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Metatarsal osteotomy

Daniel Pollack
A 55-year-old man with poliomyelitis presented with a plantarflexed foot and painful ulceration of the sub-first metatarsophalangeal joint present for many years. A two-stage procedure was performed to bring the foot to 90°, perpendicular to the leg, and resolve the ulceration. The first stage corrected only soft-tissue components. It involved using a hydrosurgery system to debride and prepare the ulcer, a unilobed rotational skin plasty to close the ulcer, and a tendo Achillis lengthening to decrease forefoot pressure...
January 2018: Journal of the American Podiatric Medical Association
Takumi Matsumoto, Christopher E Gross, Selene G Parekh
Distal Chevron osteotomy is a well-established surgical procedure for mild to moderate hallux valgus deformity. Many methods have been described for fixation of osteotomy site; secure fixation, enabling large displacement of the metatarsal head, is one of the essentials of this procedure. The purpose of the present study was to evaluate the short-term radiographic outcome of a distal Chevron osteotomy using an intramedullary plate for the correction of hallux valgus deformity. The present study evaluated 37 patients (40 feet) who underwent distal Chevron osteotomy using an intramedullary plate by periodic radiographs obtained preoperatively and at 4 weeks, 8 weeks, 3 months, and 6 months postoperatively...
March 1, 2018: Foot & Ankle Specialist
Ilker Abdullah Sarikaya, Ali Seker, Ozan Ali Erdal, Mehmet Ali Talmac, Muharrem Inan
OBJECTIVE: This study aimed to present a treatment algorithm for the correction of the hallux valgus deformity in Cerebral Palsy (CP) patients and to discuss the outcomes based on our clinical and radiological results. METHODS: 29 patients (45 feet) were included in the study. The mean age of the patients at the time of the surgery was 14 (range 6-22) years. The mean follow-up was 33 (range 22-59) months. A reconstructive procedure was performed on 19 patients (27 feet); a soft tissue surgery and exostectomy of the bunion in six patients (11 feet); and MTP joint arthrodesis in four patients (7 feet)...
February 22, 2018: Acta Orthopaedica et Traumatologica Turcica
Aharon S Finestone, Eran Tamir, Guy Ron, Itay Wiser, Gabriel Agar
Background: Diabetic foot ulcers are frequently related to elevated pressure under a bony prominence. Conservative treatment includes offloading with orthopaedic shoes and custom made orthotics or plaster casts. While casting in plaster is usually effective in achieving primary closure of foot ulcers, recurrence rates are high. Minimally invasive surgical offloading that includes correction of foot deformities has good short and long term results. The surgery alleviates the pressure under the bony prominence, thus enabling prompt ulcer healing, negating the patient's dependence on expensive shoes and orthotics, with a lower chance of recurrence...
2018: Journal of Foot and Ankle Research
Neil L Duplantier, Ronald J Mitchell, Steve Zambrano, Aaron C Stone, Domenica A Delgado, Bradley S Lambert, Michael R Moreno, Joshua D Harris, Patrick C McCulloch, David M Lintner, Kevin E Varner
BACKGROUND: Fifth metatarsal base fractures of the metaphyseal-diaphyseal watershed junction (Jones fracture) are commonly treated with surgical fixation in athletes. Intramedullary screw fixation remains the most utilized construct, although plantar-lateral plating is an alternative. Purpose/Hypothesis: The purpose was to compare the mechanical strength of fracture fixation between an intramedullary screw and plantar-lateral plating. The hypothesis was that plantar-lateral plate fixation would allow for more cycles and higher peak loads before failure, as well as less fracture gapping, than would an intramedullary screw in cadaveric foot specimens with simulated Jones fractures exposed to cantilever bending...
February 1, 2018: American Journal of Sports Medicine
Konstantinos Tsikopoulos, Periklis Papaioannou, Dimitrios Kitridis, Dimitris Mavridis, Dimitrios Georgiannos
PURPOSE: The conventional surgical treatment of moderate to severe hallux valgus (HV) deformity includes proximal metatarsal osteotomies (PMOs). Recent evidence suggests that the extension of indications for distal metatarsal osteotomies (DMOs) may result in comparable outcomes. The purpose of this study was to compare the efficacy of proximal with that of distal metatarsal osteotomies for moderate to severe HV deformity. METHODS: We searched PubMed, Scopus, and CENTRAL up to 25 July 2017...
February 10, 2018: International Orthopaedics
J W K Louwerens
The present article presents a short summary concerning the pathomechanisms and clinical presentation of foot deformities in Charcot-Marie-Tooth syndrome. Furthermore, a classification system is introduced and based on a recently performed review of the literature an operative treatment algorithm is provided. The operative technique of the following surgical procedures is described in more detail: 1. dorsiflexion osteotomy at the base of the 1st metatarsus, 2. dorsiflexion osteotomy at the base of a lesser metatarsal bone, 3...
February 7, 2018: Operative Orthopädie und Traumatologie
Masahiro Horita, Keiichiro Nishida, Kenzo Hashizume, Yoshihisa Nasu, Kenta Saiga, Ryuichi Nakahara, Takahiro Machida, Hideki Ohashi, Toshifumi Ozaki
BACKGROUND: We investigated the clinical outcomes of resection and joint-preserving arthroplasty for forefoot deformities in patients with rheumatoid arthritis. METHODS: Sixteen feet of 14 women (average age, 67.1 years; range, 53-82) underwent resection arthroplasty of the metatarsal head (resection group), and 18 feet of 15 women (average age, 61.3 years; range, 40-73) underwent a metatarsophalangeal joint-preserving procedure with shortening oblique metatarsal osteotomies of the lesser toes (joint preservation group)...
February 1, 2018: Foot & Ankle International
A H Matthews, N A Jagodzinski, M Westwood, J E Metcalfe, K T Trimble
BACKGROUND: Dislocated metatarsophalangeal joints from clawed or hammer toes can be a disabling consequence of several conditions. The Cobb-Stainsby forefoot arthroplasty combines partial phalangectomy (Stainsby) with extensor tendon transfer to the metatarsal head (Cobb). We present a retrospective, three surgeon case series of 215 toes in 126 patients. METHODS: Early results and complications were gathered from the medical charts of 126 patients who met the inclusion criteria...
February 2018: Foot and Ankle Surgery: Official Journal of the European Society of Foot and Ankle Surgeons
Francesc Malagelada, Miki Dalmau-Pastor, Betlem Fargues, Maria Cristina Manzanares-Céspedes, Fernando Peña, Jordi Vega
BACKGROUND: The purpose of this study is to describe a simple and reproducible method to localize the neurological structures at risk and to describe a safe zone for hallux minimally invasive surgery (MIS) procedures. METHODS: Ten fresh-frozen cadaveric feet were dissected to identify the dorsomedial digital nerve (DMDN) and the dorsolateral digital nerve (DLDN) of the first toe. Axial sections were performed at the sites of metatarsal osteotomies. We documented the position of the nerves with respect to the extensor hallucis longus (EHL) tendon using a clock method superimposed on the axial section RESULTS: The DMDN was found at an average of 26...
February 2018: Foot and Ankle Surgery: Official Journal of the European Society of Foot and Ankle Surgeons
Rodrigo Díaz Fernández
BACKGROUND: With hundreds of operative methods described for correction of hallux valgus we can state that the ideal surgical treatment is still controversial. The Bösch technique has been used as a percutaneous way of correcting hallux valgus deformities with the use of a pin fixation. The aim of this study is to evaluate a new method of fixation by using a percutaneous locking plate. METHODS: Between June 2013 and January 2015, 24 consecutive percutaneous subcapital osteotomies of the first metatarsal bone were performed for the treatment of painful hallux valgus deformities in 24 patients...
September 20, 2017: Foot and Ankle Surgery: Official Journal of the European Society of Foot and Ankle Surgeons
Ichiro Tonogai, Fumio Hayashi, Yoshihiro Tsuruo, Koichi Sairyo
BACKGROUND: The aims of this study were to identify the artery feeding the fifth metatarsal and determine how bunionette osteotomy could injure this vessel. METHODS: The nutrient artery entering the fifth metatarsal was investigated in 10 adult cadaveric lower limbs by barium injection and enhanced computed tomography. RESULTS: The nutrient artery entered the medial aspect of the fifth metatarsal around the junction of the middle and proximal thirds obliquely from a distal direction (mean angle 36°) in the coronal plane in all cases; in the axial plane, the point of entry and direction of the artery was medial-plantar (mean angle 49°)...
October 29, 2017: Foot and Ankle Surgery: Official Journal of the European Society of Foot and Ankle Surgeons
Seiya Ohzawa, Makoto Kubota
BACKGROUND: The purpose of this retrospective study was to evaluate the clinical and radiological results of hallux valgus surgery using a plantar locking plate. METHODS: Proximal oblique metatarsal osteotomy combined with distal soft tissue treatment was performed in 59 adult patients (68 feet) with hallux valgus, using an anatomically pre-contoured plantar locking plate for fixation of the osteotomy. The median age was 64.0 years and the median follow-up period was 16...
June 17, 2017: Foot and Ankle Surgery: Official Journal of the European Society of Foot and Ankle Surgeons
David C Lee, Cesar de Cesar Netto, Jackson Rucker Staggers, Rebecca Siegel, Richard Chen, Su-Young Bae, Lew C Schon
BACKGROUND: Bunionette deformity is a painful bony prominence of the 5th metatarsal. We evaluated outcomes of using a Kramer osteotomy to treat this condition. METHODS: Retrospective study of patients treated with a Kramer osteotomy from 2003 and 2016. Outcome measures included Foot Functional Index (FFI) and radiographic measurements. RESULTS: 38 patients (43 feet) with an average follow-up of 55 months. Mean postoperative FFI1 was 19.4...
July 18, 2017: Foot and Ankle Surgery: Official Journal of the European Society of Foot and Ankle Surgeons
M Curtin, E Murphy, C Bryan, P Moroney
BACKGROUND: Hallux valgus is a common condition with in excess of 120 procedures described in the literature for its correction. Traditionally, distal metatarsal osteotomies have been employed in the treatment of mild deformities, with proximal osteotomies being reserved for more severe presentations. The Scarf osteotomy without internal fixation allows large translations which can successfully correct severe hallux valgus deformities, without limitations related to screw placement. METHODS: This is a retrospective single surgeon case series performed over a three year period...
March 9, 2017: Foot and Ankle Surgery: Official Journal of the European Society of Foot and Ankle Surgeons
Bruno Magnan, Ingrid Bonetti, Stefano Negri, Tommaso Maluta, Carlo Dall'Oca, Elena Samaila
BACKGROUND: Clinical and radiological results of percutaneous distal metatarsal minimally invasive osteotomy (DMMO) of the lesser rays for surgical treatment of primary metatarsalgia due to plantar overpressure with metatarsophalangeal instability are described. The aim of this prospective study was to assess the efficacy, feasibility and safety of this minimally invasive surgical (MIS) technique, verifying the possibility to lower the complication rate related to surgical exposures, to reduce operating times with comparable functional and cosmetic results to those reported with traditional open procedures...
April 27, 2017: Foot and Ankle Surgery: Official Journal of the European Society of Foot and Ankle Surgeons
Uğur Şaylı, Budak Akman, Altuğ Tanrıöver, Çiğdem Kaspar, Melih Güven, Turhan Özler
BACKGROUND: Intrinsically stable diaphyseal osteotomy gained popularity in recent years for symptomatic hallux valgus deformities. In this study, Scarf osteotomy results, in surgical management of moderate to severe hallux valgus, are presented. METHODS AND PATIENTS: Study group consisted of 40 feet of 32 (28 females, four males) patients surgically managed by Scarf osteotomy between September 2009 and 2011, with a mean age of 52,98 (range, 31-75) years at the time of surgery...
May 29, 2017: Foot and Ankle Surgery: Official Journal of the European Society of Foot and Ankle Surgeons
Ichiro Tonogai, Keizo Wada, Kosaku Higashino, Yoshihiro Fukui, Koichi Sairyo
BACKGROUND: Osteotomy for hallux valgus interrupts intraosseous blood supply to the first metatarsal, presumably causing non-union, delayed union, or osteonecrosis of the head of the first metatarsal. We investigated the first metatarsal nutrient artery, arising from the first dorsal metatarsal artery, and identified aspects of surgical technique contributing to nutrient artery injury. METHODS: Enhanced computed tomography scans of 8 feet of 8 fresh cadavers were assessed...
June 2, 2017: Foot and Ankle Surgery: Official Journal of the European Society of Foot and Ankle Surgeons
Jun Young Choi, Hee Chan Ahn, Sang Hee Kim, Si Young Lee, Jin Soo Suh
BACKGROUND: We aimed to compare the clinical and radiographic outcomes of minimally invasive surgery (MIS) and distal chevron metatarsal osteotomy (DCMO) for young female patients with mild-to-moderate juvenile hallux valgus deformity. METHODS: We retrospectively reviewed the radiographs and clinical findings of young female patients with mild-to-moderate juvenile hallux valgus who underwent MIS (25 feet) or DCMO (30 feet). In 12 of 25 MIS feet, 2.0-mm bio-absorbable pins were used as an additional fixation device crossing the osteotomy site, and 1...
December 23, 2017: Foot and Ankle Surgery: Official Journal of the European Society of Foot and Ankle Surgeons
Bruno Magnan, Stefano Negri, Tommaso Maluta, Carlo Dall'Oca, Elena Samaila
BACKGROUND: Recurrence rate of surgical treatment of hallux valgus ranges in the literature from 2.7% to 16%, regardless of used procedure. In this study, long-term results of a minimally invasive distal osteotomy of the first metatarsal bone for treatment of recurrent hallux valgus are described. METHODS: 32 consecutive percutaneous distal osteotomies of the first metatarsal were performed in 26 patients for treatment of recurrent hallux valgus. Primary surgery had been soft tissue procedures in 8 cases (25%), first metatarsal or phalangeal osteotomies in 19 cases (59...
January 12, 2018: Foot and Ankle Surgery: Official Journal of the European Society of Foot and Ankle Surgeons
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