title: Role of a Limited Transarticular Release in Severe Hallux Valgus Correction.
abstract: BACKGROUND
  Hallux valgus (HV) treatment is continuously evolving, and no definitive treatment can be recommended. Osteotomies are the main surgical choice for these deformities, but no clear role for soft tissue procedures is available.
  
  
  OBJECTIVE
  To perform a retrospective comparison of the radiographic and clinical outcomes of 2 groups of patients with severe HV operated with the same osteotomy technique but differing on the type of lateral release.
  
  
  METHODS
  Two groups of patients with symptomatic moderate to severe HV deformities were operated with the same proximal metatarsal osteotomy, which differed on the type of lateral release: group 1 had limited transarticular lateral capsule release (n = 62), and group 2 complete lateral release, including capsule, adductor tendon, and intermetatarsal (IM) ligament (n = 57). We recorded the American Orthopaedic Foot & Ankle Society (AOFAS) score, HV and IM angles, first metatarsal shortening, concomitant metatarsal shortening osteotomies (Weil), Akin osteotomies, and complications.
  
  
  RESULTS
  The postoperative AOFAS score in group 1 was similar to that of group 2. The HV and IM angles improved in both groups with no significant difference. The multivariate analysis showed no influence of any variable analyzed on HV or IM angle improvement. Regarding AOFAS score improvement, a limited lateral release was associated with a higher increase in AOFAS score (P = .019).
  
  
  CONCLUSIONS
  No studies are available to identify which soft tissue structures are involved in HV deformities nor which have to be released, if any. A limited transarticular release can provide similar clinical and radiologic outcomes when compared with a classic open lateral release.
  
  
  METHODS
  Level IV, case series.
authors.affiliation: Clínica Alemana-Universidad del Desarrollo, Santiago, Chile.
authors.forename: Emilio
authors.initials: E
authors.lastname: Wagner
authors.affiliation: Clínica Alemana-Universidad del Desarrollo, Santiago, Chile.
authors.forename: Cristian
authors.initials: C
authors.lastname: Ortiz
authors.affiliation: Clínica Alemana-Universidad del Desarrollo, Santiago, Chile.
authors.forename: Francisco
authors.initials: F
authors.lastname: Figueroa
authors.affiliation: Traumatology and orthopedic surgeon, Monterrey, Mexico.
authors.forename: Omar
authors.initials: O
authors.lastname: Vela
authors.affiliation: Clínica Alemana-Universidad del Desarrollo, Santiago, Chile pwagner@alemana.cl.
authors.forename: Pablo
authors.initials: P
authors.lastname: Wagner
authors.affiliation: Division of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: John S
authors.initials: JS
authors.lastname: Gould
mesh_terms: D005260:Female; D006215:Hallux Valgus / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010027:Osteotomy; D011859:Radiography; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: American Orthopaedic Foot & Ankle Society score; complete lateral release; hallux valgus; intermetatarsal angle; limited transarticular release