The Multiplanar Effect of First Metatarsal Osteotomy on Sesamoid Position

Osteodesis for Hallux Valgus Correction: Is it Effective?

“…that the first metatarsal might not be realigned without an osteotomy might have stemmed from preoperative assessments when the displaced lateral sesamoid and contractures blocked proper first metatarsal realignment during manual examination. Simultaneous correction of the hallux valgus and medial sesamoid position in our patients also confirmed the importance of metatarsus primus varus correction as reported by others [5,12,22,24,28]. In a similar concept, bone-to-bone suture-cable mechanism, mini-tightrope, and suture-button techniques have been successful for first metatarsal realignment without osteotomies [9,29].…”

“…Hallux valgus is a progressive condition likely attributable to the majority of stresses being borne by the first ray in walking [10]. Generally, correction of metatarsus primus varus has been regarded as the primary surgical objective because its correction facilitates effective hallux valgus and metatarsosesamoid dissociation correction [5,12,22,28].…”

The Relationship Between the Sesamoid Complex and the First Metatarsal After Hallux Valgus Surgery Without Lateral Soft-Tissue Release: A Prospective Study

“…Because the position of the sesamoid complex is fixed (9,17,18), we have concluded that the sesamoids must not be the focus of the surgery; rather, the displacement of the first metatarsal must be addressed. Correcting the relationship between the first metatarsal head and the sesamoid complex will result from correcting the first metatarsal displacement.…”

“…In hallux valgus, the sesamoids take an intermediate position between the first and second metatarsal heads, producing a predominantly lateral force on the first metatarsophalangeal joint (MTPJ) that increases abduction of the great toe, increasing the first metatarsophalangeal (abduction) angle (8,(13)(14)(15)(16). However, the position of the sesamoids relative to the second metatarsal is fixed (9,17,18), indicating that the first metatarsal, not the sesamoid complex, is displaced medially relative to the sesamoids. Thus, we have questioned the need for lateral soft tissue release, specifically sectioning (and, perhaps, transfer) of the conjoined tendon of adductor hallucis, sectioning of the fibular sesamoidal ligament, and transection of the deep transverse intermetatarsal ligament, in isolation or combed, to restore balance to the first MTPJ-sesamoid complex.…”

The use of a syndesmosis procedure for the treatment of hallux valgus

“…There were 26 women. The mean age of the patients was 46 years (18 to 70) and the mean follow-up was 26 Hallux valgus and metatarsus primus varus are often associated. 1 On that basis some argue that successful surgical correction of a hallux valgus deformity depends largely on the effectiveness of the correction of the metatarsus primus varus.…”