The potentially dangerous zone of the dorsomedial cutaneous nerve in minimally invasive surgery for hallux valgus: a cadaveric study

Abstract

Background This study aims to describe the distribution of the dorsomedial cutaneous nerve (DMCN) in the middle and proximal parts of the metatarsal from a lateral view. The purpose is to provide guidance to surgeons in protecting the nerve during the 3rd and 4th generation minimally invasive surgery (MIS) for hallux valgus (HV). Methods A total of 20 cadaveric feet were dissected to expose the course of the DMCN and sentinel vein. Measurements of the distances between the nerve/vein and the upper border of the metatarsal, as well as the height of the metatarsal, were taken from a lateral view. The distribution area was then described in proportion. Results At the base of the metatarsal, the DMCN was distributed in the upper 25.7% of the area. When it reached the middle of the metatarsal, the DMCN was distributed in the upper 13.2–47.2% of the area. As for the sentinel vein, it was distributed in the upper 23.5–71.9% and upper 4.1–52.7%, respectively, at these two positions. Conclusions The area, which is above the line connecting the upper 1/4 point at the base of the first metatarsal and the 1/2 point at the middle of the first metatarsal, is a dangerous zone for the DMCN. Avoiding the zone is recommended during MIS for HV.

A Joy‐Stick Assistant Three‐Dimensional Modified Technique of Minimally Invasive Surgery for Mild or Moderate Hallux Valgus

“… 11 It has been reported that the dorsomedial cutaneous nerve is most vulnerable in MIS for HV, surgeons need to have deep anatomical knowledge and meticulous surgical techniques to avoid neurovascular injury. 12 , 13 Moreover, how to correct multi‐directional deformities in HV in MICA remains difficult because of previous osteotomy design, limited operating space and instruments. The so‐called fourth generation of MIS has been raised to cover the shortage of MICA.…”