Supraligamentous Approach of Lateral Release in Endoscopic Lateral Soft Tissue Procedure

Many surgical methods are available for hallux valgus, but consensus regarding the best management has yet to be established. Minimally invasive techniques are gaining popularity with the potential advantages of better cosmetic outcome, less postoperative pain, and decreasing recovery time because surgical exposure and deep soft tissue dissection are less extensive and possibly gentler. Recently, techniques of the endoscopic distal soft tissue procedure have been reported, in which an endoscopic approach of the classic distal soft tissue procedure is described. The intermetatarsal ligament, adductor hallucis insertion, and the lateral capsuloligamentous complex of the first metatarsophalangeal joint is released during the endoscopic lateral release. However, the intermetatarsal ligament does not contribute to development of the hallux valgus deformity, and release of the ligament is not necessary for correction of the deformity. Instead, preservation of the intermetatarsal ligament may protect the interdigital nerve and reduce the risk of nerve injury during endoscopic lateral release. In this technical note, the technical details of supraligamentous approach of lateral release in endoscopic lateral soft tissue procedure (or EDSTP) is described. This approach can help to reduce the risk of injury to the interdigital nerve during endoscopic lateral release.