Yu-Bok Park1, Keun-Bae Lee1, Sung-Kyu Kim1, Jong-Keun Seon1, Jun-Young Lee2. 1. Department of Orthopedic Surgery, Chonnam National University Medical School and Hospital, 42 Jebongro, Dong-gu, Gwangju, 501-757, Republic of Korea. E-mail address for K.-B. Lee: kbleeos@chonnam.ac.kr. 2. Department of Orthopedic Surgery, College of Medicine, Chosun University, 365 Pilmun-daero, Dong-gu, Gwangju, 501-717, Republic of Korea.
Abstract
INTRODUCTION: 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. STEP 1 MEDIAL TRANSARTICULAR APPROACH SKIN INCISION AND MEDIAL CAPSULOTOMY: Make a medial longitudinal skin incision over the first metatarsophalangeal joint, perform a longitudinal midline capsulotomy, and excise the medial eminence. STEP 2 MEDIAL TRANSARTICULAR APPROACH DISTAL SOFT-TISSUE PROCEDURE: 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. STEP 3 MEDIAL TRANSARTICULAR APPROACH DISTAL CHEVRON OSTEOTOMY: Create a v-osteotomy, displace the capital fragment laterally, and impact it onto the shaft. STEP 4 MEDIAL TRANSARTICULAR APPROACH POSTOPERATIVE MANAGEMENT: Patients walk in a postoperative shoe after surgery, and early metatarsophalangeal stretching exercises are encouraged. STEP 1 DORSAL FIRST WEB-SPACE APPROACH SKIN INCISION: Make a 3-cm dorsal longitudinal incision centered on the first intermetatarsal web space. STEP 2 DORSAL FIRST WEB-SPACE APPROACH DISTAL SOFT-TISSUE PROCEDURE: Dissect the adductor hallucis tendon, transect the fibular sesamoid-metatarsal and transverse metatarsal ligaments, and perforate the first metatarsophalangeal joint capsule. STEP 3 DORSAL FIRST WEB-SPACE APPROACH DISTAL CHEVRON OSTEOTOMY: Perform as for the medial transarticular approach. STEP 4 DORSAL FIRST WEB-SPACE APPROACH POSTOPERATIVE MANAGEMENT: The same as for the medial transarticular approach. RESULTS: 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.
INTRODUCTION: 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. STEP 1 MEDIAL TRANSARTICULAR APPROACH SKIN INCISION AND MEDIAL CAPSULOTOMY: Make a medial longitudinal skin incision over the first metatarsophalangeal joint, perform a longitudinal midline capsulotomy, and excise the medial eminence. STEP 2 MEDIAL TRANSARTICULAR APPROACH DISTAL SOFT-TISSUE PROCEDURE: 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. STEP 3 MEDIAL TRANSARTICULAR APPROACH DISTAL CHEVRON OSTEOTOMY: Create a v-osteotomy, displace the capital fragment laterally, and impact it onto the shaft. STEP 4 MEDIAL TRANSARTICULAR APPROACH POSTOPERATIVE MANAGEMENT: Patients walk in a postoperative shoe after surgery, and early metatarsophalangeal stretching exercises are encouraged. STEP 1 DORSAL FIRST WEB-SPACE APPROACH SKIN INCISION: Make a 3-cm dorsal longitudinal incision centered on the first intermetatarsal web space. STEP 2 DORSAL FIRST WEB-SPACE APPROACH DISTAL SOFT-TISSUE PROCEDURE: Dissect the adductor hallucis tendon, transect the fibular sesamoid-metatarsal and transverse metatarsal ligaments, and perforate the first metatarsophalangeal joint capsule. STEP 3 DORSAL FIRST WEB-SPACE APPROACH DISTAL CHEVRON OSTEOTOMY: Perform as for the medial transarticular approach. STEP 4 DORSAL FIRST WEB-SPACE APPROACH POSTOPERATIVE MANAGEMENT: The same as for the medial transarticular approach. RESULTS: 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.
Authors: Samuel K K Ling; Yuen-Man Wu; Charles Li; Tun Hing Lui; Patrick Shu-Hang Yung Journal: J Orthop Translat Date: 2020-05-13 Impact factor: 5.191