Two techniques of transarticular distal soft-tissue release combined with distal chevron osteotomy for hallux valgus : a prospective randomized study.

Abstract

This study aimed to determine differences in radiological and clinical outcomes between two groups with hallux valgus deformity who underwent distal chevron osteotomy and two different types of transarticular distal soft-tissue release. In one group, transarticular release was performed with lateral metatarsosesamoid suspensory ligament (MSL) release, whereas in the other, MSL release was not performed. A total of 76 patients were randomized into two groups: distal chevron osteotomy with transarticular soft-tissue release either including lateral MSL release (Group A, n = 39) or without lateral MSL release (Group B, n = 37). The primary outcome was the hallux valgus angle (HVA) at 12 months postoperatively, with secondary outcomes including the inter-metatarsal angle (IMA), sesamoid position, Foot and Ankle Outcome Score (FAOS), Foot Functional Index (FFI), visual analogue scale (VAS) for pain, patient satisfaction, and first metatarsophalangeal (MTP) joint range of motion (ROM). Sub-group analysis was performed to investigate differences in the effect of distal soft-tissue release with regard to the severity of the deformity. At the 12-month follow-up, both groups showed significant improvements in radiological parameters (HVA, IMA, and sesamoid position) and functional scores (FAOS, FFI, and VAS pain), with no significant differences between groups overall. Patient satisfaction and ROM of the first MTP joint also showed no significant differences between the groups. In the sub-group analysis, there were no significant differences between the groups in mean preoperative HVA and IMA for both moderate and severe deformities. At 12 months postoperatively, mean HVA and IMA did not differ significantly between the groups with moderate deformities, whereas they were significantly lower in Group A than in Group B in severe deformities. Lateral MSL release is not essential for treating moderate hallux valgus deformities with distal chevron osteotomy and transarticular distal soft-tissue release. However, lateral MSL release may be beneficial in patients with severe deformities.