Lateral Soft-Tissue Release with Medial Transarticular or Dorsal First Web-Space Approach Combined with Distal Chevron Osteotomy for Moderate-to-Severe Hallux Valgus.

Abstract

We describe the medial transarticular and dorsal first web-space soft-tissue approaches, used in combination with an osteotomy, for the surgical correction of painful hallux valgus. Make a medial longitudinal skin incision over the first metatarsophalangeal joint, perform a longitudinal midline capsulotomy, and excise the medial eminence. Distract and widen the first metatarsophalangeal joint, apply manual traction to the great toe, transect the adductor hallucis, and apply varus stress to the first metatarsophalangeal joint. Create a v-osteotomy, displace the capital fragment laterally, and impact it onto the shaft. Patients walk in a postoperative shoe after surgery, and early metatarsophalangeal stretching exercises are encouraged. Make a 3-cm dorsal longitudinal incision centered on the first intermetatarsal web space. Dissect the adductor hallucis tendon, transect the fibular sesamoid-metatarsal and transverse metatarsal ligaments, and perforate the first metatarsophalangeal joint capsule. Perform as for the medial transarticular approach. The same as for the medial transarticular approach. We studied 122 female patients (122 feet) who had undergone distal chevron osteotomy with a distal soft-tissue procedure for the treatment of symptomatic, unilateral, moderate-to-severe hallux valgus.IndicationsContraindicationsPitfalls & Challenges.