Surgical technique
The patient was given spinal or general anesthesia based on the anesthesiologist’s recommendation. The patient was placed in a supine position, and a lower extremity tourniquet was applied for better surgical vision. During the operation, a lateral soft tissue release was performed in the same manner as described by Schneider [For the L-shaped medial capsulorrhaphy technique, before chevron osteotomy, a vertical capsular incision (short arm) was first performed proximal to the base of the proximal phalanx. Then, a dorsomedial incision extending from the interphalangeal joint to the midshaft of the first metatarsal (long arm) was made in the capsule parallel to the first metatarsal, creating a plantarly based capsular flap. Third, after the extra medial eminence was removed from the metatarsal shaft during the chevron osteotomy, the redundant edges of the capsular flap were resected carefully, and the tip was sutured to the capsule piece distal to the first proximal phalanges [In the modified U-shaped group, the medial capsule and collateral ligament were dissected completely from the distal metatarsal, and then a transverse U-shaped capsular flap was formed (Fig. The U-shaped capsular flap preparing. The medial capsule was exposed (left) and a transversal U-shaped capsular flap is formed (right) during the U-shaped medial capsulorrhaphy procedureThe U-shaped capsular flap fixation. A 1.2-mm hole was drilled perpendicular from dorsal to plantar of the distal fragment. A resorbable-coated VICRYL thread was used to stitch the medial capsule and collateral ligament in a running-locking interrupted fashion. One end of the proximal suture was pulled through the hole and knot it with the other end until the great toe became straight (left). Resorbable thread was used to reinforce the terminal of medial soft tissue (right)