J Korean Foot Ankle Soc.  2017 Jun;21(2):55-60. 10.14193/jkfas.2017.21.2.55.

The Effectiveness of Plantar Aponeurosis Release for the Limitation in First Metatarsophalangeal Joint Extension after Hallux Valgus Surgery

• Choi HJ
• Kim DW
• Kang YH
• Park JH
• Son CM

• KMID: 2382425
• DOI: http://doi.org/10.14193/jkfas.2017.21.2.55

Abstract

PURPOSE
Stiffness in the first metatarsophalangeal joint after surgery for hallux valgus has been reported. The goal of this study was to test the efficacy of releasing plantar aponeurosis for improving the range of extension in the first metatarsophalangeal joint that was limited after hallux valgus surgery.
MATERIALS AND METHODS
Thirteen patients (1 man, 12 women [17 feet]; median age, 54.4 years; range, 44~69 years) with limited first metatarsophalangeal joint extension after hallux valgus surgery, who underwent an additional procedure of plantar aponeurosis release between March 2015 and August 2015, were included. Subsequently, the passive range of extension in the first metatarsophalangeal joint was evaluated via knee extension and flexion positions. Hallux valgus angle, inter-metatarsal angle, distal metatarsal articular angle, and talo-first metatarsal angle were measured on weightbearing dorsoplantar and lateral radiographs of the foot preoperatively.
RESULTS
The mean range of extension for the first metatarsophalangeal joint improved significantly, from 2.5° to 40.9° in the knee extension position (p<0.00). The mean extension range for the first metatarsophalangeal joint also improved, from 18.2° to 43.2° in the knee flexion position (p<0.00). In all patients, congruence of the first metatarsophalangeal joint was recovered.
CONCLUSION
Plantar aponeurosis release is an effective additional procedure for improving the extension range of the first metatarsophalangeal joint after hallux valgus surgery.

Keyword

Plantar aponeurosis; Functional hallux limitus; Hallux valgus

MeSH Terms

Female
Foot
Hallux Valgus*
Hallux*
Humans
Knee
Metatarsal Bones
Metatarsophalangeal Joint*
Weight-Bearing

Figure

• 

  Figure 1 (A) In cases of intermetatarsal angle (IMA) less than 15°, distal chevron osteotomy was performed and one 1.6 mm-diameter Kirschner wire (K-wire) was fixed. (B) In cases of IMA more than 16°, proximal reverse chevron osteotomy was performed and two 1.6 mm-diameter K-wire was fixed.

• 

  Figure 2 (A) This photo presented limitation of first metatarsophalangeal joint (1MTP) extension while, supporting the first metatarsal head with a palm, and assuming a weightbearing position with knee 0° of extension after finishing all of the procedures for hallux valgus surgery. (B) This photo presented improvement of 1MTP extension after partial release of the plantar aponeurosis with same position.

• 

  Figure 3 (A) After longitudinal skin incision over the medial tuberosity of the calcaneus was made, dissection was performed precisely to avoid any injuries at the medial calcaneal nerve branch and calcaneal origin of plantar aponeurosis was exposed. (B) Further dissection was performed to separate plantar aponeurosis from abductor hallucis muscle using freer elevator. (C) At 1 cm distal from the origin of plantar aponeurosis, medial half of the plantar aponeurosis was cut using metzenbaum scissors. (D) After partial release of the plantar aponeurosis, it was elongated by passive stretching with maximal force.

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