ABSTRACT
Lateral release is often an integral step in surgical correction of hallux valgus
and can be performed using open or minimally invasive techniques. We investigated
whether these techniques cause iatrogenic damage to arteries, nerves, tendons, or
joint capsules. In this cadaver study, lateral release was performed on 9 pairs of
specimens by a specialized foot surgeon. The specimens were randomly assigned to each
group. The operations were followed by anatomical preparation, data collection, photo
documentation, and statistical analysis. Iatrogenic damage to arteries, nerves, tendons,
or joint capsules was rare, regardless of the surgical technique used. However, with
the minimally invasive technique, the tendon of the extensor hallucis longus muscle
and the sensitive terminal branches of the fibular nerve were at risk due to their
anatomical proximity to the access portal. The deep transverse metatarsal ligament
was potentially at risk if the adductor hallucis muscle was completely detached from
the lateral sesamoid. When the deep transverse metatarsal ligament was transected
there was risk of damaging the underlying plantar neurovascular structures. Both surgical
techniques are safe in terms of the risk of injury to neighboring neurovascular and
soft tissue structures.
Level of Clinical Evidence
Keywords
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 accessOne-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:
Subscribe to The Journal of Foot and Ankle SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Prevalence of hallux valgus in the general population: a systematic review and meta-analysis.J Foot Ankle Res. 2010; 3: 1-9
- Efficacy of first metatarsophalangeal joint lateral release in hallux valgus surgery.Orthop Traumatol Surg Res. 2013; 99: 425-431
- Lateral soft-tissue release through a medial incision: anatomic comparison of two techniques.Foot Ankle Surg. 2015; 21: 113-118
- Hallux valgus–etiology, anatomy, treatment and surgical considerations.Clin Orthop Relat Res. 1981; 157: 31-41
- Hallux valgus correction with metatarsal osteotomy: effect of a lateral distal soft tissue procedure.Foot Ankle Int. 1995; 16: 132-138
- Distal chevron osteotomy with intra-articular lateral soft-tissue release for treatment of moderate to severe hallux valgus deformity.J Formos Med Assoc. 1996; 95: 776-781
- Correction of high-grade sesamoid bone dislocation in hallux valgus using Austin's osteotomy with and without lateral soft tissue release.Z Orthop Ihre Grenzgeb. 1997; 135: 150-156
- Surgical treatment of moderate hallux valgus: a comparison of distal chevron metatarsal osteotomy with and without lateral soft-tissue release.Foot Ankle Spec. 2017; 10: 524-530
- Transarticular distal soft-tissue release with an arthroscopic blade for hallux valgus correction.Foot Ankle Int. 2004; 25: 13-18
- Transmetatarsal lateral release in hallux valgus surgery: technical tip.Foot Ankle Int. 2012; 33: 844-847
- Technique tip: lateral soft-tissue release for correction of hallux valgus through a medial incision using a dorsal flap over the first metatarsal.Foot Ankle Int. 2007; 28: 949-951
- Distal soft tissue release using direct and indirect approaches: an anatomic study.Foot Ankle Int. 1996; 17: 458-463
- Minimally invasive hallux valgus correction.Orthop Clin North Am. 2009; 40: 525-530
- Hallux valgus: effectiveness and safety of minimally invasive surgery. A systematic review.Br Med Bull. 2011; 97: 149-167
- Minimally invasive forefoot surgery: a cadaveric study.Foot Ankle Int. 2012; 33: 1139-1144
- Minimally invasive hallux valgus surgery: a critical review of the evidence.Int Orthop. 2013; 37: 1731-1735
- Endoscopic distal soft-tissue release in the treatment of hallux valgus: a cadaveric study.Arthrosc J Arthrosc Relat Surg. 2010; 26: 1111-1116
- Release of the lateral structures of the first metatarsophalangeal joint during hallux valgus surgery.Acta Chir Orthop Traumatol Cech. 2012; 79: 222-227
- Lateral release in hallux valgus deformity: from anatomic study to surgical tip.J Foot Ankle Surg. 2013; 52: 298-302
- Minimally invasive Akin osteotomy and lateral release: anatomical structures at risk—a cadaveric study.Foot. 2016; 27: 32-35
- Anatomical study of minimally invasive lateral release techniques for hallux valgus treatment.Foot Ankle Int. 2020; 41: 984-992
- Avascular necrosis of the first metatarsal head: incidence in distal osteotomy combined with lateral soft tissue release.Foot Ankle Int. 1994; 15: 59-63
- Avascular necrosis after first metatarsal head osteotomies.J Foot Surg. 1984; 23: 429-435
- Blood flow to the metatarsal head after chevron bunionectomy.Foot Ankle Int. 2005; 26: 526-529
- Influence of different anatomical structures on distal soft tissue procedure in hallux valgus surgery.Foot Ankle Int. 2012; 33: 991-996
- Distal soft tissue procedure in hallux valgus surgery: biomechanical background and technique.Int Orthop. 2013; 37: 1669-1675
- The shape of the lateral edge of the first metatarsal head as a risk factor for recurrence of hallux valgus.JBJS. 2007; 89: 2163-2172
- Sequential lateral soft-tissue release of the big toe: an anatomic trial.Z Orthop Unfall. 2007; 145: 322-326
- Tensile properties of the deep transverse metatarsal ligament in hallux valgus a consort-compliant article.Med (United States). 2016; 95: e2843
- Comparative radiographic analysis of parameters in feet with and without hallux valgus.Foot Ankle Int. 1995; 16: 139-143
- The adductor hallucis revisited.Foot Ankle Int. 2001; 22: 186-191
Article info
Publication history
Published online: July 22, 2021
Footnotes
Financial Disclosure: The authors received no financial support for the research, authorship, and/or publication of this article.
Conflict of interest: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Conflict of Interest (CoI) forms for all authors are available online.
Copyright Transfer Statement: Forms for all authors are available online.
Compliance With Ethical Standards: The study has been approved by the local ethics committee of the Medical Faculty at the University of Jena, Germany, and was performed in accordance with the 1964 Declaration of Helsinki and the German Data Protection Act. Written informed consent for scientific investigations was given by all donors during their life time at the Institute of Anatomy, University Hospital Jena (Germany).
Identification
Copyright
© 2021 by the American College of Foot and Ankle Surgeons. All rights reserved.
