Effect of Intraoperative Tibial Sesamoid Position on Hallux Valgus Recurrence and Pain

The importance of the sesamoid position on first metatarsophalangeal joint alignment has been well established. Among the primary goals of surgical intervention for hallux valgus deformities is restoration of the relationship between the sesamoids and the first metatarsal head. However, the influence of the intraoperative tibial sesamoid position (TSP) on hallux valgus recurrence and postoperative pain has not been well delineated in the literature.

Fifty patients who underwent hallux valgus surgery by a single surgeon between 2008 and 2020 were analyzed. Preoperative, intraoperative, and postoperative radiographs were evaluated, and medical records were reviewed for preoperative and postoperative visual analog scale pain scores.

Using bivariate analysis, we investigated the influence of TSP on overall recurrence rates and postoperative pain levels. A significant correlation (P < .10) between TSP and postoperative hallux valgus recurrence was noted, with intraoperative Hardy and Clapham grades 1 to 3 demonstrating a lower likelihood of deformity recurrence. Although a trend toward lower pain scores was noted in patients with a Hardy and Clapham grade of 1 to 3 compared with those with grades 4 and 5, the reduction in pain was not found to be statistically significant.

These study results suggest that intraoperative TSPs of 4 or above are a risk factor for recurrence of hallux valgus deformity. Therefore, every effort must be made to obtain the lowest possible TSP to reduce the risk of hallux valgus recurrence.