Therapeutic, Level IV: Case study.

The extensor hallucis capsularis is an accessory extensor tendon with varied occurrence. Here, we present the case of a 40-year-old man with chronic extensor hallucis longus tendon rupture treated using extensor hallucis capsularis tendon as a double-bundle autograft. He had dropped a knife proximal to the right hallux metatarsophalangeal joint 4 months ago. Computed tomography revealed the presence of extensor hallucis capsularis, with its width and thickness, and the point of divergence from the extensor hallucis longus tendon. Because direct suturing was considered difficult and the extensor hallucis capsularis tendon was sufficiently wide and long, double-bundle autograft transplantation of extensor hallucis capsularis was performed. At 1-year follow-up examination, the patient retained almost full function of his hallux. To the best of our knowledge, this is the first case to use this technique. Using the extensor hallucis capsularis tendon for grafting should be carefully considered because the variable width and length may limit the graft strength. Level of evidence: IV

Background: Few studies have reported results of minimally invasive chevron Akin osteotomy (MICA) for moderate to severe hallux valgus correction. This study aims to evaluate MICA for moderate to severe hallux valgus radiographically and clinically. Methods: Forty feet were prospectively reviewed. Twenty-eight feet (70%) had a severe deformity (hallux valgus angle (HVA) ≥40° and/or first intermetatarsal angle (IMA) ≥18°). We measured HVA, IMA, lateral shape of the metatarsal head (round sign), tibial sesamoid position, first metatarsal shortening on anteroposterior weightbearing radiographs, and inclination angle of first metatarsal on lateral weightbearing radiographs. We evaluated the Japanese Society for Surgery of the Foot hallux scale and Self-Administered Foot Evaluation Questionnaire responses preoperatively and at the most recent follow-up. Results: All measurements except shortening and inclination angle improved significantly. Both clinical scale and all subscores significantly improved. Conclusions: MICA improved moderate to severe hallux valgus both radiographically and clinically. Level of Evidence: Level IV: case series

Therapeutic, Level IV: Case series.