Sensory Nerves at Risk During Hallux Valgus Surgery: Anatomical Insights and Preventive Strategies-A Systematic...

Area of Science:

• Anatomy
• Orthopedic Surgery
• Nerve Surgery

Background:

• Hallux valgus is a prevalent forefoot deformity.
• Surgical correction can lead to sensory nerve complications.
• Injury to specific nerves like the medial branch of the medial dorsal cutaneous nerve (MDCNm) is a concern.

Purpose of the Study:

• To synthesize evidence and anatomical landmarks for nerve identification.
• To reduce the risk of iatrogenic nerve injury during hallux valgus surgery.
• To provide practical guidance for surgeons.

Main Methods:

• Systematic review following PRISMA guidelines.
• Searched PubMed, Embase, and Cochrane databases up to February 2025.
• Included studies on hallux sensory nerve anatomy from the first tarsometatarsal to interphalangeal joints.

Main Results:

• Evidence is strongest for medial branch of the medial dorsal cutaneous nerve (MDCNm) localization.
• Palpation and ultrasonography are effective methods for identifying the MDCNm relative to the extensor hallucis longus (EHL).
• Established clock-face references and vein landmarks aid nerve identification, though hallux valgus severity can alter nerve positions.

Conclusions:

• Combining palpation, ultrasonography, and vein landmarks can minimize sensory nerve injury.
• Awareness of specific danger zones is crucial for surgical safety.
• Further clinical validation in deformed feet is needed.