Purpose The purpose of this study was to report a modified U-shaped medial capsulorrhaphy and compare its clinical and radiological differences with an inverted L-shaped capsulorrhaphy in hallux valgus (HV) surgery. Methods A prospective study of 78 patients was performed between January 2018 and October 2021. All patients underwent chevron osteotomy and soft tissue procedures for HV, and the patients were randomly separated into 2 groups according to the medial capsule closing techniques: a modified U-shaped capsulorrhaphy (group U) and an L-shaped capsulorrhaphy (group L). All patients were followed for at least a year. The preoperative and follow-up data were collected for each patient and included patient demographics, weight-bearing radiographs of the foot, the active range of motion (ROM) of the first metatarsophalangeal (MTP) joint and the American Orthopedic Foot and Ankle Society (AOFAS) forefoot score. Mann–Whitney U test was used for the comparison of the postoperative measures between the groups. Results In total, 75 patients with 80 affected feet met the inclusion criteria, with 38 patients (41 feet) in group U and 37 patients (39 feet) in group L. One year after surgery, the mean hallux valgus angle (HVA), intermetatarsal angle (IMA), and AOFAS score in group U improved from 29.5 to 7.1, from 13.4 to 7.1, and from 53.4 to 85.5, respectively. The mean HVA, IMA, and AOFAS score in group L improved from 31.2 to 9.6, from 13.5 to 7.9, and from 52.3 to 86.6, respectively. Comparing the 1-year postoperative measures between the 2 groups, a significant difference was found in HVA (P = 0.02), but not found in IMA and AOFAS score (P = 0.25 and P = 0.24, respectively). The mean ROM of the first MTP joint was 66.3 degrees preoperatively and 53.3 degrees at the 1-year follow-up in group U, while 63.3 and 47.5 in group L. The degrees of ROM after 1 year in group U were better than those in group L (P = 0.04). Conclusion Compared to the inverted L-shaped capsulorrhaphy, the modified U-shaped capsulorrhaphy provided a better ROM of the first MTP joint; at 1 year following surgery, the modified U-shaped capsulorrhaphy maintained the normal HVA better.

Purpose: The distal soft tissue procedure is an integral component of bunion surgery to aid in hallux valgus angular (HVA) correction. There are some reports about the lateral soft tissue release, but rarely about medial capsular placation. The purpose of this study was to report a modified U-shaped medial capsulorrhaphy and compare its clinical and radiological differences with an inverted L-shaped capsulorrhaphy. Methods: A prospective analysis and review of 78 consecutive patients was performed between January 2018 and October 2021. All patients underwent chevron osteotomy and soft tissue procedure for hallux valgus (HV), and the patients were separated into 2 groups according to the implemented medial capsule closing technique. The modified U-shaped capsulorrhaphy was implemented for patients in group A, and the L-shaped capsulorrhaphy was done for patients in group B. All patients were followed for at least a year. The preoperative and follow-up data were collected for each patient, which include patient demographics, weightbearing radiographs of the foot, the active range of motion (ROM) of first metatarsophalangeal (MTP) joint and clinical results. Results: In total, 75 patients with 80 feet met the inclusion criteria, there were 38 cases (41 feet) in group A and 37 cases (39 feet) in group B.Comparing the degrees of HVA and intramedullary angle (IMA) at 1 year after surgery, the statistical value of IMA was insignificant (P =0.216), but a statistically significant difference in HVA was observed between the 2 groups (P= 0.017). The degrees of ROM of the first MTP joint after 1 year in group A were better than group B (P = 0.03). American Orthopaedic Foot and Ankle forefoot score (AOFAS, forefoot) was 53.37±7.66 preoperatively and 85.51±3.94 at one-year follow-up in Group A and 52.3±8 and 86.56±3.87 respectively in Group B. Significant improvement was achieved for both groups, but neither group showed any statistically significant differences (P = 0.232). Conclusion: Compared to the inverted L-shaped capsulorrhaphy, the modified U-shaped capsulorrhaphy can provide a better ROM of the first MTP joint, and the modified U-shaped capsulorrhaphy can help maintain the normal HVA better 1 year following surgery; it could be a better choice for medial soft tissue reconstruction in HV surgery.

BackgroundWe proposed a new method to evaluate the height of the posterior articular surface in displaced intra-articular calcaneal fractures (DIACFs) by drawing two lines on the lateral radiograph of hindfoot: one line was drawn from the apex of the posterior facet to the apex of the posterior tuberosity (the apex line), and the other line was drawn from the apex of the anterior process to the posterior process (the anterior posterior process line). The aim of this study was to analyze the relationship between these two lines in normal calcanei and their changes in DIACFs.MethodsLateral radiographs of normal calcanei and DIACFs between January 2018 and February 2020 were collected. We draw two lines on the lateral radiograph, one line was the apex line and the other line was the anterior posterior process line. The value of the angle formed by these two lines was recorded, if these two lines were parallel to each other, the angle was recorded as 0°. if these two lines formed an angle anteriorly this was recorded as positive, and if these two lines formed an angle behind the calcaneum this was recorded as negative.ResultsIn 135 normal calcanei lateral radiographs, the minimum angle was − 8°, and the maximum angle was 6°, with an average angle of -1 ± 3°. In 145 DIACFs, the minimum angle was 6°; the maximum angle was 37°, and the average angle was 17°±6°. The difference between normal calcanei and DIACFs was statistically significant (P༜.001).ConclusionThe relationship between the apex line and the anterior posterior process line on lateral radiograph can evaluate the height of the calcaneal posterior facet simply and accurately. The two lines are approximately parallel or angulated backward in the normal calcanei, in DIACFs, these two lines angulated forward.Level of Evidence: Level III-retrospective comparative study.