Repair of the medial collateral ligaments of the first metatarsophalangeal joint. Clinical observation

Introduction: The development of effective methods for Hallux Valgus, that provide a long-term reproducible result is a pressing issue in foot surgery. Currently, combined techniques addressing the complex biomechanical changes associated with the development of Hallux valgus show the most promising results.

Materials and Methods: This study presents a clinical observation of a 54-year-old patient (O.) with Hallux valgus toe and varus deviation of the first metatarsal bone. The patient underwent reconstructive surgery, including scarf osteotomy and Akin osteotomy. Intraoperatively, a significant thinning of the capsule and the medial ligamentous complex in the dorso-proximal part, with detachment from the fixation point to the head of the first metatarsal bone, was revealed. Medial collateral ligaments plasty of the first metatarsophalangeal joint was performed. The follow-up period was 12 months, including questionnaire surveys, physical examinations, assessments of movement amplitude, and objective evaluations using VAS, SF-36, and AOFAS questionnaires. The range of motion in the first metatarsophalangeal joint was 90 degrees for extension (dorsiflexion) and 30 degrees for flexion (plantar flexion).

Results: Preoperatively, pain was rated at 80 on the VAS, SF-36 at 35%, and AOFAS at 59. Post-surgery, significant improvements were observed in all questionnaires (VAS = 0, SF-36 = 95, and AOFAS = 100), along with the recovery of movement amplitude of the metatarsophalangeal joint. The intertarsal angle decreased from 21° to 8 degrees, and the Hallux Valgus angle reduced from 50° to 12 degrees. The radiographs showed no negative dynamics three months and one year post-surgery. The range of motion in the first metatarsophalangeal joint aſter surgery was 85 degrees for extension (dorsiflexion) and 15 degrees for flexion (plantar flexion).

Conclusion: Addressing the pathogenetic links in the development of Hallux valgus, coupled with the restoration of the ligamentous apparatus of the metatarsophalangeal joint, allows for a reliable long-term result. This study underscores the effectiveness of a modern personalized approach, contributing to improved outcomes in the treatment of orthopedic patients.

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