PodiatryToday Issue Number: Volumne 28 – Issue 5 – May 2015
Author(s): William Fishco, DPM, FACFAS, and Ronald Ray, DPM, FACFAS
Point-Counterpoint: Should You Release Soft Tissues For A Bunionectomy featuring Dr. Ronald Ray, DPM
Emphasizing examples of sound radiographic and intraoperative assessment, and citing emerging research on frontal plane rotation and the chevron osteotomy, this author asserts that a lateral soft tissue release is not an absolute necessity with hallux valgus correction.
By Ronald Ray, DPM, FACFAS
The lateral soft tissue release is a common procedure that surgeons perform in conjunction with hallux valgus correction. However, one should determine the actual need for the release of the lateral soft tissues on a case-by-case basis, focusing on clinical, radiographic and intraoperative criteria. In some cases, a lateral soft tissue release is not necessary.
Determining the need for a lateral soft tissue release can start with the clinical and radiographic examinations. Beginning with the clinical examination, distract the hallux and try to appreciate the extent of the opening between the lateral aspect of the first metatarsal head and the base of the proximal phalanx. Joints that permit lateral gapping with medial translation may have a greater degree of compliance of the soft tissues laterally. Then check the ease of reduction of the hallux from its abducted position to a neutral or adducted position. A rigid or abrupt endpoint (the “end feel of the joint”) may signify a contracted lateral side. In contrast, a more flexible or soft endpoint may be consistent with greater soft tissue compliance or forgiveness.