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Many surgical procedures for treating hallux valgus deformity have been described. In 1923, Silver1 explained that hallux valgus resulted from muscle imbalance, and described an operation for realignment of the first metatarsophalangeal joint. Subsequently, McBride2,3 and Hansen4 pointed out that the conjoined adductor tendon, which inserts into the base of the proximal phalanx of the hallux, was a major deforming force. They also noted that displacement of the fibular sesamoid into the first intermetatarsal space occurs with progressive hallux valgus deformity (Figs IA-B). McBride advocated removal of the deforming force by releasing the conjoined tendon and excising the lobular sesamoid. Subsequently, he reimplanted the conjoined tendon into the lateral aspect of the first metatarsal.
DuVries5 modified the McBride procedure by suturing the adductor tendon into the interval between the first and second metatarsal heads. The goal of all three procedures was to correct the pathologic anatomy in a hallux valgus deformity, without disrupting the weightbearing function of the metatarsophalangeal joint.
INDICATIONS
The modified McBride procedure is indicated for a moderate hallux valgus deformity (a hallux valgus angle of 20° to 40°3). The 1-2 intermetatarsal angle should not exceed 15°. Following these parameters, one can anticipate approximately a 50% correction of the hallux valgus angulation, and approximately a 40% correction of the intermetatarsal angle.
When a fixed metatarsus primus varus deformity is present, a basilar crescentic osteotomy is performed, as well as a modified McBride procedure.
Age is not a contraindication for this procedure as long as there is adequate vascular status. Pain is the most frequent patient complaint, as well as occasional cosmetic complaints. Performance of this procedure does not preclude correction of lesser toe deformities.
CONTRAINDICATIONS
Contraindications include an impaired vascular status, advanced arthritis of the metatarsophalangeal joint, and a hallux valgus deformity with a congruous metatarsophalangeal joint. Patients with systemic arthritides and destruction of periarticular soft tissue structures should not be considered for this procedure, as failure is likely.
In general, hallux valgus deformities exceeding 40° and an associated 1-2 intermetatarsal angle exceeding 15° are relative contraindications for this procedure.
TECHNIQUE
Under tourniquet control, the initial skin incision is made on the dorsal aspect of the foot in the first intermetatarsal space. The incision is deepened through the subcutaneous tissue until the...