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Comparison of Distal Soft-Tissue Procedures Combined with a Distal Chevron Osteotomy for Moderate to Severe Hallux Valgus: First Web-Space Versus Transarticular Approach
Yu-Bok Park, MD1; Keun-Bae Lee, MD, PhD1; Sung-Kyu Kim, MD1; Jong-Keun Seon, MD, PhD1; Jun-Young Lee, MD, PhD2
1 Department of Orthopaedic 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 Orthopaedic Surgery, College of Medicine, Chosun University, 365 Pilmun-daero, Dong-gu, Gwangju, 501-717, Republic of Korea
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Investigation performed at the Department of Orthopaedic Surgery, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea



Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. None of the authors, or their institution(s), have had any financial relationship, in the thirty-six months prior to submission of this work, with any entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. Also, no author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2013 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2013 Nov 06;95(21):e158 1-8. doi: 10.2106/JBJS.L.01017
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Abstract

Background: 

There are two surgical approaches for distal soft-tissue procedures for the correction of hallux valgus—the dorsal first web-space approach, and the medial transarticular approach. The purpose of this study was to compare the outcomes achieved after use of either of these approaches combined with a distal chevron osteotomy in patients with moderate to severe hallux valgus.

Methods: 

One hundred and twenty-two female patients (122 feet) who underwent a distal chevron osteotomy as part of a distal soft-tissue procedure for the treatment of symptomatic unilateral moderate to severe hallux valgus constituted the study cohort. The 122 feet were randomly divided into two groups: namely, a dorsal first web-space approach (group D; sixty feet) and a medial transarticular approach (group M; sixty-two feet). The clinical and radiographic results of the two groups were compared at a mean follow-up time of thirty-eight months.

Results: 

The American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot scale hallux metatarsophalangeal-interphalangeal scores improved from a mean and standard deviation of 55.5 ± 12.8 points preoperatively to 93.5 ± 6.3 points at the final follow-up in group D and from 54.9 ± 12.6 points preoperatively to 93.6 ± 6.2 points at the final follow-up in group M. The mean hallux valgus angle in groups D and M was reduced from 32.2° ± 6.3° and 33.1° ± 8.4° preoperatively to 10.5° ± 5.5° and 9.9° ± 5.5°, respectively, at the time of final follow-up. The mean first intermetatarsal angle in groups D and M was reduced from 15.0° ± 2.8° and 15.3° ± 2.7° preoperatively to 6.5° ± 2.2° and 6.3° ± 2.4°, respectively, at the final follow-up. The clinical and radiographic outcomes were not significantly different between the two groups.

Conclusions: 

The final clinical and radiographic outcomes between the two approaches for distal soft-tissue procedures were comparable and equally successful. Accordingly, the results of this study suggest that the medial transarticular approach is an effective and reliable means of lateral soft-tissue release compared with the dorsal first web-space approach.

Level of Evidence: 

Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

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    References

    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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    Cemal Kazimoglu
    Posted on November 19, 2013
    Is soft tissue release neccessary for the correction of moderate hallux valgus surgery with distal chevron osteotomy?
    İzmir Katip Celebi Üniversity, Izmir, Turkey

    We read with interest the article of Yu-Bok Park et al. The authors presented lateral soft tissue release as a standard procedure for the correction of moderate and severe hallux valgus deformity with distal chevron osteotomy in their study.  However, the necessity of a soft tissue procedure for correction of moderate hallux valgus surgery with distal chevron osteotomy is a matter of debate. Lee BJ et al.[1] compared the necessity of lateral soft tissue release for the treatment of hallux valgus. The authors revealed that there is no need to perform lateral soft tissue release for moderate deformities. I think that lateral soft tissue release should only be performed when necessary correction cannot be obtained after the osteotomy.

    Lateral soft tissue release may not only result in osteonecrosis of the metatarsal head, as the authors stated, but also may prevent decreased range of motion of the first metatarsophalangeal joint, neuritis of the dorsal or plantar lateral digital nerve, and cosmetic dissatisfaction with a dorsal scar.


    REFERENCE
    1. Lee HJ, Chung JW, Chu IT, Kim YC.Comparison of distal chevron osteotomy with and without lateral soft tissue release for the treatment of hallux valgus.Foot Ankle Int. 2010 Apr;31(4):291-5.

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