Correction of Recurred Hallux Valgus Deformity by Endoscopic Distal Soft Tissue Procedure

Abstract

The underlying reason for recurrence of hallux valgus deformity after bunion surgery is multifactorial and includes surgeon-based and patient-based factors as well as original components of deformity initially unaddressed at the index procedure. Surgical treatment of a recurred hallux valgus deformity should be undertaken using the same guidelines for correction of a primary hallux valgus deformity. It requires correction of bony alignment, restoration of joint congruity, and achievement of soft tissue balance. The purpose of this Technical Note is to describe the details of endoscopic soft tissue procedure to correct a recurred hallux valgus deformity. To successfully complete this procedure, adequate lateral release to achieve soft tissue balance around the first metatarsophalangeal joint with reduction of the sesamoid bones is mandatory.

Figures

Fig 1

Correction of recurred right hallux valgus deformity by endoscopic distal soft tissue procedure. The patient is in supine position with the legs spread. Lateral release of the first metatarsophalangeal joint is performed via the toe web and plantar portals. (A) The toe web portal (TWP) is located at the dorsum of the first toe web. A cannula-trocar is inserted via the TWP and advanced proximally under the intermetatarsal ligament. The insertion should be gentle and there should not be any resistance encountered until the plantar aponeurosis is reached. The aponeurosis is penetrated by the cannula-trocar at the level of the tarsometatarsal joint. The plantar skin over the trocar tip is incised to create the plantar portal (PP). (B) The cannula-trocar is removed, and the trocar is inserted again via the TWP to the PP. (C) The cannula is inserted via the PP along the trocar to the TWP.

Fig 2

Correction of recurred right hallux valgus deformity by endoscopic distal soft tissue procedure. The patient is in supine position with the legs spread. (A) The plantar portal (PP) is the viewing portal. (B) The adductor hallucis (AdH) insertion to the lateral sesamoid bone is released by the retrograde knife (RK) via the toe web portal (TWP).

Fig 3

Correction of recurred right hallux valgus deformity by endoscopic distal soft tissue procedure. The patient is in supine position with the legs spread. (A) The plantar portal (PP) is the viewing portal. The arthroscope is turned to view the lateral capsuloligamentous complex of the first metatarsophalangeal joint. (B) The lateral capsuloligamentous complex is released by the retrograde knife (RK) via the toe web portal (TWP). (LS, lateral sesamoid bone; MT, first metatarsal head.)

Fig 4

Correction of recurred right hallux valgus deformity by endoscopic distal soft tissue procedure. The patient is in supine position with the legs spread. (A) A gauze roll is put in the first toe web to abduct the great toe and relax the medial capsule. The proximal bunion portal (PBP) is the viewing portal. (B) The bunion is resected with an arthroscopic burr (AB) via the distal bunion portal (DBP).

Fig 5

Correction of recurred right hallux valgus deformity by endoscopic distal soft tissue procedure. The patient is in supine position with the legs spread. (A) Preoperative radiograph of the illustrated case showed recurrence of hallux valgus deformity after bilateral Ludloff osteotomy and right Akin osteotomy (arrow). (B) Radiograph 1 year after right endoscopic distal soft tissue procedure. (PS, proximal screw transfixing the first and second metatarsal bases; S, screws for fixation of the osteotomies.)