DISTAL SOFT-TISSUE RELEASE USING DIRECT AND INDIRECT APPROACHES - AN ANATOMIC STUDY

Two surgical approaches for distal soft tissue release in the correcti on of hallux valgus, one using a dorsal first web space incision and t he other a longitudinal medial capsulotomy incision (used also for med ial eminence resection), were studied to compare and delineate the str uctures actually incised. Anatomic dissections were performed on six f resh-frozen amputation specimens using each of the approaches. The ade quacy of release of the adductor hallucis, transverse and oblique head s, first metatarsophalangeal lateral capsule, and suspensory ligament was reviewed. Any inadvertent damage to the first metatarsal head cart ilage, second metatarsophalangeal capsule, and lateral head of the fle xor hallucis brevis tendon was also noted, Distal soft tissue release is thought to be an important part of hallux valgus surgery, Based on our anatomic dissections, the actual extent of the release may be inco nsistent and unpredictable, and may have implications for the predicta bility of results after hallux valgus surgery.