Comparison of open lateral release and transarticular lateral release in distal chevron metatarsal osteotomy for hallux valgus correction

Abstract

Purpose: The aim of this study was to investigate the difference in clinical and radiographic outcomes between conventional open lateral soft tissue release (OLSTR) and transarticular lateral soft tissue release (TLSTR) in patients undergoing distal chevron metatarsal osteotomy (DCMO) for hallux valgus (HV) correction.

Methods: This study included weight-bearing anteroposterior radiographs of 138 patients (185 feet) with HV that underwent DCMO and Akin phalangeal osteotomy at a mean age of 51.7 years (21-74) with a mean 26 months of follow-up between June 2004 and June 2010. Patients were classified into two groups: OLSTR as group 1 (84 feet) and TLSTR as group 2 (101 feet). We evaluated clinical and radiographic outcomes between the two groups using the American Orthopaedic Foot and Ankle Society hallux score, visual analogue scale pain score, hallux valgus angle, intermetatarsal angle and complications, pre- and post-operatively.

Results: There were no significant differences between the two groups except for post-operative complications such as first metatarsophalangeal joint (MTPJ) stiffness (group 1) and post-operative hallux varus (group 2).

Conclusions: Clinical and radiographic outcomes between OLSTR and TLSTR in HV correction using DCMO were not significantly different except for post-operative limitation of motion of the first MTPJ and hallux varus tendency. Different precautions should be taken into account when choosing the type of lateral soft tissue release due to possible complications associated with each technique.

Figures

Fig. 1

Technique of TLSTR. a Photograph of TLSTR through the medial incision, showing that a no. 15 blade was inserted into the widened first MTPJ space while the first toe was pulled distally. b Release of the conjoined tendon of the adductor hallucis using a no. 15 blade through the first MTPJ space

Fig. 2

OLSTR case. a Preoperative weight-bearing foot AP showing HVA 38° and IMA 18°. b Six-week post-operative weight-bearing foot AP showing DCMO with Akin phalangeal osteotomy. c Twenty-six-month post-operative weight-bearing foot AP at final follow-up showing HVA 4° and IMA 5°

Fig. 3

TLSTR case. a Preoperative weight-bearing foot AP showing HVA 37° and IMA 16°. b Two-month post-operative weight-bearing foot AP showing DCMO with Akin phalangeal osteotomy. c Twenty-eight-month post-operative weight-bearing foot AP at final follow-up showing HVA 4° and IMA 5°

Fig. 4

Hallux varus complication. a Preoperative weight-bearing foot AP showing HVA 30° and IMA 14°. b Two-week post-operative weight-bearing foot AP showing DCMO and Akin phalangeal osteotomy with TLSTR. c Twenty-six-month post-operative weight-bearing foot AP at final follow-up showing hallux varus (HVA −13°) and IMA 3°