Post-Traumatic Hallux Valgus: A Modified Surgical Technique

Abstract

Post-traumatic hallux valgus, a turf toe variant, is a rare, yet limiting injury. According to the literature, the deformity has been associated with acute medial collateral ligament tears, turf toe variant injuries, Lisfranc injury patterns, and first metatarsal fractures. There have been few documented cases of post-traumatic hallux valgus secondary to medial collateral ligament tears, and the treatment has been variable. Some authors have described direct end-to-end repair of the ligament to address the deformity, while others have described a modified McBride bunionectomy involving a Silver bunionectomy, lateral soft tissue release, and medial capsular and ligamentous repair. We propose a modified technique similar to the modified McBride bunionectomy, however, with the use of an all-suture anchor in the medial capsular and ligamentous repair. Our belief is that the all-suture anchor will allow for a stronger repair that will meet the physical demands of everyday ambulation and athletic participation. We used this technique in an individual who had evidence of a medial ligamentous complex injury of the hallux on MRI and failed conservative management. Postoperatively, the patient is immobilized until they can begin working on range of motion, strengthening, and finally to achieve return to full activity and sports.

Surgical Repair of Posttraumatic Hallux Valgus Deformity in a Collegiate Football Player

“…This is especially important to establish because of the significant soft-tissue dissection and immobilization required with a surgical intervention. We believe that our novel surgical technique using an all-suture anchor provides a repair that once healed, holds up to the high stresses placed on it 8 . Higher load to failure values in suture anchors versus sutures has been consistently reported in biomechanical studies 10 .…”

“…The associated sutures were passed in a mattress fashion through the plantar aspect of the capsular layer. While holding the hallux in neutral position, suture knots were then tied down to help re-establish the accessory ligament and the plantar capsule to the metatarsal head 8 (Fig. 6).…”

“…On the day of surgery, a regional block was performed in the preoperative area. He underwent a modified McBride procedure commonly used in the treatment of hallux valgus deformity, however with the utilization of an all-suture anchor to repair the medial ligamentous complex 8 (Video 1). Once the medial approach to the MTP joint was completed, he was noted to have complete disruption of the MCL (Fig.…”

“…We then performed our medial ligamentous complex repair. A double-loaded all-suture anchor was placed on the central portion of the medial aspect of the first metatarsal head 8 (Fig. 5).…”

“…A #2 nonabsorbable suture was used proximally to imbricate the remaining proximal capsule again in a pants-over-vest fashion. Postoperatively, the operative extremity was placed in a short leg splint with a toe spica component to hold the great toe in neutral to slight adduction 8 (Fig. 7).…”