ArticleFoot & ankle orthopaedics2026
Sensory Nerves at Risk During Hallux Valgus Surgery: Anatomical Insights and Preventive Strategies-A Systematic Review.
Article in Foot & ankle orthopaedics, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Hallux valgus is a common forefoot deformity. Sensory complications after correction can result from iatrogenic injury to the medial branch of the medial dorsal cutaneous nerve (MDCNm), lateral dorsal cutaneous nerve (LDCN), medial plantar cutaneous nerve (MPCN), and lateral plantar cutaneous nerve (LPCN). We synthesized evidence and landmarks to aid nerve identification and reduce injury. Methods: Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, PubMed, Embase, and Cochrane were searched to February 2025 using 'nerve anatomy', 'hallux valgus' and 'bunion'. English/French studies describing course, measurements or localization of hallux sensory nerves from the first tarsometatarsal to interphalangeal joints were included. Results: From 863 records, 13 studies were included comprising cadaveric, imaging, and clinical series with both normal and hallux valgus feet. Evidence was most robust for MDCNm localization. Palpation during resisted hallux extension and targeted ultrasonography were reported as low-cost methods to define the MDCNm in relation to the extensor hallucis longus (EHL). Palpation showed 100% sensitivity (positive predictive value [PPV] 99%), whereas novice ultrasonography achieved 75% sensitivity (PPV 100%) in cadaveric feet before dissection. At the metatarsophalangeal (MTP) level, a transverse 'clock-face' reference (EHL at 12 o'clock) typically locates the MDCNm between 10 and 12 o'clock for a right foot. A communicating dorsoplantar 'sentinel' vein crosses the MDCNm about 2 cm proximal to MTP, with the nerve running deep to the vein. Limited data place the LDCN at 11-12, LPCN at 5-6 and MPCN at 7-8 o'clock. Most maps were derived from non-deformed feet. Hallux valgus severity shifts the MDCNm-EHL intersection proximally and may widen the medial danger zone to ~19 mm. Ultrasonography suggests MPCN lies within 3 to 4 mm of the metatarsal head and medial sesamoid, helping define capsulotomy limits; data for LPCN remain still limited. Conclusion: Combining palpation, ultrasonography and vein-based landmarks with awareness of axial danger zones may reduce sensory nerve injury during hallux valgus surgery; clinical validation in deformed feet remains necessary.
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