against the lateral release in hallux valgus surgery
TRANSCRIPT
AGAINST the Lateral Release in Hallux Valgus Surgery
• Andrew J. Meyr, DPM* -Clinical Professor, Temple University School of Podiatric Medicine -Program Director, Temple University Hospital Podiatric Surgical Residency Program -Podiatric Director, Temple University Hospital Limb Salvage Center -Curator, The Shoe Museum at TUSPM
*I have no disclosures relevant to this talk….except that I taught Dr. Sansosti most everything of what she knows.
• APMA Annual Scientific Meeting • July 13, 2019
• Henry Ford said: Anyone who stops learning is old, whether at twenty or eighty. • David Hockney’s Mount Fuji and Flowers
AGAINST the Lateral Release in Hallux Valgus Surgery
• Andrew J. Meyr, DPM* -Clinical Professor, Temple University School of Podiatric Medicine -Program Director, Temple University Hospital Podiatric Surgical Residency Program -Podiatric Director, Temple University Hospital Limb Salvage Center -Curator, The Shoe Museum at TUSPM
*I have no disclosures relevant to this talk….except that I taught Dr. Sansosti most everything of what she knows.
• APMA Annual Scientific Meeting • July 13, 2019
• Henry Ford said: Anyone who stops learning is old, whether at twenty or eighty. • David Hockney’s Mount Fuji and Flowers
Lower Extremity Anatomy: Forefoot Arthrology
• AJM • TUSPM Department of Surgery
• Kettering said: “Knowledge is not understanding.
You can know a lot about something and not really understand it.”
• Da Vinci’s Lower Extremity Drawings
The Hallucal Metatarsophalangeal Joint
-The Sesamoid Apparatus -Five ligaments which
hold the sesamoids strongly in relation to the proximal phalanx and relatively weakly to the first metatarsal:
-Plantar Metatarsophalangeal Ligament
-Medial and Lateral Metatarsosesamoid Ligaments
-Intersesamoid Ligament -Phalangeosesamoid
Ligament (1 vs. 2)
The Hallucal Metatarsophalangeal Joint
-The Sesamoid Apparatus -Five ligaments which
hold the sesamoids strongly in relation to the proximal phalanx and relatively weakly to the first metatarsal:
-Plantar Metatarsophalangeal Ligament
-Medial and Lateral Metatarsosesamoid Ligaments
-Intersesamoid Ligament -Phalangeosesamoid
Ligament (1 vs. 2)
Firmly attached to the phalangeal base and loosely attached to the plantar metatarsal neck. Sesamoids embedded within this structure.
Strong attachment between the sesamoids with the deep transverse metatarsal ligament additionally found laterally.
Strong attachment between the sesamoids and the phalangeal base.
Attachment between the dorsal tubercle on the metatarsal head to the marginal sides of the sesamoids.
The Hallucal Metatarsophalangeal Joint
-The Sesamoid Apparatus -Five ligaments which
hold the sesamoids strongly in relation to the proximal phalanx and relatively weakly to the first metatarsal:
-Plantar Metatarsophalangeal Ligament
-Medial and Lateral Metatarsosesamoid Ligaments
-Intersesamoid Ligament -Phalangeosesamoid
Ligament (1 vs. 2)
Firmly attached to the phalangeal base and loosely attached to the plantar metatarsal neck. Sesamoids embedded within this structure.
Strong attachment between the sesamoids with the deep transverse metatarsal ligament additionally found laterally.
Strong attachment between the sesamoids and the phalangeal base.
Attachment between the dorsal tubercle on the metatarsal head to the marginal sides of the sesamoids.
Soft Tissue Structures that Attach to the Sesamoids/Proximal Phalangeal Base:
-Medial and lateral metatarsosesamoid ligaments -Medial and lateral collateral ligaments -Plantar metatarsophalangeal ligament insertion -Intersesamoid ligament origin and insertion -Phalangeosesamoid ligament(s) origin and insertion -Deep transverse metatarsal ligament -Insertion of the EHB -Insertion of the FHB -Insertion of the Adductor hallucis -Insertion of the Abductor Hallucis -Medial band of the plantar fascia
Soft Tissue Structures that Attach to the First Metatarsal Head:
-Medial and lateral metatarsosesamoid ligaments -Medial and lateral collateral ligaments
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Hallux Abductovalgus
The sesamoids “sublux” into the interspace.
We need to “relocate” the
sesamoids intra-operatively.
Pubmed ID#: 10609457
Pubmed ID#: 10609457
N=75 feet
IMA: 12.1° 4.1° HAA: 24.6° 7.4° TSP: 4.9 2.7 Tibial Sesamoid Distance: 31.3mm 31.3mm
Pubmed ID#: 20123290
N=46 feet
IMA: 12.8° 5.6° HAA: 22.4° 9.0° TSP: 3.7 2.0
Tibial Sesamoid Distance: 30.6mm 30.2mm
Pubmed ID#: 20123290
N=46 feet
IMA: 12.8° 5.6° HAA: 22.4° 9.0° TSP: 3.7 2.0
Tibial Sesamoid Distance: 30.6mm 30.2mm
Pubmed ID#: 20123290
N=46 feet
SRA: 16.3° 8.6°
Sesamoid Distance: 30.0mm 29.8mm
Pubmed ID#: 20123290
N=46 feet
SRA: 16.3° 8.6°
Sesamoid Distance: 30.0mm 29.8mm
Soft Tissue Structures that Attach to the Sesamoids/Proximal Phalangeal Base:
-Medial and lateral metatarsosesamoid ligaments -Medial and lateral collateral ligaments -Plantar metatarsophalangeal ligament insertion -Intersesamoid ligament origin and insertion -Phalangeosesamoid ligament(s) origin and insertion -Deep transverse metatarsal ligament -Insertion of the EHB -Insertion of the FHB -Insertion of the Adductor hallucis -Insertion of the Abductor Hallucis -Medial band of the plantar fascia
Soft Tissue Structures that Attach to the First Metatarsal Head:
-Medial and lateral metatarsosesamoid ligaments -Medial and lateral collateral ligaments
>
Does this improve my ability to realign the MPJ, or simply destabilize the sesamoids/phalanx relative to the rest of the foot?
Pubmed ID#: 24556491
Complete reduction of the 1st MPJ without
capsulotomy let alone a lateral release.
IPJ fusion, Distal Akin osteotomy, Central Akin osteotomy, Oblique Akin osteotomy, Proximal Akin ostetomy, Bonney-Kessel osteotomy, Keller arthroplasty, etc.
McBride procedure, Modified McBride procedure, MPJ arthrodesis, Silver osteotomy, Hiss procedure, etc. Mayo osteotomy, Stone osteotomy, Reverdin osteotomy, Reverdin-Green osteotomy, Reverdin-Laird osteotomy, Reverdin-Todd osteotomy, Austin osteotomy, Bicorrectional Austin, Tricorrectional Austin, Mitchell osteotomy, Roux osteotomy, Miller osteotomy, Hohmann osteotomy, Wilson osteotomy, Distal L osteotomy, Kalish osteotomy, Mygind osteotomy, Vogler osteotomy, Peabody osteotomy, Percutaneous osteotomy, DRATO procedure, Distal cresentic osteotomy etc.
Scarf osteotomy, Ludloff osteotomy, Mau osteotomy, Crescentic osteotomy, Crescentic osteotomy with a shelf, Opening base wedge osteotomy, Closing base wedge osteotomy, Juvara closing base wedge osteotomy, Trehowan procedure, Logroscino procedure, Lambrinudi osteotomy, Proximal Austin osteotomy, etc.
Lapidus arthrodesis Cotton-Westman osteotomy, Brenner procedure, etc.
Statistical difference in HAA correction between two groups
(not IMA, TSP, nor Functional outcomes).
Actual Difference: 15.9 vs. 15.3 degrees of
correction
Pubmed ID#: 30321921
Pubmed ID#: 28103730
Pubmed ID#: 28103730
Pubmed ID#: 26208509
The lateral release has a some historical precedent, but is not supported by anatomic common sense, clinical experience or the scientific literature.
Take Home Points
The lateral release has a some historical precedent, but is not supported by anatomic common sense, clinical experience or the scientific literature.
Take Home Points
-TUH Podiatric Surgical Residency Program: http://www.tuhpod.weebly.com/ -TUSPM Podcast Network: https://soundcloud.com/user-79150427 -AJM PRISM App: https://itunes.apple.com/us/app/podiatry-prism/id1089332577?mt=8
• Please do not hesitate to contact Andy if there is anything at all that he can do for you:
Questions?
T E A Ex AV
Hallux Abductovalgus