Tendon balancing in hallux valgus surgery

Recurrent valgus of the hallux after hallux valgus surgery is an unpleasant complication. A possible cause is the imbalance and maltracking of particularly the extensor hallucis longus (EHL) and less frequently the flexor hallucis longus (FHL) or extensor hallucis brevis (EHB) tendon of the hallux. In patients with a tight achilles tendon, the EHL tendon can be recruited to aid dorsiflexion of the foot, creating imbalance. The literature on this subject is very scarce. In 10 patients with severe hallux valgus, a perioperative evaluation after performing the osteotomies and capsular closure showed tight extensor or flexor tendons of the hallux with residual valgus maltracking. A balancing of the tendons was performed with a -realignment -lengthening procedure. A good clinical result was obtained in all patients. No adverse effects were seen after tendon balancing. Strength in all tendons was at least 3+, except in one patient with multiple sclerosis. No weaknesses or -difficulties during walking were reported. Tendon balancing could play a role in prevention of hallux valgus recurrences and can be performed without loss of strength or compromising of walking ability.