Lateral Soft-Tissue Release with Medial Transarticular or Dorsal First Web-Space Approach Combined...
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![Page 1: Lateral Soft-Tissue Release with Medial Transarticular or Dorsal First Web-Space Approach Combined with Distal Chevron Osteotomy for Moderate-to-Severe.](https://reader036.fdocuments.us/reader036/viewer/2022062720/56649f0c5503460f94c1f6f6/html5/thumbnails/1.jpg)
Lateral Soft-Tissue Release with Medial Transarticular or Dorsal First Web-Space Approach Combined with Distal
Chevron Osteotomy for Moderate-to-Severe Hallux Valgus
by Yu-Bok Park, Keun-Bae Lee, Sung-Kyu Kim, Jong-Keun Seon, and Jun-Young Lee
JBJS Essent Surg TechVolume 4(4):e24
December 24, 2014
©2014 by The Journal of Bone and Joint Surgery, Inc.
![Page 2: Lateral Soft-Tissue Release with Medial Transarticular or Dorsal First Web-Space Approach Combined with Distal Chevron Osteotomy for Moderate-to-Severe.](https://reader036.fdocuments.us/reader036/viewer/2022062720/56649f0c5503460f94c1f6f6/html5/thumbnails/2.jpg)
A medial longitudinal skin incision.
Yu-Bok Park et al. JBJS Essent Surg Tech 2014;4:e24
©2014 by The Journal of Bone and Joint Surgery, Inc.
![Page 3: Lateral Soft-Tissue Release with Medial Transarticular or Dorsal First Web-Space Approach Combined with Distal Chevron Osteotomy for Moderate-to-Severe.](https://reader036.fdocuments.us/reader036/viewer/2022062720/56649f0c5503460f94c1f6f6/html5/thumbnails/3.jpg)
A longitudinal midline capsulotomy.
Yu-Bok Park et al. JBJS Essent Surg Tech 2014;4:e24
©2014 by The Journal of Bone and Joint Surgery, Inc.
![Page 4: Lateral Soft-Tissue Release with Medial Transarticular or Dorsal First Web-Space Approach Combined with Distal Chevron Osteotomy for Moderate-to-Severe.](https://reader036.fdocuments.us/reader036/viewer/2022062720/56649f0c5503460f94c1f6f6/html5/thumbnails/4.jpg)
The first metatarsophalangeal joint is distracted distally with use of two vein retractors and application of manual traction to the great toe to allow clear visualization of the lateral soft-tissue
structures.
Yu-Bok Park et al. JBJS Essent Surg Tech 2014;4:e24
©2014 by The Journal of Bone and Joint Surgery, Inc.
![Page 5: Lateral Soft-Tissue Release with Medial Transarticular or Dorsal First Web-Space Approach Combined with Distal Chevron Osteotomy for Moderate-to-Severe.](https://reader036.fdocuments.us/reader036/viewer/2022062720/56649f0c5503460f94c1f6f6/html5/thumbnails/5.jpg)
The lateral joint capsule (arrow) is visualized through the metatarsophalangeal joint, which is distracted with use of a mosquito clamp.
Yu-Bok Park et al. JBJS Essent Surg Tech 2014;4:e24
©2014 by The Journal of Bone and Joint Surgery, Inc.
![Page 6: Lateral Soft-Tissue Release with Medial Transarticular or Dorsal First Web-Space Approach Combined with Distal Chevron Osteotomy for Moderate-to-Severe.](https://reader036.fdocuments.us/reader036/viewer/2022062720/56649f0c5503460f94c1f6f6/html5/thumbnails/6.jpg)
After the lateral joint capsule is released with use of a number-15 blade, the adductor hallucis tendon (arrow) is observed.
Yu-Bok Park et al. JBJS Essent Surg Tech 2014;4:e24
©2014 by The Journal of Bone and Joint Surgery, Inc.
![Page 7: Lateral Soft-Tissue Release with Medial Transarticular or Dorsal First Web-Space Approach Combined with Distal Chevron Osteotomy for Moderate-to-Severe.](https://reader036.fdocuments.us/reader036/viewer/2022062720/56649f0c5503460f94c1f6f6/html5/thumbnails/7.jpg)
The adductor hallucis tendon is released completely.
Yu-Bok Park et al. JBJS Essent Surg Tech 2014;4:e24
©2014 by The Journal of Bone and Joint Surgery, Inc.
![Page 8: Lateral Soft-Tissue Release with Medial Transarticular or Dorsal First Web-Space Approach Combined with Distal Chevron Osteotomy for Moderate-to-Severe.](https://reader036.fdocuments.us/reader036/viewer/2022062720/56649f0c5503460f94c1f6f6/html5/thumbnails/8.jpg)
Illustration showing the conjoined tendon of the adductor hallucis tendon transected from its insertion into the base of the proximal phalanx.
Yu-Bok Park et al. JBJS Essent Surg Tech 2014;4:e24
©2014 by The Journal of Bone and Joint Surgery, Inc.
![Page 9: Lateral Soft-Tissue Release with Medial Transarticular or Dorsal First Web-Space Approach Combined with Distal Chevron Osteotomy for Moderate-to-Severe.](https://reader036.fdocuments.us/reader036/viewer/2022062720/56649f0c5503460f94c1f6f6/html5/thumbnails/9.jpg)
Varus stress is applied to the first metatarsophalangeal joint to complete the release of the adductor hallucis tendon at the proximal phalanx.
Yu-Bok Park et al. JBJS Essent Surg Tech 2014;4:e24
©2014 by The Journal of Bone and Joint Surgery, Inc.
![Page 10: Lateral Soft-Tissue Release with Medial Transarticular or Dorsal First Web-Space Approach Combined with Distal Chevron Osteotomy for Moderate-to-Severe.](https://reader036.fdocuments.us/reader036/viewer/2022062720/56649f0c5503460f94c1f6f6/html5/thumbnails/10.jpg)
A 60° v-osteotomy is created and centered in the first metatarsal head.
Yu-Bok Park et al. JBJS Essent Surg Tech 2014;4:e24
©2014 by The Journal of Bone and Joint Surgery, Inc.
![Page 11: Lateral Soft-Tissue Release with Medial Transarticular or Dorsal First Web-Space Approach Combined with Distal Chevron Osteotomy for Moderate-to-Severe.](https://reader036.fdocuments.us/reader036/viewer/2022062720/56649f0c5503460f94c1f6f6/html5/thumbnails/11.jpg)
The capital fragment is translated about 7 mm laterally and manually impacted onto the shaft to obtain a stable reduction.
Yu-Bok Park et al. JBJS Essent Surg Tech 2014;4:e24
©2014 by The Journal of Bone and Joint Surgery, Inc.
![Page 12: Lateral Soft-Tissue Release with Medial Transarticular or Dorsal First Web-Space Approach Combined with Distal Chevron Osteotomy for Moderate-to-Severe.](https://reader036.fdocuments.us/reader036/viewer/2022062720/56649f0c5503460f94c1f6f6/html5/thumbnails/12.jpg)
Yu-Bok Park et al. JBJS Essent Surg Tech 2014;4:e24
©2014 by The Journal of Bone and Joint Surgery, Inc.
![Page 13: Lateral Soft-Tissue Release with Medial Transarticular or Dorsal First Web-Space Approach Combined with Distal Chevron Osteotomy for Moderate-to-Severe.](https://reader036.fdocuments.us/reader036/viewer/2022062720/56649f0c5503460f94c1f6f6/html5/thumbnails/13.jpg)
Yu-Bok Park et al. JBJS Essent Surg Tech 2014;4:e24
©2014 by The Journal of Bone and Joint Surgery, Inc.
![Page 14: Lateral Soft-Tissue Release with Medial Transarticular or Dorsal First Web-Space Approach Combined with Distal Chevron Osteotomy for Moderate-to-Severe.](https://reader036.fdocuments.us/reader036/viewer/2022062720/56649f0c5503460f94c1f6f6/html5/thumbnails/14.jpg)
Postoperative shoe.
Yu-Bok Park et al. JBJS Essent Surg Tech 2014;4:e24
©2014 by The Journal of Bone and Joint Surgery, Inc.
![Page 15: Lateral Soft-Tissue Release with Medial Transarticular or Dorsal First Web-Space Approach Combined with Distal Chevron Osteotomy for Moderate-to-Severe.](https://reader036.fdocuments.us/reader036/viewer/2022062720/56649f0c5503460f94c1f6f6/html5/thumbnails/15.jpg)
The adductor hallucis tendon is identified with use of a mosquito clamp.
Yu-Bok Park et al. JBJS Essent Surg Tech 2014;4:e24
©2014 by The Journal of Bone and Joint Surgery, Inc.
![Page 16: Lateral Soft-Tissue Release with Medial Transarticular or Dorsal First Web-Space Approach Combined with Distal Chevron Osteotomy for Moderate-to-Severe.](https://reader036.fdocuments.us/reader036/viewer/2022062720/56649f0c5503460f94c1f6f6/html5/thumbnails/16.jpg)
The adductor hallucis tendon (arrow) has been released from its insertion at the base of the proximal phalanx of the great toe.
Yu-Bok Park et al. JBJS Essent Surg Tech 2014;4:e24
©2014 by The Journal of Bone and Joint Surgery, Inc.
![Page 17: Lateral Soft-Tissue Release with Medial Transarticular or Dorsal First Web-Space Approach Combined with Distal Chevron Osteotomy for Moderate-to-Severe.](https://reader036.fdocuments.us/reader036/viewer/2022062720/56649f0c5503460f94c1f6f6/html5/thumbnails/17.jpg)
After the fibular sesamoid-metatarsal ligament is released, the fibular sesamoid (arrow) can be observed.
Yu-Bok Park et al. JBJS Essent Surg Tech 2014;4:e24
©2014 by The Journal of Bone and Joint Surgery, Inc.
![Page 18: Lateral Soft-Tissue Release with Medial Transarticular or Dorsal First Web-Space Approach Combined with Distal Chevron Osteotomy for Moderate-to-Severe.](https://reader036.fdocuments.us/reader036/viewer/2022062720/56649f0c5503460f94c1f6f6/html5/thumbnails/18.jpg)
The transverse metatarsal ligament (arrow) has been identified and transected.
Yu-Bok Park et al. JBJS Essent Surg Tech 2014;4:e24
©2014 by The Journal of Bone and Joint Surgery, Inc.
![Page 19: Lateral Soft-Tissue Release with Medial Transarticular or Dorsal First Web-Space Approach Combined with Distal Chevron Osteotomy for Moderate-to-Severe.](https://reader036.fdocuments.us/reader036/viewer/2022062720/56649f0c5503460f94c1f6f6/html5/thumbnails/19.jpg)
The preoperative hallux valgus angle was 38°, the first-second intermetatarsal angle was 19°, and the tibial sesamoid position was grade 3.
Yu-Bok Park et al. JBJS Essent Surg Tech 2014;4:e24
©2014 by The Journal of Bone and Joint Surgery, Inc.
![Page 20: Lateral Soft-Tissue Release with Medial Transarticular or Dorsal First Web-Space Approach Combined with Distal Chevron Osteotomy for Moderate-to-Severe.](https://reader036.fdocuments.us/reader036/viewer/2022062720/56649f0c5503460f94c1f6f6/html5/thumbnails/20.jpg)
Preoperative clinical photograph.
Yu-Bok Park et al. JBJS Essent Surg Tech 2014;4:e24
©2014 by The Journal of Bone and Joint Surgery, Inc.
![Page 21: Lateral Soft-Tissue Release with Medial Transarticular or Dorsal First Web-Space Approach Combined with Distal Chevron Osteotomy for Moderate-to-Severe.](https://reader036.fdocuments.us/reader036/viewer/2022062720/56649f0c5503460f94c1f6f6/html5/thumbnails/21.jpg)
Postoperative anteroposterior radiograph.
Yu-Bok Park et al. JBJS Essent Surg Tech 2014;4:e24
©2014 by The Journal of Bone and Joint Surgery, Inc.
![Page 22: Lateral Soft-Tissue Release with Medial Transarticular or Dorsal First Web-Space Approach Combined with Distal Chevron Osteotomy for Moderate-to-Severe.](https://reader036.fdocuments.us/reader036/viewer/2022062720/56649f0c5503460f94c1f6f6/html5/thumbnails/22.jpg)
The hallux valgus angle was 10°, the first-second intermetatarsal angle was 9°, and the tibial sesamoid position was grade 2 at the time of final follow-up.
Yu-Bok Park et al. JBJS Essent Surg Tech 2014;4:e24
©2014 by The Journal of Bone and Joint Surgery, Inc.
![Page 23: Lateral Soft-Tissue Release with Medial Transarticular or Dorsal First Web-Space Approach Combined with Distal Chevron Osteotomy for Moderate-to-Severe.](https://reader036.fdocuments.us/reader036/viewer/2022062720/56649f0c5503460f94c1f6f6/html5/thumbnails/23.jpg)
Clinical photograph at the time of final follow-up.
Yu-Bok Park et al. JBJS Essent Surg Tech 2014;4:e24
©2014 by The Journal of Bone and Joint Surgery, Inc.