Hallux valgus correction with metatarsal osteotomy: effect of a lateral distal soft tissue procedure.

The purpose of this study was to compare the results of hallux valgus correction using a proximal metatarsal osteotomy with or without a lateral distal metatarsophalangeal soft tissue procedure. This procedure included release of the lateral joint capsule and transfer of the adductor tendon into the neck of the metatarsal. Two groups of patients were reviewed retrospectively. In the first group (17 patients and 25 feet), a proximal closing wedge osteotomy and an Akin osteotomy were performed. In the second group (22 patients and 31 feet), in addition to the osteotomies, the adductor tendon and lateral capsule were released from the sesamoid and the adductor tendon was sutured into the neck of the first metatarsal. Exostectomy and plication of the medial capsule were done in all cases. Physical examination at follow-up revealed significantly more first metatarsophalangeal stiffness in the second group. The average arc of motion was 62 degrees in the first group and 46 degrees in the second. Radiographically, however, results were significantly better in the second group. The average intermetatarsal angle was 9.6 degrees for group 1 and 6.1 degrees for group 2. The average hallux valgus angle was 15 degrees for group 1 and 10 degrees in group 2. Complications included three pin tract infections and four dorsal malunions. The lateral distal soft tissue procedure ensured a more reliable correction of the bunion deformity. However, it resulted in a significant amount of postoperative first metatarsophalangeal stiffness.