Abstract
The 1st-2nd intermetatarsal angular component of the hallux valgus deformity can be corrected by an osteotomysparing technique using ultra high molecular weight polyethylene (UHMWPE) braided suture (Fiberwire, Arthrex, Naples, FL) attached endo-buttons to reduce and maintain the correction. This paper will outline the surgical approach, advantages and post-operative care necessary to implement this technique.
Highlights
INTRODUCTION & INDICATIONSThis is a novel, osteotomy-sparing technique using Fiberwire-attached endo-buttons to correct the intermetatarsal angle (IMA) component of the hallux valgus (HV) deformity[1,2].The indications for this procedure include: (1) IMA of less than 20 degrees, (2) hallux valgus angle (HVA) less than 30 degrees, (3) absence of instability at the metatarsocuneiform (MC) joint, (4) distal metatarsal articular angle (DMAA) less than 10 degrees, (5) an incongruent joint is not a contraindication, and (6) the presence of an interphalangeus deformity is not a contraindication.Contraindications to the use of this technique include: (1) diabetes mellitus, (2) systemic auto-immune diseases such as gout, rheumatoid arthritis, psoriatic arthritis, or lupus, (3) primary arthritis of the first metatarsophalangeal joint, (4) HVA of greater than 30 degrees, (5) IMA of greater than 20 degrees, (6) DMAA greater than 10 degrees, (7) instability or arthritis of the 1st MC joint, and (8) irreducibility of the IMA.MODIFIED MCBRIDE PROCEDUREThe initial incision is placed longitudinally and distally between the first metatarsal and the second metatarsal (Fig. 1).Ideally this incision is placed slightly lateral to the midline between the first and second metatarsal bones to enhance access to the lateral side of the second metatarsal
Applying an adduction stress to the proximal phalanx of the great toe will enhance the visualization of the adductor tendon as it attaches to the base of the proximal phalanx and the fibular sesamoid
With a #11 blade the adductor tendon is sharply released from its attachments to the base of the proximal phalanx and the lateral aspect of the fibular sesamoid (Fig 2)
Summary
INTRODUCTION & INDICATIONSThis is a novel, osteotomy-sparing technique using Fiberwire-attached endo-buttons to correct the intermetatarsal angle (IMA) component of the hallux valgus (HV) deformity[1,2].The indications for this procedure include: (1) IMA of less than 20 degrees, (2) hallux valgus angle (HVA) less than 30 degrees, (3) absence of instability at the metatarsocuneiform (MC) joint, (4) distal metatarsal articular angle (DMAA) less than 10 degrees, (5) an incongruent joint is not a contraindication, and (6) the presence of an interphalangeus deformity is not a contraindication.Contraindications to the use of this technique include: (1) diabetes mellitus, (2) systemic auto-immune diseases such as gout, rheumatoid arthritis, psoriatic arthritis, or lupus, (3) primary arthritis of the first metatarsophalangeal joint, (4) HVA of greater than 30 degrees, (5) IMA of greater than 20 degrees, (6) DMAA greater than 10 degrees, (7) instability or arthritis of the 1st MC joint, and (8) irreducibility of the IMA.MODIFIED MCBRIDE PROCEDUREThe initial incision is placed longitudinally and distally between the first metatarsal and the second metatarsal (Fig. 1).Ideally this incision is placed slightly lateral to the midline between the first and second metatarsal bones to enhance access to the lateral side of the second metatarsal. This is a novel, osteotomy-sparing technique using Fiberwire-attached endo-buttons to correct the intermetatarsal angle (IMA) component of the hallux valgus (HV) deformity[1,2]. With a #11 blade the adductor tendon is sharply released from its attachments to the base of the proximal phalanx and the lateral aspect of the fibular sesamoid (Fig 2).
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