Endoscopic Distal Soft Tissue Procedure in Hallux Valgus Surgery

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Plantar plate deficiency is the major pathology causing metatarsophalangeal joint instability. As the joint subluxates dorsally, the lumbrical is tethered at the medial side of the joint by the deep metatarsal ligament and becomes a deforming force for the development of crossover toe deformity. Plantar plate repair or reconstruction is a logical surgical treatment option. This can be performed through a dorsal or plantar approach. The purpose of this technical note is to report a minimally invasive technique of crossover toe deformity correction by suturing the plantar plate to the extensor tendon. It is indicated for symptomatic crossover toe deformity that is not responsive to nonsurgical treatment. It is contraindicated if the metatarsophalangeal joint is degenerated, destructed, or dislocated, or there is interdigital neuroma at the sides of the deformed toe, or the deformity is caused by bony deformities of the metatarsal head or the proximal phalanx.C rossover second toe is one of the common forefoot deformities. Plantar plate insufficiency is the most common cause. It may progress with time to toe coronal and sagittal plane malalignment and even frank metatarsophalangeal (MTP) joint dislocation. 1,2 Conservative treatment including the toe splint can rarely delay the progression. Surgical treatments of this deformity include soft tissue balancing procedures to stabilize the MTP joint (plantar plate repair, tendon release or transfer, and periarticular soft-tissue release) and/or bony procedures (metatarsal/phalangeal osteotomy, arthrodesis, and excisional arthroplasty), and even toe amputation. 3 The Girdlestone-Taylor flexor-to-extensor tendon transfer is an effective method to stabilize the sagittal alignment of the MTP joint, but it may not be able to restore a normal coronal alignment of the MTP joint in crossover toe deformity. [4][5][6] Postoperative toe stiffness is also common after the transfer. 2,5,7 Plantar plate repair has the advantage of addressing the plantar plate insufficiency that is the primary pathology of instability of the MTP joint. It has been shown that plantar plate repair is as effective as tendon transfer in stabilization of the MTP joint with less postoperative stiffness and discomfort. 5 Tears of the plantar plate can be treated by primary repair with or without the use of suture anchor or distal advancement of the plate to the base of the proximal phalanx through bone tunnels. 8 It can be performed through the plantar 2,7 or dorsal 3,8-17 approaches. The plantar approach can reach the plantar plate directly. However, blunt dissection at the plantar wound may disrupt the organized fat septae resulting in extensive plantar scarring. 7 The dorsal approach has the advantage of avoidance of plantar dissection and scar formation. Concomitant procedures, for example, periarticular soft tissue release, extensor tendon lengthening, and Weil metatarsal osteotomy, can be performed together with repair of the plantar plate through the same dorsal incision. 3,[8][9][10][11][12...

Section: Correction Of the Deformity And Tying The Sutures To The Extmentioning

confidence: 99%

Correction of Crossover Toe Deformity by Arthroscopically Assisted Plantar Plate Tenodesis

Lui¹

2016

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“…The passage of the cannula-trocar through the plantar soft tissue should be gentle until the plantar aponeurosis is reached. [12][13][14][15][16] This can reduce the risk of injury to the plantar neurovascular structures. Sometimes, the plantar screw hole is obliterated.…”

Section: Removal Of Screw and Portal Placementmentioning

confidence: 99%

Revision Lapidus Arthrodesis by Bone Endoscopy

Lui¹

2016

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Revision arthrodesis is indicated in symptomatic nonunion of the first tarsometatarsal joint. Revision by first tarsometatarsal arthroscopy cannot deal with the dilated screw tract and associated bone cysts. Revision by bone endoscopy is indicated in symptomatic nonunion of the first tarsometatarsal joint, which is previously fixed by transarticular screw along with loosening of the screw and bone cyst formation. The screw tract makes up the portal tract, with the proximal and distal ends of the tract corresponding to the proximal and distal portals, respectively. In this technical note, we describe zonal debridement and bone grafting of the bone cysts, nonunion site, and the screw tract via the bone endoscopy. This can resolve all the co-pathologies of nonunion of the first tarsometatarsal fusion.

“…3 Recently, an arthroscopyassisted hallux valgus deformity correction with percutaneous screw fixation has been reported. [3][4][5] It employs the same principle as the open procedure. The widened intermetatarsal angle is reduced manually and held in position by screws transfixing the bases of the first and second metatarsals and interosseous suture between the first and second metatarsal necks.…”

mentioning

confidence: 99%

“…The widened intermetatarsal angle is reduced manually and held in position by screws transfixing the bases of the first and second metatarsals and interosseous suture between the first and second metatarsal necks. [3][4][5] This Technical Note describes the details of endoscopic soft tissue procedure in correction of recurred hallux valgus deformity. This technique is indicated in symptomatic recurrence of hallux valgus deformity especially in high-risk patients who have ulceration or recurrent ulceration as a means of performing limb preservation/salvage without extensive soft tissue and osseous trauma.…”

mentioning

confidence: 99%

“…6 It is contraindicated if the recurrence is asymptomatic, 1 there is significant bony deformity due to previous bunion surgery, the distal metatarsal articular angle is greater than 10 , or the intermetatarsal space cannot be closed up manually. [3][4][5] It is also contraindicated in patients with joint stiffness after the bunion surgery, including hallux rigidus, chondrolysis, and severe degenerative joint disease. 2 Recurrence after excessive removal of the bunion and a large defect in the articular surface of the metatarsal head is another contraindication.…”

mentioning

confidence: 99%

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Correction of Recurred Hallux Valgus Deformity by Endoscopic Distal Soft Tissue Procedure

Lui¹

2017

Self Cite

Abstract:The underlying reason for recurrence of hallux valgus deformity after bunion surgery is multifactorial and includes surgeon-based and patient-based factors as well as original components of deformity initially unaddressed at the index procedure. Surgical treatment of a recurred hallux valgus deformity should be undertaken using the same guidelines for correction of a primary hallux valgus deformity. It requires correction of bony alignment, restoration of joint congruity, and achievement of soft tissue balance. The purpose of this Technical Note is to describe the details of endoscopic soft tissue procedure to correct a recurred hallux valgus deformity. To successfully complete this procedure, adequate lateral release to achieve soft tissue balance around the first metatarsophalangeal joint with reduction of the sesamoid bones is mandatory.