Lateral soft-tissue release through a medial incision: Anatomic comparison of two techniques.
BACKGROUND
The distal soft tissue procedure is an integral part of hallux valgus surgery, providing soft tissue balance and alignment restoration of the first metatarsophalangeal joint. Various approaches have been established to this end. For techniques that do not include a separate dorsal incision, lateral release may be achieved via a transarticular approach or via a medial incision and a dorsal flap over the first metatarsal. Compared to the double-incision technique, these techniques are not only cosmetically superior and thus meet the demands of most surgeons and patients.


METHODS
Using six pairs of frozen cadaveric feet, lateral release was performed using one of the above techniques in a randomized manner with pair comparison. The specimens were then dissected and the completeness of the release as well as any damage to anatomic structures was documented.


RESULTS
The transarticular technique enabled complete release of the metatarsal-sesamoid suspensory ligament (MSL) and the transverse and oblique head of the adductor hallucis muscle in five of six specimens. The comparative technique enabled the same in only two of six cases for the adductor hallucis muscle and in four cases for the MSL. The transarticular approach achieved complete release of the lateral joint capsule in three of six specimens, whereas the dorsal approach achieved no release in any specimen. Neither of the methods caused any macroscopic injury to the surfaces of the first metatarsophalangeal joint. The examined arteries, veins, and nerves remained intact in all specimens treated with the transarticular approach, but dorsal release resulted in one documented injury to the first dorsal metatarsal artery and its concomitant veins.


CONCLUSIONS
Compared to release by dissection superficially to the extensor tendons, transarticular release provides a more complete lateral release and less injuries to neurovascular bundles. Further anatomic and clinical studies are needed, however, before conclusive recommendations can be made.
Katholisches Klinikum Mainz, Foot and Ankle Surgery, An der Goldgrube 11, Mainz DE 55131, Germany. Electronic address: p-simons@kkmainz.de.
Paul
P
Simons
Katholisches Klinikum Mainz, Foot and Ankle Surgery, An der Goldgrube 11, Mainz DE 55131, Germany. Electronic address: k-klos@kkmainz.de.
Kajetan
K
Klos
Friedrich-Schiller-University Jena, Department of Trauma, Hand and Reconstructive Surgery, Erlanger-Allee 101, Jena DE 07743, Germany. Electronic address: clemensloracher@gmx.de.
Clemens
C
Loracher
Vice Rector of Research, Technical University of Varna, 1,Studentska Str., 9010 Varna, Bulgaria. Electronic address: skulev@tu-varna.bg.
Hristo K
HK
Skulev
Friedrich-Schiller-University Jena, Department of Trauma, Hand and Reconstructive Surgery, Erlanger-Allee 101, Jena DE 07743, Germany. Electronic address: Florian.gras@med.uni-jena.de.
Florian
F
Gras
Friedrich-Schiller-University Jena, Department of Trauma, Hand and Reconstructive Surgery, Erlanger-Allee 101, Jena DE 07743, Germany. Electronic address: Gunther.hofmann@med.uni-jena.de.
Gunther O
GO
Hofmann
Institut für Anatomie 1, Friedrich Schiller Universität, Jena, Germany. Electronic address: Rosemarie.Froeber@med.uni-jena.de.
Rosemarie
R
Fröber
D000368:Aged; D000369:Aged, 80 and over; D002102:Cadaver; D004210:Dissection; D005260:Female; D005528:Foot / Q000033:anatomy & histology / Q000601:surgery*; D006215:Hallux Valgus / Q000601:surgery*; D006801:Humans; D017746:Joint Capsule / Q000601:surgery; D008023:Ligaments, Articular / Q000601:surgery; D008683:Metatarsophalangeal Joint / Q000601:surgery; D018482:Muscle, Skeletal / Q000601:surgery
Anatomy; Articular surgery; Cadaver; Hallux valgus surgery; Humans; Ligaments; Orthopedics methods; Toe Joint