J Korean Foot Ankle Soc.  2023 Dec;27(4):123-130. 10.14193/jkfas.2023.27.4.123.

Distal Soft Tissue Procedure in Hallux Valgus Deformity: Comparison of Modified Mcbride Procedure and Trans-Articular Approach

• Lee J
• Kim K
• Park SJ

• KMID: 2552991
• DOI: http://doi.org/10.14193/jkfas.2023.27.4.123

Abstract

Purpose
“Hallux valgus” is a common disease encountered in clinical practice and is accompanied by foot deformities. Conservative treatment is commonly used in the early stages of hallux valgus. On the other hand, surgical treatment often becomes necessary as the deformity progresses. Surgical treatments involve various osteotomy methods or joint fusion procedures combined with soft tissue release, and outcomes from these surgical treatments are generally favorable. This study compared two soft tissue release techniques in the hallux region.
Materials and Methods
This study conducted a retrospective cohort study on 48 participants who underwent surgical treatment for hallux valgus at a single institution from March 1, 2018, to March 31, 2023. A scarf osteotomy was performed in all cases, and the “Modified Mcbride procedure” or “Trans-articular approach” was done for soft tissue release. Hallux valgus angle (HVA), intermetatarsal angle (IMA), and the degree of subluxation of the lateral sesamoid were measured through simple foot radiographs taken before surgery and one year after surgery.
Results
In the Modified Mcbride procedure group, HVA, IMA, and the sesamoid position grade decreased from 34.94º to 9.98º, 15.64º to 5.44º, and 2.47 to 0.44, respectively. In the trans-articular approach group, HVA, IMA, and the sesamoid position grade decreased from 33.42º to 7.34º, 15.06º to 6.03º, and 2.17 to 0.58, respectively. There was no significant difference in these changes between the preoperative and one-year postoperative measurements for both techniques (p-value>0.05).
Conclusion
A radiological assessment of soft tissue release through the Modified Mcbride procedure and trans-articular approach in hallux valgus did not show significant differences. Therefore, both surgical techniques can be considered in the distal soft tissue release for a hallux valgus correction.

Keyword

Foot; Hallux valgus; Distal soft tissue procedure; Therapeutics

Figure

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  Figure 1 Radiographs showing the pre-operative deformity (A) and the immediate post-operative correction through modified Mcbride procedure and Scarf osteotomy, Akin osteotomy (B). As well as Fig. 1, final follow up radiographs (C) shows well maintained 1st metatarsophalangeal joint alignment.

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  Figure 2 Radiographs showing the pre-operative deformity (A) and the immediate post-operative correction through the trans-articular distal soft tissue release and Scarf osteotomy (B). Last follow up radiographs (C) shows maintained neutral 1st metatarsophalangeal joint alignment.

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  Figure 3 Radiographic measurements of the hallux valgus angle; angle between two yellow line.

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  Figure 4 Radiographic measurements of the intermetatarsal angle; angle between two yellow line.

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  Figure 5 Radiographs showing the sesamoid subluxation grade from normal to severe. (A) Grade 0 shows ≤25% of the lateral sesamoid exposed lateral to the lateral border of 1st metatarsal head, (B) grade 1 shows >25% and ≤50% of lateral sesamoid exposed as same way, (C) grade 2 shows >50% and ≤75% of lateral sesamoid exposed as same way, (D) grade 3 shows >75% of lateral sesamoid exposed as same way.

• 

  Figure 6 Distal soft tissue release through the trans-articular approach. With the assistance of C-arm intensifier, release of adductor hallucis tendon and lateral capsulotomy were done.

Reference

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