparison of modified U-shaped and inverted L-shaped medial capsulorrhaphy in hallux valgus surgery: a prospective, randomized controlled trial of 75 patients
Xiaohua Wei, Xiong Liu, Peng Zhang & Shifeng Liu
Journal of Orthopaedic Surgery and Research volume 18, Article number: 313 (2023)

Purpose
The purpose of this study was to report a modified U-shaped medial capsulorrhaphy and compare its clinical and radiological differences with an inverted L-shaped capsulorrhaphy in hallux valgus (HV) surgery.

Methods
A prospective study of 78 patients was performed between January 2018 and October 2021. All patients underwent chevron osteotomy and soft tissue procedures for HV, and the patients were randomly separated into 2 groups according to the medial capsule closing techniques: a modified U-shaped capsulorrhaphy (group U) and an L-shaped capsulorrhaphy (group L). All patients were followed for at least a year. The preoperative and follow-up data were collected for each patient and included patient demographics, weight-bearing radiographs of the foot, the active range of motion (ROM) of the first metatarsophalangeal (MTP) joint and the American Orthopedic Foot and Ankle Society (AOFAS) forefoot score. Mann–Whitney U test was used for the comparison of the postoperative measures between the groups.

Results
In total, 75 patients with 80 affected feet met the inclusion criteria, with 38 patients (41 feet) in group U and 37 patients (39 feet) in group L. One year after surgery, the mean hallux valgus angle (HVA), intermetatarsal angle (IMA), and AOFAS score in group U improved from 29.5 to 7.1, from 13.4 to 7.1, and from 53.4 to 85.5, respectively. The mean HVA, IMA, and AOFAS score in group L improved from 31.2 to 9.6, from 13.5 to 7.9, and from 52.3 to 86.6, respectively. Comparing the 1-year postoperative measures between the 2 groups, a significant difference was found in HVA (P = 0.02), but not found in IMA and AOFAS score (P = 0.25 and P = 0.24, respectively). The mean ROM of the first MTP joint was 66.3 degrees preoperatively and 53.3 degrees at the 1-year follow-up in group U, while 63.3 and 47.5 in group L. The degrees of ROM after 1 year in group U were better than those in group L (P = 0.04).

Conclusion
Compared to the inverted L-shaped capsulorrhaphy, the modified U-shaped capsulorrhaphy provided a better ROM of the first MTP joint; at 1 year following surgery, the modified U-shaped capsulorrhaphy maintained the normal HVA better.
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First metatarsophalangeal joint lateral release in hallux valgus surgery

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First metatarsophalangeal joint lateral release in hallux valgus surgery

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Intra-articular injections of the first metatarsophalangeal joint

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Dislocation of the second metatarsophalangeal joint in hallux valgus

Foot orthoses for first metatarsophalangeal joint osteoarthritis

Effect by custom-made foot orthoses with added support under the first metatarsophalangeal joint

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Share This Page

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