McBride, Clin Orthop Relat Res 1934 - The Conservative Operation for Bunions: End Results and Refinements of Technique

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The Conservative Operation for Bunions: End Results and Refinements of Technique

McBride·Clin Orthop Relat Res·1934·Review article

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McBride's 1928 classic describes a soft-tissue-only correction for hallux valgus. The procedure requires no osteotomy and no joint resection. It is built on the principle that the adductor hallucis conjoined tendon is the dominant deforming force and can be rerouted to become corrective.

Key Findings

The adductor hallucis and flexor hallucis brevis share a conjoined tendon that inserts on the lateral base of the proximal phalanx. McBride identified this as the primary mechanical driver of hallux valgus — once the toe is everted even slightly, these muscles gain a powerful mechanical advantage over the toe abductors.
In a majority of hallux valgus cases, the lateral sesamoid migrates between the first and second metatarsal heads. Once fixed by inflammatory changes, it creates a persistent medially directed force on the first metatarsal with every step, perpetuating and worsening the deformity.
The procedure has four steps:
- 1. Release the conjoined adductor tendon from the lateral proximal phalanx
- 2. Transplant it to the dorsum of the first metatarsal head
- 3. Selective lateral sesamoidectomy (only if eroded, displaced, or abnormal)
- 4. Medial eminence resection and capsule repair
- No osteotomy. No joint resection.
Lateral sesamoidectomy is selective, not routine. The sesamoid is removed only if eroded, abnormally shaped, or displaced. This distinction matters. Routine sesamoidectomy is not part of the original McBride description.
The procedure is contraindicated in three scenarios:
- Hallux rigidus
- Extreme deformity
- Marked articular surface changes
- Outside these contraindications, it was originally designed for younger patients but found to have broader applicability.
Postoperative protocol: cast and sutures removed at 1-10 days, weight-bearing permitted at 2 weeks, adhesive plaster overcorrection maintained for 4-6 weeks. This is notably early mobilization for the era.

Board PearlThe McBride procedure corrects hallux valgus without osteotomy by releasing and rerouting the adductor hallucis tendon to eliminate the primary deforming force.

The Conservative Operation for Bunions: End Results and Refinements of Technique.

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|

The Conservative Operation for Bunions: End Results and Refinements of Technique

McBride·Clin Orthop Relat Res·1934·Review article

|

McBride's 1928 classic describes a soft-tissue-only correction for hallux valgus. The procedure requires no osteotomy and no joint resection. It is built on the principle that the adductor hallucis conjoined tendon is the dominant deforming force and can be rerouted to become corrective.

Key Findings

The adductor hallucis and flexor hallucis brevis share a conjoined tendon that inserts on the lateral base of the proximal phalanx. McBride identified this as the primary mechanical driver of hallux valgus — once the toe is everted even slightly, these muscles gain a powerful mechanical advantage over the toe abductors.
In a majority of hallux valgus cases, the lateral sesamoid migrates between the first and second metatarsal heads. Once fixed by inflammatory changes, it creates a persistent medially directed force on the first metatarsal with every step, perpetuating and worsening the deformity.
The procedure has four steps:
- 1. Release the conjoined adductor tendon from the lateral proximal phalanx
- 2. Transplant it to the dorsum of the first metatarsal head
- 3. Selective lateral sesamoidectomy (only if eroded, displaced, or abnormal)
- 4. Medial eminence resection and capsule repair
- No osteotomy. No joint resection.
Lateral sesamoidectomy is selective, not routine. The sesamoid is removed only if eroded, abnormally shaped, or displaced. This distinction matters. Routine sesamoidectomy is not part of the original McBride description.
The procedure is contraindicated in three scenarios:
- Hallux rigidus
- Extreme deformity
- Marked articular surface changes
- Outside these contraindications, it was originally designed for younger patients but found to have broader applicability.
Postoperative protocol: cast and sutures removed at 1-10 days, weight-bearing permitted at 2 weeks, adhesive plaster overcorrection maintained for 4-6 weeks. This is notably early mobilization for the era.

Board PearlThe McBride procedure corrects hallux valgus without osteotomy by releasing and rerouting the adductor hallucis tendon to eliminate the primary deforming force.

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