Hallux valgus

Last evidence check March 2010

The McBride procedure extends the simple bunionectomy by releasing the adductor tendon from the proximal phalanx (where it is believed to contribute to the valgus deformity) and transferring it to the neck of the first metatarsal (where it is expected to draw the first metatarsal out of varus). The original procedure included the excision of the fibular sesamoid, but Mann showed this increased the risk of hallux varus. The fibular sesmoid is now generally left.

The largest series of McBride procedures is by Mann and Pfeffinger (1991). They reviewed 72 feet in 47 patients, of whom 92% were clinically satisfied and 64% could wear any shoe. Radiological results were comparable with other distal procedures. The traditional McBride procedure involved excision of the fibular sesamoid. Mann and Pfeffinger did this in most of their procedures, with a 10% hallux varus rate.

Other smaller series have reported slightly less success - around 80%. In poor-quality retrospective comparisons with the Mitchell and DCO, the McBride did, if anything slightly worse.

The McBride operation is acceptable but should probably be limited to mild-moderate deformities. There is a need for comparative trials against other operations aimed at this group of patients such as the chevron, Mitchell or Wilson osteotomies.