Dr. Vladimir Zeetser, DPM, FACFAS
America's Premier Foot & Ankle Surgeon
Advanced Modified Mini-TightRope Bunion Surgery
The treatment of hallux valgus deformity includes the assessment of the hallux valgus angle, the intermetatarsal angle and the contribution of an interphalageus deformity. Additionally, there must be an assessment of the presence or absence of arthritic involvement of both the first metatarsocuneiform joint and the first metatarsophalangeal joint. Other considerations are the orientation of the distal metatarsal articular angle and the orientation and stability of the first metatarsocuneiform joint.
Various methods have been described to correct the intermetatarsal angle. Soft tissue correction can be achieved by suturing the lateral capsule of the first metatarsal to the medial capsule of the second metatarsal, incorporating the intervening, previously released adductor tendon. A loss of reduction can occur due to the forces that oppose the suture repair as well as the possibility that poor tissue quality can contribute to a loss of reduction.
In the presence of more rigid deformities the intermetatarsal angle is reduced by using a distal or proximal osteotomy of the first metatarsal. Such osteotomies can be tec hnically challenging. A rather daunting list of consequences and potential complications include delayed union, malunion, nonunion, excessive shortening of the first metatarsal, avascular necrosis, hardware failure and prolonged protected ambulation.
The Mini TightRope is useful as an alternative and adjunct method for reduction of the intermetatarsal angle. A FiberWire« and button construct is placed across (distally or proximally) the first and second metatarsals. As the FiberWire is tightened, the intermetatarsal angle is reduced to a normal angle (less than 9-11┬░) The suture tied over the lateral button maintains a secure reduction of the intermetatarsal angle. Used alone or in conjunction with the distal soft tissue intermetatarsal repair, this technique affords a greater degree of strength and security than can be achieved with the soft tissue repair alone. Additionally, the Mini TightRope System provides a more technically straightforward method of reducing and maintaining the intermetatarsal angle than with conventional osteotomies while avoiding the complications associated with osteotomies.