155 The Procedures – Soft Tissue Procedures in Forefoot Surgery
Soft Tissue Procedures in Forefoot Surgery
In Hallux Valgus Correction
We observed that the osteotomies are not suffi- cient to provide a good hallux valgus correction:
Therefore, we perform in almost each case an additional MTP lateral release and medial soft tissue tightening (Fig. 19a).
Fig. 19a. Soft tissue procedures in hallux valgus correction.
1, 2, 3. The release of the metatarso-sesamoidal phalangeal complex (MSPC) is necessary in almost all cases.
4, 5. The medial capsuloraphy is also necessary in almost all cases, in fact it is a medial soft tissue tightening (a:
including the abductor muscle). It is rarely a simple closure of the MTP medial aspect.
6. In each case, the Load Simulation Test (LST) in the only test for assessing the correction after medial tightening.
156 Forefoot Reconstruction In Lesser Toes Deformity Correction
We observed that most of hammertoe or claw toe deformities can only be corrected by soft tissue procedure. This correction has to be insured in most cases by temporary K-wiring excluding the MTP joint (for four weeks), the K-wire is only 1mm diameter. Removing such K-wiring is painless, ordinary made when removing the bandage. The different soft tissue procedures are
described Fig. 19b. However, even when toe arthroplasty condylectomy or fusion is neces- sary, soft tissue procedures are highly recom- mended to insure the correction. On the lesser rays, whatever the procedure performed, the last step is certainly a soft tissue surgery: Most of soft tissue procedure can be performed by mini inva- sive or percutaneous surgery (Fig. 19d).
Fig. 19b. Soft tissue procedure in hammer or claw toe correction. Chronological steps: 1.
1. Chronological steps.
2. The MTP passive plantar flexion is correct, nothing more to do in the MTP.
3. MTP dorsal release (one by per cutaneous procedure).
4. The PIP seems to be rigid.
5. PIP dorsal flexion obtained by manipulation: no more thing to do on the PIP, except temporary axial K-wiring.
6. PIP plantar release (this may be also performed by per cutaneous procedure).
7, 8. Assessment of the need of long flexor tendon lengthening.
9. Distal section of the long flexor tendon.
157 The Procedures – Soft Tissue Procedures in Forefoot Surgery
Fig. 19c. Soft tissue procedures in hammer toe correction. Chronological steps: 2.
1. Toe K wiring, excluding the MTP joint, is often required to ensure the correction with soft tissue.
2. The K wiring emphasizes the need of the extensor tendons lengthening.
3. Percutaneous lengthening of the extensor tendon.
4. Lengthening with the green procedure.
5. Need of medial MTP release (this should be lateral release if required).
6. Final correction assessed by the load simulation test.
Fig. 19d. percutaneous surgery for soft tissue.
1, 2. MTP release for loss of plantar flexion.
3. PIP plantar release for hammer or claw toe.
4. Cut of flexor tendons.
5. Cut of extensor tendons.
