The Hallux Metatarsophalangeal Capsule: An Anatomic Study With Respect to Percutaneous Hallux Valgus Correction

Abstract

Background: Minimally invasive surgery for the treatment of hallux valgus deformities has become increasingly popular. Knowledge of the location of the hallux metatarsophalangeal (MTP) proximal capsular origin on the metatarsal neck is essential for surgeons in planning and executing extracapsular corrective osteotomies. A cadaveric study was undertaken to further study this anatomic relationship. Methods: Ten nonpaired fresh-frozen frozen cadaveric specimens were used for this study. Careful dissection was performed, and the capsular origin of the hallux MTP joint was measured from the central portion of the metatarsal head in the medial, lateral, dorsal, plantarmedial, and plantarlateral dimensions. Results: The ten specimens had a mean age of 77 years, with 5 female and 5 male. The mean distances from the central hallux metatarsal head to the MTP capsular origin were 15.2 mm dorsally, 8.4 mm medially, 9.6 mm laterally, 19.3 mm plantarmedially, and 21.0 mm plantarlaterally. Conclusion: The MTP capsular origin at the hallux metatarsal varies at different anatomic positions. Knowledge of this capsular anatomy is critical for orthopedic surgeons when planning and performing minimally invasive distal metatarsal osteotomies for the correction of hallux valgus. Type of Study: Cadaveric Study.

Management of Anxiety for Ambulatory Hallux Valgus Surgery With a Virtual Reality Hypnosis Mask: Randomized Controlled Trial

“…21,22 The clinical and radiologic *results of minimally invasive percutaneous surgery have not been shown to be inferior to open surgery, with fewer complications. 6,8,23,24,36 Furthermore, the use of wide-awake local anesthesia as used in this series has been shown to be well accepted by patients, as well as effective in reducing postoperative pain and anxiety in foot surgery. 5,25,29,35 It is more compatible with an earlier return to ambulatory care than general anesthesia or sciatic nerve block.…”

Clinical guideline on the third generation minimally invasive surgery for hallux valgus

“…Compared to the traditional Chevron osteotomy, the location of the osteotomy in MICA is extracapsular and located in close proximity to the first metatarsal neck. The extra-articular osteotomy may offer advantages over the intra-articular osteotomy in several key aspects [ [18] , [19] , [20] ]: (1) The extra-articular osteotomy procedure minimizes capsular trauma, in which efforts are made to preserve the proximal attachment of the capsule intact. (2) The intra-articular osteotomy created with a Shannon burr inevitably generates bony debris, which may persist within the joint despite thorough irrigation.…”