Case Report| Volume 49, ISSUE 5, P488.e15-488.e19, September 2010

Download started.


Bilateral Second Metatarsal Stress Fractures After Hallux Valgus Correction With the Use of a Tension Wire and Button Fixation System


      The pathomechanics and treatments of hallux valgus vary widely by deformity and surgeon, and are extensively described in the orthopedic and podiatric literature. With each newly described treatment, new complications can be encountered. In this report, we describe the case of a 22-year-old woman who underwent bilateral hallux valgus repair with a tension wire and button fixation system, and developed bilateral second metatarsal stress fracture at the point of fixation application during the postoperative period. Although this fixation system has been useful in our practice, like other surgical implants, it conveys a certain amount of risk that should be considered by surgeons using the device.

      Level of Evidence


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The Journal of Foot and Ankle Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Coughlin M.J.
        • Jones C.
        Hallux valgus: demographics, etiology and radiographic assessment.
        Foot Ankle Int. 2007; 28: 759-777
        • Saro C.
        • Andren B.
        • Wildemyr Z.
        • Tasi L.
        Outcome after distal metatarsal osteotomy for hallux valgus: a prospective randomized controlled trial of two methods.
        Foot Ankle Int. 2007; 28: 778-787
      1. Tips and surgical pearls: osteotomy sparing correction of hallux valgus and metatarsus primus varus—the Mini TightRope System. Arthrex website. January 2008. Available at: Accessed October 25, 2008.

      2. Mini TightRope® for hallux valgus correction and Lisfranc ligament repair: surgical technique. Available at: Accessed September 1, 2008.

      3. Arthrex Research and Development: The effect of tunnel placement in the second metatarsal on the ultimate strength of the second metatarsal after hallux valgus correction using the tight rope system. Available at: Accessed September 1, 2008.

        • Myerson M.S.
        • Badekas A.
        Hypermobility of the first ray.
        Foot Ankle Clinic. 2000; 5: 469-484
      4. O'Neil P, Schon L, Parks B. Hallux valgus correction: a comparison of intermetatarsal angle and first metatarsal-cuneiform joint pressure before and after correction. Available at: Accessed September 1, 2008.

        • Wu D.Y.
        Syndesmosis procedure: a non-osteotomy approach to metatarsus primus varus correction.
        Foot Ankle Int. 2007; 28: 1000-1006