Proximal metatarsal osteotomy and distal soft tissue reconstruction as treatment for hallux valgus deformity

• Published in: Keio journal of medicine Vol. 54; no. 2; pp. 60 - 65
• Main Authors: Coughlin, Michael J., Grimes, J. Speight
• Format: Journal Article
• Language: English
• Published: Japan The Keio Journal of Medicine 2005
• Subjects: Adult; Anesthesia; bunion; Child; Hallux valgus; Hallux Valgus - rehabilitation; Hallux Valgus - surgery; Humans; Joint Capsule - surgery; Ligaments, Articular - surgery; Metatarsus - surgery; osteotomy; Osteotomy - methods; Postoperative Care; Preoperative Care; Wound Healing
• ISSN: 0022-9717; 1880-1293
• DOI: 10.2302/kjm.54.60

The correction of a hallux valgus deformity with a proximal 1st metatarsal osteotomy and distal soft tissue repair is achieved with a three-incision technique. A lateral soft tissue release and reconstruction at the first metatarsophalangeal joint releases contracted structures including the lateral capsule, the transverse inter-metatarsal ligament and the conjoint adductor tendon. Rarely is the lateral sesamoid excised. Through a medial incision, the medial eminence or exostosis is resected. The sesamoids are realigned and the medial capsule is reefed. With a third incision, a proximal first meta-tarsal osteotomy is performed that corrects a widened 1-2 intermetatarsal angle. With correction of the hallux valgus and the 1-2 intermetatarsal angle, pronation of the hallux is corrected. This correction is routinely used for hallux valgus deformities characterized by subluxation of the metatarsophalangeal joint. In the presence of a mild hallux valgus deformity an osteotomy may not be necessary. With degenerative arthritis or a congruent metatarsophalangeal joint, alternative surgical procedures are indicated.