Distal Chevron metatarsal osteotomy for bunionette

Nineteen distal chevron metatarsal osteotomy operations were performed in 13 patients with painful bunionette. The average duration of follow-up was 7.1 years. Mean forefoot score improved from 35.8 points to 73.9 points out of a possible 75 points. Intermetatarsal 4-5 angle, metatarsophalangeal 5 angle, and forefoot width improved significantly. Overall results were considered good in 17 feet and fair in 2; there were no failures. Complications were transfer metatarsalgia (1 foot) and wound infection (1 foot). Distal chevron fifth metatarsal osteotomy is effective treatment for symptomatic bunionette.

A retrospective analysis of distal Chevron and Basilar osteotomies of the first metatarsal for correction of intermetatarsal angles in the range of 13 to 16 degrees

A retrospective study was performed for Austin (Chevron) and basilar type osteotomies of the first metatarsal in patients with preoperative intermetatarsal angles in the range of 13 to 16 degrees. Results indicated better radiographic correction for both groups than in previous studies. When comparing the results for the Chevron and basilar groups, the radiographic results were almost identical, but the Chevron group appeared to have a slightly better subjective result with less complications of metatarsalgia and callus formation and a better range of motion. Comparing intermetatarsal angle correction as a function of the preoperative hallux adductus, no definitive conclusions were made. However, the trend appears to have reduced correction with higher hallux abductus angles.

[Fracture-dislocation of the tarso-metatarsal joint]

Tarsometatarsal fracture-dislocations are considered a rare entity. In fact, that kind of trauma is not easy to diagnose, and a lot of those cases are overlooked. We present here the conclusions of a review of the world literature available.

Freiberg's disease in diabetes mellitus

We evaluated a total of 13 cases of Freiberg's disease in patients aged 47-77 years collected over an 8-year period. Seven were associated with diabetes mellitus and one with chronic renal failure; the remainder had no underlying disease. Atrophy of intrinsic small foot muscles secondary to neuropathy, which is prevalent in diabetes mellitus, may play a part in the development of Freiberg's infraction.

[High arched forefoot--pes cavus metatarsus congenitus. A case report]

This is a rare congenital deformity. Because of it's typical aspect the name "pes cavus metatarsus congenitus" was given. Complete operative correction is easily done.

[Initial experience with the closed method of subcapital osteotomy of the 1st metatarsus in hallux valgus]

The authors summarize initial findings with Bösh's modification of Hohmann's subcapital osteotomy made by means of a cutter from a short dermal incision under X-ray control. The valgosity and rotation of the hallux are corrected by a lateral and possibly plantar shift and by derotation of the head of the metatarsus. The position of the head is ensured by supporting the medial exostosis by a wire inserted by the intramedullary route into the Ist metatarsus. The operation was performed in five female patients aged 37-60 years on nine feet. The results were evaluated after 10-13 months. For osteotomy conic cutters were used (diameter of base 2.1 mm and 5 mm) and a drill (3000 rotations per minute) from the small instrumentarium of SYNTHES Co. The Kirschner wire was removed after four weeks and fixation a with a plaster spica of the toe took, depending on healing, 7-12 weeks after operation. In all instances marked correction of the position of the toe occurred (reduction of the valgosity angle by 8-19 degrees). As to subjective evaluation, four patients evaluated the result as excellent, three as satisfactory, i.e. disappearance or marked reduction of complains and once as unsatisfactory with persisting pain and difficulties as regards footwear. After analysis of the first early results the authors recommend to indicate the operation in valgosity of the toe up to 35 degrees and minimal arthrosis, to perform the osteotomy in a strictly subcapital and extracapsular position and to reduce the period of fixation. The advantage of the method is that the metatarsophalangeal joint is not damaged, the operation is sparing, marked correction of the position of the toes is achieved, the time of operation is short and the scar is not visible.

[Fractures and luxations of the mid- and forefoot]

Fractures of the mid- and forefoot, as well as luxations of the Chopart and Lisfranc joints, have in the past often been treated conservatively if not with therapeutic nihilism. In light of the modern operative techniques and claims regarding anatomic and functional restitution, this management from should be reconsidered. Shortening and malposition can be corrected by internal fixation and joint surfaces are being reconstructed, thus restoring the load-bearing capacity of the plantar arch. Post-traumatic impairment can be completely or at least partially avoided by early specific measures. The present study describes fractures and luxations of the fore-foot distal to Chopart joint and the present state of treatment, including complications and risks arising from the treatment of these injuries.

The treatment of Köhler's second syndrome by continuous skeletal traction

Osteochondrosis of the head of the second metatarsal bone, also known as Köhler's second disease, is typical of the second decade of life. This disease is characterized by evident symptoms during its acute phase, successively resulting in permanent changes in the metatarsal head. The authors propose a new method which is easy to use and which leads to rapid resolution of the osteochondrosis as well as to a rapid resumption of normal life and sports activity.

[A case of osteopoikilosis]

On the basis of literature and own observation a very rare form is discussed of skeletal system anomaly--osteopoikilosis+ which is considered to be a genetically determined, benign skeletal dysplasia. It manifests itself with numerous spotty densities of bony structure situated usually near the joints of long bones. They may be erroneously regarded as malignant metastases. The reported case of osteopoikilosis+ conformis the hereditary character of the disease.

External fixation in multiply injured children

External fixation treatment for selected fractures can be as readily applied to children as to adults, although only a small percentage of pediatric fractures require this method. The best situations for the use of external fixation in children are in cases of multiple organ system injuries and in fractures associated with skin loss or large wounds. In these situations, while the child's other problems are being treated, external fixation provides excellent temporary stabilization to facilitate fracture management.

[The intraosseous ganglion. The differential diagnosis of pain in the forefoot]

The intraosseous ganglion is a rare benign cystic lesion of bone which is frequently located in close association with the articular cartilage of the distal metaphysis of long bones. In many cases, it is clinically silent but it may cause persistent pain. The commonest location is at the ankle. It appears radiographically as a well-demarcated circular or oval radiotranslucent defect surrounded by a thin margin of sclerotic bone. Treatment consists of curettage and bone grafting.

[Follow-up following Lelièvre's method of metatarsal head resection]

From 1975 to 1987 on 107 cases of severe deformities of the forefoot a resection of the metatarsal heads according to the method of Lelièvre was performed. As to the success of this method special features of this operation and especially the requirements of postoperative treatment will be explained. Possible complications of healing will be detailed. The procedure of resecting the heads of the metatarsal bones according to Lelièvre seems to be recommendable in order to prevent immovability, especially in case of advanced inflammable alterations of the joints in the forefoot.

Surgical treatment of metatarsus adductus using a combined soft tissue and osseous approach

Children between 6 and 8 years of age with metatarsus adductus deformity have been considered to be in the gray zone for surgical correction. Should osseous or soft tissue procedures be implemented to reduce the adducted attitude of the metatarsals? The literature clearly describes one or the other and the intermediary chondrotomy procedure described by Johnson. The use of a combined approach has not been presented. The present authors offer a brief review of metatarsus adductus, and two case reports using a modified, combined approach. Two 7-year-old girls presented with bilateral resistant metatarsus adductus deformities. The authors contend that the first and fifth metatarsals are the major deforming forces in this age group, and may be corrected with base wedge osteotomies, while the central three metatarsals are more amendable to capsular and ligamentous releases. Advantages of soft tissue procedures on the central rays include avoidance of extensive dissection, creating less trauma and avoidance of the need for internal fixation. The obvious disadvantage is the inability to adequately reduce the deformity. This can be assessed intraoperatively. These authors, therefore, conclude that this modified surgical approach is a viable alternative to the previously described procedures for resistant metatarsus adductus.

Freiberg's infraction of the second metatarsal head with formation of multiple loose bodies

Freiberg's infraction is an osteonecrotic disease process that most often involves the head of the second metatarsal. Establishing a diagnosis can be difficult early in the disease course, mimicking such pathologic processes as stress fracture, septic joint infection, tumors, metatarsalgia, various arthritic diseases, etc. A review of the literature reveals many treatment options and many theories of its etiology. The clinical signs and symptoms, review of the etiologies, radiographic presentation, and conservative and surgical treatments of this disease are presented. A case history and treatment summary of a patient afflicted with Freiberg's infarction involving the second metatarsophalangeal joint of the right foot is presented. Treatment consisted of evacuation of multiple loose bodies from the joint, resection arthroplasty of the diseased joint, and insertion of a total joint prosthesis.

Unicameral bone cyst of the first metatarsal

An unusual case of a unicameral bone cyst located in the head of the first metatarsal is presented with a review of the literature. This benign bone tumor is rarely found in the metatarsal bones. Pathologic, clinical, and radiographic findings, as well as a differential diagnosis will be discussed.

Freiberg disease complicating unrelated trauma

Freiberg's infraction is an avascular necrosis of the metatarsal head characterized by the development of disorderliness of chondrogenesis and osteogenesis in previously normal bone. Radiographic findings follow the pathological progression of bony changes. The presented cases document the development of avascular necrosis in a previously normal metatarsal that occurred after trauma or surgery elsewhere in the foot. It is suggested that infraction of the metatarsal head resulted from microfracture caused by abnormal stress.

A new method for radiography of weight-bearing metatarsal heads

A radiographic system has been developed that provides a standardized quantitative analysis of the forefoot. The patient stands fully weight-bearing on a horizontal plexiglass platform that is constructed to ensure reproducible placement between the cassette, patient, and beam. Measurements are made from the images of radiopaque rulers placed in line with the first metatarsophalangeal joint of each foot. The height of each metatarsal head can then be calculated based on measurements obtained on the radiograph. Graphs plotted from the data demonstrate the height of the metatarsal heads in a normal individual, changes in the height of the metatarsal heads with and without weight-bearing, before and after insole placement, and before and after metatarsal osteotomy. This information may be useful in obtaining a better understanding of abnormalities of the forefoot as related to bony anatomy and load distribution.