Bunion surgery: can capsular closure influence range of motion?

Abstract

The incidence of first metatarsophalangeal joint (MTPJ) stiffness following bunion surgery varies in the literature. We performed a cadaveric study to investigate whether capsular closure can influence range of first MTPJ motion. A direct medial approach was performed on 10 cadaveric feet. The range of motion of the 1st MTPJ was recorded, and a ‘Y’ capsulotomy performed. The capsule was then closed in neutral, full plantar flexion, and full dorsi flexion, and the range of motion recorded. Capsular closure with the first MTPJ in neutral did not affect range of motion, whilst closure at the limit of plantar flexion resulted in a mean loss of 14° of dorsi flexion (range 12–15°, p<0.01). Closure in dorsi flexion resulted in a mean loss of 9° of plantar flexion (range 0–20°, p<0.05). In a cadaveric model, capsular closure in extreme flexion/extension reduces range of motion in the first MTP.