Review Question - QID 211462

Failure to release the adductor hallucis tendon on the lateral side of the 1st MTP may result in recurrent hallux valgus deformity. Label D corresponds to the adductor hallucis.

There is considerable variability in surgical treatment to correct hallux valgus, with numerous procedures described. Successful surgery depends on preoperative assessment and decision making on the best surgical procedure for the patient. Utilizing a soft tissue procedure, in addition to an osteotomy, is useful when the MTP joint is incongruent (lateral subluxation of the proximal phalanx on the metatarsal head). Failure to release the adductor hallucis, sesamoid suspensory ligament, and the first MTP capsule can result in hallux recurrence. Conversely, hallux varus can occur with an excessive lateral release, lateral sesadoiectomy, and aggressive medial capsular tightening.

Perera et al. reviewed the various static and dynamic stabilizers that affect the fine balance of the first ray. They describe the pathogenesis of hallux valgus, including the plantar and lateral attachment of the adductor hallucis which pulls the phalanx into pronation and tethers the base.

Devos et al. review the concept of hallux varus. They focus on iatrogenic hallux varus which they state can be due to loss of medial bony support, as well as an aggressive release of lateral soft tissues. This leads to unopposed pull from the abductor hallucis and the medial head of flexor hallucis brevis (FHB) and varus deformity.

Figure A shows a clinical photograph of a patient with recurrent hallux valgus. Figure B (unlabeled) and Illustration A (labeled) show the first metatarsophalangeal joint (MTPJ) and the major structures around the joint.

Incorrect Answers:
Answer 1: Label A points to the flexor hallucis longus, is which does play a role in the stability of the first MTP joint; it is not routinely cut or involved in a soft tissue release for hallux valgus.
Answer 2: Label B points to the abductor hallucis, which does become a deforming force causing pronation of the MTPJ in hallux valgus. However, it is not a primary driver of recurrent hallux valgus.
Answer 3: Label C depicts the flexor hallux brevis (FHB) muscle bellies, which do not contribute to recurrent hallux valgus deformity.
Answer 5: Label E points to the lateral sesamoid, which should not be removed as it may lead to hallux varus.