J Korean Foot Ankle Soc.  2019 Dec;23(4):166-172. 10.14193/jkfas.2019.23.4.166.

Surgical Outcomes of the Reinforcing Technique of a Weakened Medial Capsule in Severe Hallux Valgus Using Internal Brace

• Lee JK
• Kang C
• Hwang DS
• Lee GS
• Hwang JM
• Seo GW
• Kim DH

• KMID: 2465940
• DOI: http://doi.org/10.14193/jkfas.2019.23.4.166

Abstract

PURPOSE
This study evaluated the clinical and radiological results after reinforcement of the weakened medial joint capsule using Internal Brace (Arthrex) for treating severe hallux valgus.
MATERIALS AND METHODS
This study reviewed 56 cases of 50 patients that were followed-up postoperatively for at least 12 months, from September 2017 until August 2018. An extended distal chevron osteotomy combined with a distal soft-tissue release was performed by a single surgeon to treat severe hallux valgus. Internal Brace was applied in 12 cases (group A) who had weakened medial joint capsules, and capsulorrhaphy was performed in 44 cases (group B), and these two groups were compared postoperatively for the clinical and radiological results. The postoperative complications were also investigated.
RESULTS
No significant differences at 1-year follow-up on the Manchester-Oxford Foot Questionnaire and the patients' satisfaction scores were found between the two groups (p=0.905 and p=0.668, respectively). For the radiology, the changes of the values between before surgery and at 1-year follow-up according to the group showed no significant differences in the hallux valgus angle, intermetatarsal angle, and the hallux interphalangeal angle (p=0.986, p=0.516, p=0.754, respectively). Recurrence of hallux valgus was reported in two cases in group A, and in three cases in group B. Transfer metatarsalgia occurred in 4 cases in group B.
CONCLUSION
Based on these results, we recommend the capsule reinforcing technique using Internal Brace as a successful operative option for treating a weakened medial capsule in patients with severe hallux valgus.

Keyword

Severe hallux valgus; Extended distal chevron osteotomy; Capsulorrhaphy; Suture tape augmentation

MeSH Terms

Braces*
Follow-Up Studies
Foot
Hallux Valgus*
Hallux*
Humans
Joint Capsule
Metatarsalgia
Osteotomy
Postoperative Complications
Recurrence

Figure

• 

  Figure 1 Schematic diagram and intraoperative gross photo of extended distal chevron osteotomy (EDCO). (A) An apex was provided by the intersection point of the line crossing the metatarsal head and neck junction and the dorsal one-third line parallel to the longitudinal axis of the metatarsal bone. And, long plantar limb was cut by saw, parallel to foot plantar plane. About 70° of angle relative to the plantar limb was shown. (B) Intraoperative gross photo after EDCO was shown. (C) Intraoperative C-arm intensifier image. Distal segment was lateral deviated and then fixed using two Trim-It Drill Pin (Arthrex).

• 

  Figure 2 Intraoperative gross photos of reinforcing technique using Internal Brace (Arthrex). (A) A weakened medial joint capsule was shown. (B) We inserted Internal Brace to the proximal phalanx and then remained suture screw was removed by rongeur. Rotational center of the 1st metatarsal head was marked (arrow). (C) Knot-free absorbable suture screw was located in rotational center. (D) Extended distal chevron osteotomy was performed. Long plantar limb was shown which was cut parallel to foot plantar plane. (E) Closed wedge osteotomy was performed on the proximal phalanx. (F) After Akin procedure, knot of non-absorbable suture was inserted into cavity of suture screw to prevent irritation.

• 

  Figure 3 A 66-year-old female who was diagnosed severe hallux valgus of right foot. We performed extended distal chevron osteotomy and distal soft tissue release. And additional reinforcing technique was applied due to weakened medial capsule. Akin procedure was conducted, too. (A) Hallux valgus angle (HVA) and 1, 2-intermetatarsal angle (IMA) were checked 42.3° and 16.5° in the preoperative standing foot X-ray. (B) Standing X-ray taken postoperative 6 weeks. HVA and IMA were 4.5° and 4.4°. (C) Standing X-ray taken postoperative 12 months. HVA and IMA were 9.3° and 5.1°.

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