title: The Relationship Between the Sesamoid Complex and the First Metatarsal After Hallux Valgus Surgery Without Lateral Soft-Tissue Release: A Prospective Study.
abstract: Some investigators have emphasized restoring the relationship between the sesamoid complex and the first metatarsal head to reduce the risk of hallux valgus recurring after surgical reconstruction. In a prospective study, we analyzed whether the first metatarsophalangeal joint could be realigned after scarf-Akin bunionectomy without lateral soft tissue release. A total of 25 feet, in 22 patients, were prospectively enrolled and analyzed using anteroposterior radiographs and coronal computed tomography scans obtained before and 3 months after surgery. The Yildirim sesamoid position decreased from a preoperative of 2 (range 1 to 3) to a postoperative position of 0 (range 0 to 1; p < .001), the mean first intermetatarsal angle decreased from 12.6° ± 2.4° to 5.8° ± 2.1° (p < .001), and the mean distance between the second metatarsal and the tibial sesamoid changed from 25.7 ± 4.6 to 25.9 ± 4.6 (p = .59). Our findings suggest that dislocation of the sesamoid complex is actually caused by displacement of the first metatarsal. In conclusion, the scarf-Akin bunionectomy adequately restores the alignment of the first metatarsophalangeal joint, including restoration of the sesamoid apparatus, without direct plantar-lateral soft tissue release.
authors.affiliation: Professor, Department of Orthopedic Surgery and Traumatology, Clínica Universidad de Navarra, Pamplona, Spain. Electronic address: jlamodeespi@unav.es.
authors.forename: José María
authors.initials: JM
authors.lastname: Lamo-Espinosa
authors.affiliation: Professor, Department of Orthopedic Surgery and Traumatology, Fundación Hospital de Calahorra, Logroño, Spain.
authors.forename: Borja
authors.initials: B
authors.lastname: Flórez
authors.affiliation: Professor, Department of Orthopedic Surgery and Traumatology, Clínica Universidad de Navarra, Pamplona, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Villas
authors.affiliation: Professor, Department of Orthopedic Surgery and Traumatology, Clínica Universidad de Navarra, Pamplona, Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Pons-Villanueva
authors.affiliation: Professor, Department of Radiology, Clínica Universidad de Navarra, Pamplona, Spain.
authors.forename: José M
authors.initials: JM
authors.lastname: Bondía
authors.affiliation: Assistant Professor, Department of Radiology, Clínica Universidad de Navarra, Pamplona, Spain.
authors.forename: Jesús Dámaso
authors.initials: JD
authors.lastname: Aquerreta
authors.affiliation: Professor, Department of Orthopedic Surgery and Traumatology, Clínica Universidad de Navarra, Pamplona, Spain.
authors.forename: Matias
authors.initials: M
authors.lastname: Alfonso
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006214:Hallux / Q000000981:diagnostic imaging* / Q000601:surgery; D006215:Hallux Valgus / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000379:methods*; D011446:Prospective Studies; D019651:Plastic Surgery Procedures / Q000379:methods; D012716:Sesamoid Bones / Q000000981:diagnostic imaging* / Q000601:surgery; D014057:Tomography, X-Ray Computed
keywords: adductor hallucis; bunion; first metatarsal; great toe; proximal phalanx; tibial sesamoid