The aim of the study was to assess the clinical, radiological and paedobarographic outcome following modified Silver’s McBride’s procedure, in the treatment of Hallux Valgus. Between 1997 and 1999, Modified Silver’s McBrides procedure for Hallux Valgus was performed on 38 foot in 28 patients (18 unilateral and 10 bilateral). The median age was 60 years. The median follow up was 26 weeks. Clinical outcome measures consisted of pain, deformity, mobility, walking ability and shoe wear. Radiological outcome measures were Hallux Valgus angle, Intermetatarsal angle, 1st to 5th Metatarsal distance, 1st to 2nd metatarsal distance, and the DMAA (Distal Metatarsal Articular Angle). Paedobarographic (Musgrave) outcome of peak pressure, total force, time from heel strike to toe lift off post operatively were analysed. Preoperative visual analogue pain score was 5–8 and 0–4 postoperatively (p< 0.001). 34 feet had pain on walking preoperatively and only 11 had pain post-operatively. 12 were wearing special shoes pre- operatively and 5 post-operatively. Hallux Valgus angle was 34 pre-operatively and 19 post-operatively (p< 0.001). IMT angle was 14.53 pre-op and 10.88 postop (p< 0.001). 1st-5th MT distance was 67mm pre- op and 63mm post-op (p=0.001). 1st-2nd MT distance was 15 pre-op and 10 post-op (p=0.004). DMAA was 24.7 degrees. 21 foot an obliquity of the 1st tarsometatarsal joint was seen indicating an anatomical cause of metatarsus varus. Foot pressure studies showed a peak pressure of 1.37kg/cm2 , heel to toe off- time was 936.9ms and maximum load was 65.2 kg. There were 3 cases of superficial wound problems. One patient developed Hallux varus deformity, with no functional disability.

Conclusion: Modified Silver’s McBride procedure for the treatment of Hallux Valgus is a soft tissue procedure and is a safe alternative to the commonly practiced osteotomies for correction of this disorder.

To describe a discrete fascial canal containing the medial plantar cutaneous nerve of the great toe in operations of the great toe. Clinical Relevance: The medial plantar cutaneous nerve of the great toe is one of the terminal branches of the medial plantar nerve which itself is the anterior division of Posterior tibial nerve. This branch provides sensation to the dorsomedial aspect of the distal phalanx of the great toe.

Motor branches of the medial branch are given off proximal to the first metatarsophalangeal joint. A medial incision centred over the first metatarsophalangeal and creation of distally based capsular flap is employed in number of operations of the Hallux, e.g. Modified Silver’s McBride, Chevron Osteotomy, Replacement of the MTP Joint. The medial plantar cutaneous nerve is prone to injury if it is not identified and protected, leaving the patient with loss of sensation to the medial surface of the great toe. After dissection of the skin and superficial fascia over the medial side of the 1st MTP joint, a discrete layer of dense connective tissue is seen passing from the medial sesamoid to the medial plantar aspect of the first metatarsal. The closed blades of dissecting scissors can be inserted under this layer proximally to distally and the medial plantar cutaneous nerve can be seen to enter the canal at its proximal end. This fascial layer can then be opened and the underlying nerve thus identified and protected. Opening the tunnel proximally and identifying the nerve ensures nerve is not divided with plantar arm of distally based capsular flap. Identification and protection of this nerve prevents the complication of loss of sensation and the development of a painful neuroma, giving the patients a better outcome following surgery.