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Fletcher AN, Patel V, Cerrato R. Minimally Invasive Cheilectomy for Hallux Rigidus. Foot Ankle Clin 2024; 29:471-484. [PMID: 39068022 DOI: 10.1016/j.fcl.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/30/2024]
Abstract
Hallux metatarsophalangeal joint cheilectomy is a joint-sparing technique that involves resection of the dorsal metatarsal head osteophytes; this may be achieved through minimally invasive and arthroscopic techniques. General indications for minimally invasive surgery (MIS) cheilectomy are mild-to-moderate hallux rigidus (Grades I-II) with symptomatic dorsal osteophytes causing dorsal impingement and/or shoe wear irritation in those who have failed extensive nonoperative management. The literature confirms equivalent outcomes to open cheilectomy; however, it is somewhat inconsistent regarding superiority. The theoretic benefits of MIS cheilectomy include better cosmesis, reduced wound complications, less soft tissue disruption, and faster recovery.
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Affiliation(s)
- Amanda N Fletcher
- OrthoCarolina, 2001 Vail Avenue, Suite 200B, Charlotte, NC 28207-1222, USA.
| | - Vandan Patel
- Department of Orthopaedic Surgery, University of Michigan, 2098 S Main Street, Ann Arbor, MI 48103, USA
| | - Rebecca Cerrato
- Mercy Medical Center, Baltimore, The Institute for Foot and Ankle Reconstruction, 301 St Paul Place, Institute for Foot and Ankle Reconstruction At Mercy, Baltimore, MD 21202, USA
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Lewis TL, Lam P, Alkhalfan Y, Ray R. Minimally Invasive Surgery For Management of Bunionette Deformity (Tailor's Bunion) Using Fifth Metatarsal Osteotomies: A Systematic Review and Meta-Analysis. FOOT & ANKLE ORTHOPAEDICS 2024; 9:24730114241263095. [PMID: 39086382 PMCID: PMC11289809 DOI: 10.1177/24730114241263095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2024] Open
Abstract
Background There has been increasing interest in the use of percutaneous or minimally invasive osteotomy techniques for bunionette correction. The aim of this systematic review was to investigate the clinical and radiographic outcomes following percutaneous or minimally invasive surgery for bunionette deformity correction. Methods A systematic review following PRISMA guidelines was undertaken. All clinical studies published in MEDLINE, Embase, PubMed, and the Cochrane Library Database from inception until December 2023 reporting on the use of percutaneous or minimally invasive osteotomy techniques for bunionette deformity correction were included. The primary outcome was radiographic deformity correction. A meta-analysis of clinical and radiographic outcomes was performed to assess the mean difference following surgery. Risk of bias was assessed using the ROBINS-I tool. Results A total of 942 potential studies were identified, of which 18 were included encompassing 714 feet in 580 patients. There were no comparative studies identified. The majority of studies (n = 14/18) used an unfixed distal osteotomy technique. All studies showed a statistically significant improvement in clinical outcomes (American Orthopaedic Foot & Ankle Society ankle-hindfoot score and visual analog scale for pain) and radiologic outcomes (fourth-fifth intermetatarsal angle and fifth metatarsophalangeal angle). Complication rates ranged from 0% to 21.4%. The nonunion rate was 0% to 5.6%. Overall risk of bias was low to moderate. The most common complication was development of a hypertrophic callus that tended to resorb over time without needing further surgical intervention. Conclusion The results of this systematic review must be considered in light of the methodologic limitations of the studies analyzed-including additional procedures performed at the same time as the bunionette correction, lack of comparative studies, and heterogeneity of the case series included. Despite these limitations, our review suggests that percutaneous techniques for bunionette deformity correction are generally clinically safe and associated with improvement in radiographic alignment and patient-reported outcome measures.
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Affiliation(s)
- Thomas L. Lewis
- King’s Foot and Ankle Unit, King’s College NHS Foundation Trust, London, United Kingdom
| | - Peter Lam
- Orthopaedic and Arthritis Specialist Centre, Chatswood, Sydney, Australia
| | - Yousif Alkhalfan
- Guy’s and St Thomas’ NHS Foundation Trust, Maze Pond, London, United Kingdom
| | - Robbie Ray
- King’s Foot and Ankle Unit, King’s College NHS Foundation Trust, London, United Kingdom
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Carvalho P, Johnson H, Ferreira G, Santos J, Dalmau-Pastor M. Percutaneous distal bicortical proximal phalanx osteotomy for second toe deformities - A two-year prospective cohort study. Foot Ankle Surg 2024:S1268-7731(24)00124-3. [PMID: 38908924 DOI: 10.1016/j.fas.2024.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 06/11/2024] [Accepted: 06/12/2024] [Indexed: 06/24/2024]
Abstract
PURPOSE The main purpose of our study was to evaluate satisfaction, recurrence, bone union and other complications after a minimum of two years follow-up in patients who had percutaneous claw and hammer (CHT) second toe correction utilizing a novel distal and bicortical proximal phalanx osteotomy (DBPPO). METHODS A minimum two-year follow-up prospective cohort study was conducted on consecutive patients with symptomatic CHT deformities of the second toe corrected with percutaneous surgery. Primary outcomes included satisfaction, recurrence, bony union, and other complication rates specific to the second toe deformity correction. Secondary outcomes included Metatarsophalangeal-Interphalangeal AOFAS scale and Visual Analogue Scale (VAS). RESULTS Between January and October 2020, 34 patients (43 feet) were clinically and radiologically evaluated pre and postoperatively at a mean of 26.6 months. Thirty-eight feet (88.4 %) were satisfied or very satisfied with their second toe deformity correction and 41 feet (95.3 %) would undergo surgery on this toe again. No deformity recurrence requiring revision was found. There were two complications (4.7 %): one toe (2.3 %) with persistent numbness and one (2.3 %) had a simple infection that resolved with oral antibiotics. All 43 s toe osteotomies demonstrated bony consolidation. Stiffness was reported in nine second toes (20.9 %), seven of them (77.8 %) having a rigid pre-operative deformity. Secondary outcomes demonstrated significant improvement in the mean ( ± standard deviation) AOFAS score which increased from 47.5 ± 17.9 preoperatively to 95.7 ± 7.7 postoperatively (p < .001). Mean VAS significantly improved from 4.9 ± 2.5 preoperatively to 0.3 ± 1.3 postoperatively (p < .001). CONCLUSION Percutaneous treatment of claw and hammer second toe deformities utilizing a DBPPO resulted in high levels of satisfaction with bony consolidation, no recurrence and low complication rates at two years follow-up. LEVEL OF EVIDENCE Level II - Prospective cohort study.
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Affiliation(s)
- Paulo Carvalho
- Hospital da Ordem Terceira Chiado, Lisbon, Portugal; Hospital da Luz, Orthopedics, Setúbal, Portugal.
| | - Holly Johnson
- Hospital for Special Surgery, Orthopaedic Surgery, New York, USA.
| | - Gabriel Ferreira
- Hospital do Servidor Publico Estadual de Sao Paulo, Orthopedics, São Paulo, Brazil.
| | - João Santos
- Hospital do Espírito Santo de Évora EPE, Orthopedics, Évora, Portugal.
| | - Miki Dalmau-Pastor
- Hospital da Luz, Orthopedics, Setúbal, Portugal; Human Anatomy Unit, Department of Pathology and Experimental Therapeutics, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain.
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Li G, Zhang H, Wang X, Yang Y, Xu H, Hong J, Kong SW, Chan KB, Chong KW, Yan A, Shi Z, Ma X. Clinical guideline on the third generation minimally invasive surgery for hallux valgus. J Orthop Translat 2024; 45:48-55. [PMID: 38500804 PMCID: PMC10945049 DOI: 10.1016/j.jot.2023.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 10/27/2023] [Accepted: 10/30/2023] [Indexed: 03/20/2024] Open
Abstract
Minimally invasive surgery for hallux valgus correction, has been attracting great interests in the recent decades, due to the potential benefits of less pain, decreased recovery times, smaller scars with better cosmesis, and improved early post-operative range of motion. The most recent developments in minimally invasive surgery have evolved into the third generation with modifications of the chevron-type osteotomy. This evidence-based clinical guideline of the third generation minimally invasive surgery for hallux valgus is initiated and developed collectively by the Foot and Ankle Committee of Orthopedic Branch of Chinese Medical Doctor Association, Foot and Ankle Committee of Sports Medicine Branch of Chinese Medical Doctor Association, and Foot and Ankle Expert Committee of Orthopedic Branch of the Chinese Association of the Integrative Medicine. This clinical guideline provides recommendations for indications, contraindications, operative planning and techniques, post-operative management, management of complications, and prognosis of the third generation minimally invasive surgery for hallux valgus. The Translational Potential of this Article This comprehensive guideline aims to establish standardized recommendations for the indications, contraindications, operative techniques, and post-operative management of the third generation minimally invasive surgery for hallux valgus. By adhering to this guideline, the success rate of the procedure could be maximized. This comprehensive guideline serves as a valuable reference for practitioners interested in or preparing to perform minimally invasive surgery for hallux valgus.
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Affiliation(s)
- Guangyi Li
- Department of Orthopaedics, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- National Center for Orthopaedics, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hui Zhang
- Department of Orthopaedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Xu Wang
- Department of Orthopaedics, Huashan Hospital, Fudan University, Shanghai, China
| | - Yunfeng Yang
- Department of Orthopaedics, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Hailin Xu
- Department of Trauma and Orthopaedics, Peking University People's Hospital, Peking University, Beijing, China
| | - Jinsong Hong
- Department of Foot and Ankle Surgery, Guangzhou Orthopaedic Hospital, Guangdong, Guangzhou, China
| | | | | | | | - Alan Yan
- Sanford Health Orthopaedics & Sports Medicine, South Dakota, USA
- University of South Dakota School of Medicine, South Dakota, USA
| | - Zhongmin Shi
- Department of Orthopaedics, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- National Center for Orthopaedics, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xin Ma
- Department of Orthopaedics, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- National Center for Orthopaedics, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Foot and Ankle Committee of Orthopedic Branch of the Chinese Medical Doctor Association, Foot and Ankle Committee of Sports Medicine Branch of Chinese Medical Doctor Association, Foot and Ankle Expert Committee of the Chinese Association for Integrative Medicine
- Department of Orthopaedics, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- National Center for Orthopaedics, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Orthopaedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
- Department of Orthopaedics, Huashan Hospital, Fudan University, Shanghai, China
- Department of Orthopaedics, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
- Department of Trauma and Orthopaedics, Peking University People's Hospital, Peking University, Beijing, China
- Department of Foot and Ankle Surgery, Guangzhou Orthopaedic Hospital, Guangdong, Guangzhou, China
- Asia Medical Specialists, Hong Kong, China
- Virtus Medical Centre, Hong Kong, China
- BJIOS Orthopaedics, Singapore
- Sanford Health Orthopaedics & Sports Medicine, South Dakota, USA
- University of South Dakota School of Medicine, South Dakota, USA
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Mizher R, Rajan L, Kim J, Srikumar S, Cororaton A, Cody E, Ellis S, Johnson AH. Does the Presence of Asymptomatic Flatfoot Deformity Impact the Clinical and Radiographic Outcomes of the Minimally Invasive Chevron and Akin Bunionectomy? Foot Ankle Int 2024; 45:252-260. [PMID: 38281125 DOI: 10.1177/10711007231220553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2024]
Abstract
BACKGROUND Flatfoot deformity is believed to play a role in hallux valgus development and recurrence. While symptomatic flatfoot deformity can be treated with separate procedures at the time of hallux valgus correction, the question remains whether the patient undergoing correction of a symptomatic hallux valgus deformity should have their asymptomatic flatfoot concurrently addressed. We aimed to investigate whether the presence of asymptomatic flatfoot influences patient-reported and radiographic outcomes of the minimally invasive chevron and Akin bunionectomy. METHODS A total of 104 patients were included in this study. Forty-two asymptomatic patients met the radiographic criteria for flatfoot while 62 had a normal arch. Patient-reported outcomes were evaluated and compared between the two groups using validated PROMIS measures preoperatively and at a minimum one-year postoperatively. Radiographic outcomes including hallux valgus angle (HVA), intermetatarsal angle (IMA), Meary's angle, calcaneal pitch (CP), and talonavicular coverage angle (TNCA) were measured and compared preoperatively and minimum six-months postoperatively. RESULTS Both groups demonstrated similar preoperative and postoperative PROMIS scores with significant improvements in physical function, pain interference, pain intensity, and global physical health. Preoperatively, HVA was similar between both groups, however the flatfoot group showed a greater IMA, Meary's angle, TNCA, and lower CP. Postoperatively, HVA and IMA were similar between groups, although patients in the flatfoot group retained a significantly greater Meary's angle, TNCA, and lower CP. Both groups showed significant improvements in HVA, IMA, and TNCA. CONCLUSION Our study indicates that the minimally invasive chevron and Akin bunionectomy leads to improved clinical and radiographic hallux valgus outcomes without adversely impacting radiographic flatfoot parameters. Therefore, the MIS bunionectomy may be an effective option for hallux valgus correction in patients with mild, asymptomatic flatfoot. LEVEL OF EVIDENCE Level III, retrospective cohort.
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Affiliation(s)
- Rami Mizher
- Hospital for Special Surgery, New York, NY, USA
| | - Lavan Rajan
- Hospital for Special Surgery, New York, NY, USA
| | | | | | | | | | - Scott Ellis
- Hospital for Special Surgery, New York, NY, USA
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Gazit T, Robinson D, Khawalde K, Eisa M, Qassem K, Heller E, Yassin M. Foot Surgery Using Resorbable Magnesium Screws. J Foot Ankle Surg 2024; 63:79-84. [PMID: 37699499 DOI: 10.1053/j.jfas.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 05/04/2023] [Accepted: 09/04/2023] [Indexed: 09/14/2023]
Abstract
The use of bioabsorbable magnesium (Mg) screws is new in foot surgery. Their relative merit over conventional titanium screws has not yet been proven. This prospective case series study was conducted to compare the clinical and radiological outcomes of bioabsorbable Mg screws and titanium screws. A consecutive series of patients (n = 60; 11 men and 49 women) underwent corrective hallux valgus surgery. The minimum follow-up period was 1 year. The assessment was based on a patient questionnaire, including the American Orthopedic Foot and Ankle Society (AOFAS) hallux valgus score, visual analog scale, patient's global impression of change (PGIC), and fifth metatarsus circumference (IF5C). The radiographic assessment included the intermetatarsal and hallux valgus angles, as well as time to osteotomy union and hardware failure. At 1 year, similar results were obtained radiographically. The healing of the osteotomies was significantly faster in the Mg group. Hardware failure was common in the Mg group (5/26) than in the TI group (0/34) but hardware removal was more common in the TI group (6/34) versus the MG group (0/26). IF5C increased by 8 ± 2 mm in the Mg group. The AOFAS and PGIC scores at 6 months were similar. Validated foot scores and radiographic analysis indicated that there was no detectable difference between the groups. The fast achievement of osteotomy union compensates for a high rate of hardware failure, resulting in patient satisfaction and avoiding reoperation for hardware removal.
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Affiliation(s)
- Tomer Gazit
- Department of Orthopedic Surgery, Hasharon Hospital, Rabin Medical Center, affiliated with Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Dror Robinson
- Department of Orthopedic Surgery, Hasharon Hospital, Rabin Medical Center, affiliated with Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Kefah Khawalde
- Department of Orthopedic Surgery, Hasharon Hospital, Rabin Medical Center, affiliated with Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mohammed Eisa
- Department of Orthopedic Surgery, Hasharon Hospital, Rabin Medical Center, affiliated with Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Khaled Qassem
- Department of Orthopedic Surgery, Hasharon Hospital, Rabin Medical Center, affiliated with Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eyal Heller
- Department of Orthopedic Surgery, Hasharon Hospital, Rabin Medical Center, affiliated with Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mustafa Yassin
- Department of Orthopedic Surgery, Hasharon Hospital, Rabin Medical Center, affiliated with Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Zanchini F, Catani O, Sergio F, Boemio A, Sieczak A, Piscopo D, Risitano S, Colò G, Fusini F. Role of lateral soft tissues release in percutaneous hallux valgus correction: A medium term retrospective study. World J Orthop 2023; 14:843-852. [PMID: 38173806 PMCID: PMC10758593 DOI: 10.5312/wjo.v14.i12.843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 10/12/2023] [Accepted: 11/17/2023] [Indexed: 12/15/2023] Open
Abstract
BACKGROUND In the field of minimally invasive surgery (MIS) for the treatment of hallux valgus (HV), different techniques have begun to emerge in the literature concerning the distal osteotomy of the first metatarsal bone, the synthesis or not of the metatarsal head, the possible association with lateral soft tissues release (LSTR) and osteotomy of the base of the first phalanx. AIM To evaluate the role of LSTR on percutaneous HV correction, evaluating functional and radiographical results. METHODS From January 2012 to May 2016 a total of 396 patients with mild to moderate symptomatic HV treated with the MIS technique were included in this retrospective study. The technique provides no internal fixation (WOS). Patients were divided into the LSTR group and no LSTR group (LSTR N). This surgical procedure (LSTR) was reserved for insufficient HV angle (HVA) correction during fluoroscopic control. Patients were evaluated at each follow-up by two other authors after appropriate training by senior authors (first practitioners). Clinical evaluation was performed before surgery, 6 mo after surgery, and 48 mo follow-up. American Orthopaedic Foot and Ankle Society (AOFAS) and visual analog scale (VAS) score was used to evaluate pain and function, and complications were recorded. In addition, the incidence of relapses and the degree of joint range of motion (ROM) with the association with the LSTR (capsule, adductor tendon, phalanx-sesamoid ligament, and the deep transverse metatarsal ligament) were evaluated. Radiological parameters included HVA and intermetatarsal angle (IMA). Patient satisfaction was assessed. Student t-test and Fisher exact test were used to assess statistical analysis. RESULTS From our study it is clear that no differences in term of HVA, VAS, IMA correction, rate of complications, and AOFAS score were found between groups, while a significant improvement of the same variables was found in each group between pre and postoperative values. A significant improvement in ROM at 6 mo (P = 0.018) and 48 mo (P = 0.02) of follow-up was found in LSTR N group. Complications were rare in both groups. CONCLUSION LSTR procedure on percutaneous HV correction seems to increase postoperative joint stiffness with a comparable incidence of relapse and a low incidence of complications.
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Affiliation(s)
- Fabio Zanchini
- Division of Orthopaedics and Traumatology, Multidisciplinary Department of Medical-Surgical and Dental Specialties, Clinical Orthopeadics, University of Campania “Luigi Vanvitelli”, Naples 80138, Italy
| | - Ottorino Catani
- Department of Foot Surgery, Casa di cura Santa Maria, Santa Maria Capua Vetere 81055, Italy
| | - Fabrizio Sergio
- Department of Foot an Ankle Surgery, Casa di cura Santa Maria, Santa Maria Capua Vetere 81055, Italy
| | - Alessia Boemio
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, Clinical Orthopeadics, AOU Luigi Vanvitelli, Napoli 80138, Italy
| | - Angelo Sieczak
- Clinical Orthopeadics, University of Campania Luigi Vanvitelli, Naples 80138, Italy
| | - Davide Piscopo
- Clinical Orthopeadics, University of Campania Luigi Vanvitelli, Naples 80138, Italy
| | - Salvatore Risitano
- Department of Orthopaedic and Traumatology, Orthopaedic and Trauma Centre, Città della Salute e della Scienza di Torino, Turin 10126, Italy
| | - Gabriele Colò
- Department of Orthopaedics and Traumatology, Regional Center for Joint Arthroplasty, ASO Alessandria, Alessandria 15121, Italy
| | - Federico Fusini
- Department of Orthopaedic and Traumatology, Regina Montis Regalis Hospital, Cuneo 12084, Italy
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Di Nallo M, Lebecque J, Lucas Y Hernandez J, Laffenetre O. Percutaneous arthroscopically assisted cheilectomy combined to percutaneous proximal phalanx osteotomy in hallux rigidus: Clinical and radiological outcomes in 30 feet at a 48-month follow-up. Orthop Traumatol Surg Res 2023:103710. [PMID: 37865231 DOI: 10.1016/j.otsr.2023.103710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 02/10/2023] [Accepted: 08/25/2023] [Indexed: 10/23/2023]
Abstract
BACKGROUND Hallux rigidus is a degenerative condition affecting the middle age population. It affects patients by limiting their first metatarsophalangeal range of motion (ROM) and also, their shoe wear. The objective of our work was to present an original operative technique which preserves the native joint and improves pain with minimal complications. METHODS We conducted a retrospective multicenter cohort study of 28 patients (30 feet) suffering from moderate hallux rigidus, operated between October 2010 and October 2017 with at least 48months of follow-up. Clinical and radiological assessments included pre- and postoperative ROM, the American Orthopedic Foot and Ankle Society (AOFAS) score and forefoot radiological evaluation. No patients were lost to follow-up. RESULTS The mean AOFAS score increased from 59 (range, 51 to 67) preoperatively to 84 (range, 80 to 88) at final follow-up. A total of 37 patients (97%) were satisfied. From a ROM point of view, this remained relatively unchanged between preoperative and postoperative values. CONCLUSION The percutaneous arthroscopically assisted cheilectomy combined with a percutaneous proximal phalanx osteotomy, significantly improves pain in hallux rigidus with index minus in patients with Coughlin stage I and II after a mean of 4-year follow-up. LEVEL OF EVIDENCE IV.
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Affiliation(s)
| | - Johan Lebecque
- Orthopedic Department, Centre Hospitalier de Pau, Pau, France.
| | - Julien Lucas Y Hernandez
- Centre Médico-Universitaire du Pied, Hôpital Pellegrin, Centre Hospitalier Universitaire, Bordeaux, France.
| | - Olivier Laffenetre
- Institut de la Cheville et du Pied, 136 bis, rue Blomet, 75015 Paris, France.
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Li X, Zhang J, Fu S, Wang C, Yang F, Shi Z. First metatarsal single-screw minimally invasive chevron-akin osteotomy: A cost effective and clinically reliable technique. Front Surg 2023; 9:1047168. [PMID: 36684313 PMCID: PMC9849553 DOI: 10.3389/fsurg.2022.1047168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 12/12/2022] [Indexed: 01/06/2023] Open
Abstract
Purpose The common disease hallux valgus results in foot discomfort and dysfunction. Less soft tissue damage and faster wound healing have made minimally invasive surgery (MIS) more popular. However, little research has compared the fixation results of minimally invasive chevron-akin (MICA) osteotomy thus far. In this study, the clinical and radiographic results of MICA with first metatarsal single- or dual-screw fixation are being examined. Methods A total of 107 feet of 103 patients with mild to moderate symptomatic hallux valgus treated MICA from January 2018 to June 2020 were retrospective evaluated, with at least 12-months follow-up. 51 patients underwent single-screw fixation procedures and 52 patients received dual-screw fixation procedures. Patients were assessed preoperatively and at the final follow-up with radiographic measurements [hallux valgus angle (HVA), intermetatarsal angle (IMA) and distal metatarsal articular angle (DMAA)] and clinical scores (american orthopaedic foot and ankle society (AOFAS) forefoot score, visual analog scale (VAS) and Manchester-Oxford Foot Questionnaire (MOxFQ) scores). The coughlin satisfaction scores were also obtained. Results Both groups showed significantly improved HVA, IMA and DMAA at the final follow-up (P < 0.001). Regarding clinical outcomes, the AOFAS, VAS and MOxFQ in two categories also significantly improved postoperatively (P < 0.001). There was no obvious difference in the clinical and radiographic outcomes between the two groups (HVA, P = 0.833; IMA, P = 0.073; DMAA, P = 0.35; AOFAS, P = 0.48; VAS, P = 0.86; MOxFQ, P = 0.87). However, the single-screw fixation group showed significantly lower operation time and less number of intraoperative fluoroscopy (P < 0.001). No serious complications were observed in either group. The single-screw fixation technique saves at least $1,086 compared with the dual-screw group. Conclusion At the final follow-up, both the single- and dual-screw fixation groups had comparable good to excellent clinical and radiographic outcomes, as well as a similar incidence of complications. Additionally, the single-screw fixation group reduces overall surgical costs, number of intraoperative fluoroscopy and operational time.
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Affiliation(s)
| | | | | | | | - Fan Yang
- Correspondence: Fan Yang Zhongmin Shi
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10
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Harrasser N, Toepfer A. [Minimally invasive forefoot surgery: concept and techniques]. ORTHOPADIE (HEIDELBERG, GERMANY) 2023; 52:69-81. [PMID: 36547727 DOI: 10.1007/s00132-022-04334-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/05/2022] [Indexed: 12/24/2022]
Abstract
Minimally invasive surgery (MIS) has advanced to an established approach in the correction of all deformities of the forefoot. For the first ray the minimally invasive chevron and Akin osteotomy (MICA) shows very good clinical results and provides a broad spectrum of indications in comparison to the classical chevron osteotomy. The minimally invasive treatment of hallux rigidus also seems to achieve comparable results to the open techniques, although the surgical indications must be thoroughly evaluated. Lesser toe deformities are often easier to treat with minimally invasive osteotomy, capsule release and tendon lengthening than with complex open procedures and usually do not require any internal fixation material. Compared to the classical Weil osteotomy, distal metatarsal osteotomy shows a reduced rate of cock-up deformities and does not require internal fixation. In relation to open procedures, minimally invasive approaches should be accepted as a valuable addition and alternative to the classical open techniques due to the reduced rate of wound healing disorders and postoperative pain.
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Affiliation(s)
- N Harrasser
- Klinik und Poliklinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland. .,ECOM Excellent Center of Medicine, Arabellastr. 17, 81925, München, Deutschland.
| | - A Toepfer
- Klinik für Orthopädische Chirurgie und Traumatologie des Bewegungsapparates, Kantonsspital St. Gallen, Rohrschacher Str. 95, 9007, St. Gallen, Schweiz
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Harrasser N, Hinterwimmer F, Baumbach SF, Pfahl K, Glowalla C, Walther M, Hörterer H. The distal metatarsal screw is not always necessary in third-generation MICA: a case-control study. Arch Orthop Trauma Surg 2022:10.1007/s00402-022-04740-7. [PMID: 36577799 PMCID: PMC10374712 DOI: 10.1007/s00402-022-04740-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 12/15/2022] [Indexed: 12/29/2022]
Abstract
INTRODUCTION To evaluate the clinical and radiological results after fixation of the first metatarsal head (MTH) with one or two screws as part of the third-generation minimally invasive Chevron-Akin osteotomy (MICA) for hallux valgus deformities. MATERIALS AND METHODS Between August 2020 and November 2021, 55 MICA procedures (50 patients, male:female = 7:43), 22 with two (MICA2), 33 with one screw (MICA1) were performed for mild to severe hallux valgus deformities. Exclusion criteria were a concomitant pes adductus (Sgarlato angle > 20°) or hindfoot/midfoot deformities requiring treatment. In 27 cases, additional procedures on the forefoot (small toe corrections or metatarsal osteotomies II-V) were necessary. Pre- and post-operatively, hallux valgus angle (HVA) and intermetatarsal I/II angle (IMA) were measured. Clinically, subjective satisfaction, range of motion (ROM) of the first metatarsophalangeal joint (MTPJ), and pain level (NRS score) were evaluated. The minimum follow-up was 12 months. RESULTS Displacement of MTH was 70-90% on average, all osteotomies showed full consolidation at latest follow-up. In one case of either group, a slight subsidence of MTH was documented. The radiological and clinical parameters showed no differences between the groups. The pain level improved by an average of three points. The mobility of the MTPJ showed a slight reduction in nine cases after three months (4 MICA2, 5 MICA1) which persisted in three cases. Fifty-two of 55 patients (95%) would opt again for the operation. CONCLUSIONS Fixation of the first MTH with a single bicortical screw in MICA with moderate lateralization of MTH shows stable anchoring and good clinical results. The routine use of a second metatarsal screw can be omitted.
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Affiliation(s)
- Norbert Harrasser
- Clinic of Orthopaedics, Klinikum rechts der Isar, Technical University Munich, Ismaningerstr. 22, 81675, Munich, Germany.
| | - F Hinterwimmer
- Clinic of Orthopaedics, Klinikum rechts der Isar, Technical University Munich, Ismaningerstr. 22, 81675, Munich, Germany
| | - S F Baumbach
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - K Pfahl
- FIFA Medical Centre, Center for Foot and Ankle Surgery, Schön Clinic Munich Harlaching, Harlachinger Straße 51, 81547, Munich, Germany
| | - C Glowalla
- Clinic of Orthopaedics, Klinikum rechts der Isar, Technical University Munich, Ismaningerstr. 22, 81675, Munich, Germany
| | - M Walther
- FIFA Medical Centre, Center for Foot and Ankle Surgery, Schön Clinic Munich Harlaching, Harlachinger Straße 51, 81547, Munich, Germany
| | - H Hörterer
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
- FIFA Medical Centre, Center for Foot and Ankle Surgery, Schön Clinic Munich Harlaching, Harlachinger Straße 51, 81547, Munich, Germany
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12
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Ramírez-Andrés L, Nieto-García E, Nieto-González E, López-Ejeda N, Ferrer-Torregrosa J. Effectiveness of minimally invasive surgery using incomplete phalangeal osteotomy for symptomatic curly toe of adults with a trapezoidal phalanx: An observational study. Front Surg 2022; 9:965238. [PMID: 36204340 PMCID: PMC9530244 DOI: 10.3389/fsurg.2022.965238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 08/29/2022] [Indexed: 11/13/2022] Open
Abstract
Background and aims Digital deformity in flexion, varismus (external rotation), and adduction with the toe in both supraduction and infraduction are called clinocampodactyly or curly toe. All adult patients with symptoms and a diagnosis of semirigid/rigid curly toes underwent radiological examination to verify the presence of a trapezoidal phalanx. The purpose of this study was to quantitatively determine the degrees of improvement of a dysmetric phalanx after incomplete phalangeal osteotomy using minimally invasive surgery. The points of improvement were determined using the American Orthopedic Foot and Ankle Society (AOFAS) scale score. Methods Between May 2021 and June 2022, 30 patients diagnosed with curly toes underwent unicortical osteotomy of the affected phalanx. The convergence angle was measured and the AOFAS scale scores were compared. Results A total of 33 toes underwent surgery. The average reduction of the convergence angle was 9°. The average improvement in the AOFAS scale score was 53 points at 6 months and reached almost 90 points (89.9 ± 6.1 points). Conclusions Incomplete phalangeal osteotomy performed with minimally invasive surgery of the trapezoidal phalanges of curly toes of adults can improve alignment and AOFAS scale scores.
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Affiliation(s)
- Leonor Ramírez-Andrés
- Doctorate School, Valencia Catholic University “San Vicente Mártir,”Valencia, Spain
- Podiatry Department, Faculty of Medicine and Health Sciences, Valencia Catholic University “San Vicente Mártir,”Valencia, Spain
| | - Eduardo Nieto-García
- Podiatry Department, Faculty of Medicine and Health Sciences, Valencia Catholic University “San Vicente Mártir,”Valencia, Spain
| | - Elena Nieto-González
- Podiatry Department, Faculty of Medicine and Health Sciences, Valencia Catholic University “San Vicente Mártir,”Valencia, Spain
| | - Noemí López-Ejeda
- Unit of Physical Anthropology, Department of Biodiversity, Ecology and Evolution, Faculty of Biological Sciences, Complutense University of Madrid, Madrid, Spain
| | - Javier Ferrer-Torregrosa
- Podiatry Department, Faculty of Medicine and Health Sciences, Valencia Catholic University “San Vicente Mártir,”Valencia, Spain
- Correspondence: Javier Ferrer Torregrosa
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13
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Zhao JZ, Kaiser PB, DeGruccio C, Farina EM, Miller CP. Quality of MIS vs Open Joint Preparations of the Foot and Ankle. Foot Ankle Int 2022; 43:948-956. [PMID: 35382603 DOI: 10.1177/10711007221081865] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Minimally invasive surgery (MIS) is growing in the field of foot and ankle, and the MIS burr is an emerging tool. Although commonly used to perform osteotomies, the burr can also be used for arthrodesis joint preparation that traditionally would be performed through open incisions. To date, there is no study comparing the quality of joint preparation between using a fluoroscopy-guided MIS technique compared to traditional open techniques. The goal of this cadaveric study is to compare the percentage of joint surfaces prepared between MIS and open techniques for the most common joints that are fused in foot and ankle surgery. METHODS Open joint preparation was performed under direct visualization with open incisions. MIS joint preparation was performed percutaneously using fluoroscopic guidance alone, without arthroscopy. After joint preparation, cadaveric samples were disarticulated, and joint surfaces were analyzed for percentage of cartilaginous surface removed. The percentage of joint surface prepared was compared between the open and MIS techniques. RESULTS Ten cadaveric samples were used for the MIS technique and 5 samples for the open technique. Percentage of joint surface prepared was similar for all joint surfaces. CONCLUSION The MIS technique in the hands of experienced surgeons was found to provide overall similar percentages of surface area prepared compared to traditional open techniques. CLINICAL RELEVANCE MIS joint preparation may be useful for specific patient populations. This study suggests that MIS joint preparation is a reasonable, and possibly advantageous, alternative to open preparation in arthrodesis surgery when performed by experienced MIS surgeons.
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Affiliation(s)
- John Z Zhao
- Harvard Combined Orthopaedic Residency Program, Boston, MA, USA
| | - Philip B Kaiser
- Division of Foot and Ankle Surgery, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Christina DeGruccio
- Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Evan M Farina
- Harvard Combined Orthopaedic Residency Program, Boston, MA, USA
| | - Christopher P Miller
- Division of Foot and Ankle Surgery, Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
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14
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Gutteck N, Ulbricht M, Delank KS, Kielstein H, Schilde S. Minimally invasive hallux valgus correction with Internal Hallux Fixator® - A comparative cadaver study. Foot Ankle Surg 2022; 28:378-383. [PMID: 34275760 DOI: 10.1016/j.fas.2021.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 04/10/2021] [Accepted: 05/08/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND The Internal Hallux Fixator® (IHF®; Waldemar Link, Hamburg, Germany) was designed for open surgical hallux valgus correction. It allows a defined lateralisation of the first metatarsal head after V-shaped, Chevron-like distal metatarsal osteotomy in order to correct mild to middle hallux valgus deformities. The intramedullary fixation provides dynamic compression of the osteotomy and thus postoperative full weight bearing mobilization is an integral part of the therapy. This comparative cadaver model study investigates the feasibility of implanting the device using a minimally invasive technique and compares its capability of first metatarsal head lateralisation to the established 3rd generation MICA (Minimally Invasive Chevron and Akin osteotomy) technique. METHODS 16 fresh frozen cadaveric feet (8 left, 8 right) of 8 body donors received either MICA (Group 1), or an IHF® in a minimally invasive technique (Group 2). The achievable first metatarsal head lateralisation and operating time were measured and pitfalls recorded. RESULTS This cadaver model study confirmed, the minimally invasive implantation of the Internal Hallux Fixator® can be performed reliably via 10 mm mini incision with V-shaped distal metatarsal osteotomy. The mean first metatarsal head lateralisation was comparable between the groups with no statistically significant difference (7.2 (±1.9) mm in G1, or 8.3 (±0.8) mm in G2; p = 0.09). The IHF® was inserted and fixed in mean 3.7 (±0.6) min, whereas double screw fixation needed 10 (±3.7) min. LEVEL OF CLINICAL EVIDENCE 5, Cadaver model study.
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Affiliation(s)
- Natalia Gutteck
- Department of Orthopaedics and Traumatology, Martin Luther University Halle Wittenberg, Ernst-Grube-Strasse 40, 06120 Halle (Saale), Germany.
| | - Melina Ulbricht
- Department of Orthopaedics and Traumatology, Martin Luther University Halle Wittenberg, Ernst-Grube-Strasse 40, 06120 Halle (Saale), Germany
| | - Karl-Stefan Delank
- Department of Orthopaedics and Traumatology, Martin Luther University Halle Wittenberg, Ernst-Grube-Strasse 40, 06120 Halle (Saale), Germany
| | - Heike Kielstein
- Institute of Anatomy and Cell Biology, Martin-Luther University Halle-Wittenberg, Große Steinstraße 52, 06108 Halle (Saale), Germany
| | - Sebastian Schilde
- Department of Orthopaedics and Traumatology, Martin Luther University Halle Wittenberg, Ernst-Grube-Strasse 40, 06120 Halle (Saale), Germany
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15
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Patnaik S, Jones NJ, Dojode C, Narang A, Lal M, Iliopoulos E, Chougule S. Minimally invasive hallux valgus correction: Is it better than open surgery? Foot (Edinb) 2022; 50:101871. [PMID: 35219131 DOI: 10.1016/j.foot.2021.101871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 07/19/2021] [Accepted: 10/13/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND The aim was to compare the minimally invasive (MIS) chevron osteotomy to the well-established open chevron osteotomy for the correction of hallux valgus deformity. METHODS Two retrospective cohorts of patients treated with MIS or open chevron osteotomy for hallux valgus correction, matched for age and gender with a minimum follow up of six months were reviewed. Functional outcomes were evaluated using pre and post-operative Manchester Oxford Foot and Ankle Questionnaire (MOXFQ), Visual Analog Score (VAS) for pain and the Unified Elective Orthopaedic Score (UnEOS). Two independent, blinded examiners evaluated the radiographic correction of hallux valgus (HV) and intermetatarsal (IM) angle. RESULTS A Total of 54 cases (27 per study group) with a mean follow-up of 25.9 months were included in the study. Pre-operatively, VAS (p = 0.76) and MOXFQ (p = 0.46) scores and HV angle (p = 0.1) were comparable in both groups. However, IM angle was significantly larger in the MIS group (p = 0.005). Post-operatively there was significant improvement in VAS and MOXFQ scores as well as significant correction of the HV and IM angles (p < 0.0001) for both groups. Comparing the two procedures, there was no significant difference between groups for VAS (p = 0.34), MOXFQ scores (p = 0.56) and HV angles (p = 0.069) but the MIS technique was significantly better in improving the IM angle (p = 0.016). The post-operative UnEOS score and the Satisfaction UnEOS domain reached excellent levels for the entire cohort with no statistical difference between the two groups (p = 0.2 and 0.28 respectively). CONCLUSION Results show MIS chevron osteotomy provides better radiographic correction of the IM angle but functional outcomes for all parameters were comparable to the open technique. It can therefore be considered at least equivalent to standard open surgery when compared using validated Patient Reported Outcome Measures (PROMs).
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Affiliation(s)
- Surendra Patnaik
- East Surrey Hospital, Canada Avenue, Redhill, RH1 5RH, United Kingdom.
| | - Neil John Jones
- East Surrey Hospital, Canada Avenue, Redhill, RH1 5RH, United Kingdom.
| | - Chetan Dojode
- East Surrey Hospital, Canada Avenue, Redhill, RH1 5RH, United Kingdom.
| | - Ashish Narang
- East Surrey Hospital, Canada Avenue, Redhill, RH1 5RH, United Kingdom.
| | - Mohan Lal
- East Surrey Hospital, Canada Avenue, Redhill, RH1 5RH, United Kingdom.
| | - Efthymios Iliopoulos
- Royal Sussex County Hospital, Barry Building, Eastern Road, Brighton, BN2 5BE, United Kingdom.
| | - Sanjay Chougule
- East Surrey Hospital, Canada Avenue, Redhill, RH1 5RH, United Kingdom.
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16
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Toepfer A, Strässle M. 3rd generation MICA with the "K-wires-first technique" - a step-by-step instruction and preliminary results. BMC Musculoskelet Disord 2022; 23:66. [PMID: 35042485 PMCID: PMC8767719 DOI: 10.1186/s12891-021-04972-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 11/29/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Minimally-invasive techniques for hallux valgus correction are becoming increasingly popular. In the last decades, multiple techniques for minimally-invasive hallux valgus correction have been described. MICA (Minimally-invasive Chevron & Akin), representing the 3rd generation of minimally-invasive hallux valgus correction, combines the advantages of an extraarticular osteotomy, stable internal fixation, and high potential for correction. This report aims to provide a step-by-step instruction of the surgical technique with the "K-wires-first" MICA modification, illustrated by detailed imaging of both intraoperative fluoroscopy and clinical imaging as well as corresponding sawbone models for each step. Preliminary results including radiological outcome and complications of the first 50 cases will be discussed. METHODS Between May 2018 and May 2021, 50 consecutive MICAs in 47 patients were performed with the K-wires-first technique. There were 40 women and 7 men with an average of 57.4y (range 25-78). The mean preoperative IMA was 16.2° (range 11.0-21.5), the HVA 30.6° (range 21.8-42.1). RESULTS There was one intraoperative conversion to an open surgical bunion correction corresponding to a 2% conversion rate respectively (1/50). On 3 feet (2 patients), removal of the Chevron screws was performed after 7, 9, and 12 months due to prominent and disturbing screw heads at the level of the medial cortex, accounting for a revision rate of 6% (3/50). There were no other secondary revision surgeries. The IMA decreased after MICA by a mean of 10.8° from 16.2° to 5.4° and the HVA by a mean of 22.1° from 30.6° to 8.5°, demonstrating MICA's high potential for correction. CONCLUSIONS Compared to other MICA techniques, the K-wires-first modification helps to reduce hardware malpositioning and the risk of conversion to open surgery. Furthermore, our preliminary results demonstrate a high potential for correction even for severe hallux deformities. TRIAL REGISTRATION Retrospectively registered, swissethics BASEC-ID 2021-01537, July 16th, 2021 ( www.raps.swissethics.ch ).
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Affiliation(s)
- Andreas Toepfer
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital St. Gallen, CH-9007, St. Gallen, Switzerland.
| | - Michael Strässle
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital St. Gallen, CH-9007, St. Gallen, Switzerland
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17
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Mikhail CM, Markowitz J, Di Lenarda L, Guzman J, Vulcano E. Clinical and Radiographic Outcomes of Percutaneous Chevron-Akin Osteotomies for the Correction of Hallux Valgus Deformity. Foot Ankle Int 2022; 43:32-41. [PMID: 34293943 DOI: 10.1177/10711007211031218] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Hallux valgus is a common cause of pain and dysfunction of the foot, sometimes requiring surgical correction when conservative measures fail. Although there are many methods of correction, one of the newer techniques is minimally invasive chevron-Akin (MICA). The aim of the current study is to evaluate clinical and radiographic effectiveness of MICA and narcotic use in a large patient cohort. METHODS All patients in this retrospective study were treated by a single fellowship-trained foot and ankle orthopaedic surgeon. Patient demographics were collected for all cases. Preoperative and postoperative intermetatarsal angle (IMA) and hallux valgus angle (HVA) were measured in all patients on weightbearing 3-views radiographs. The Foot Function Index (FFI) was obtained pre- and postoperatively at each visit. All patients were prescribed regular use of ibuprofen for 3 days with acetaminophen and oxycodone reserved for breakthrough pain. Use of narcotic pain medication was recorded. RESULTS A total of 274 feet in 248 patients were included in the study. Overall, 87.9% were female and 12.1% were male. The mean preoperative IMA and HVA were 13.4 and 29.1 degrees, respectively. The postoperative IMA and HVA were 4.9 and 8.9 degrees, respectively. The mean FFI score part A was 92 preoperatively and 43 postoperatively. Patient satisfaction was 91.6%. The mean postoperative 5 mg oxycodone pill consumption was 2.2. CONCLUSION MICA is good method to correct hallux valgus deformity with low postoperative narcotic use. LEVEL OF EVIDENCE Level III, restrospective cohort study of a single surgeon practice.
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Affiliation(s)
- Christopher M Mikhail
- Department of Orthopedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jonathan Markowitz
- Department of Orthopedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Luca Di Lenarda
- Department of Orthopedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Javier Guzman
- Department of Orthopedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ettore Vulcano
- Department of Orthopedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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18
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Naranjo-Ruiz C, Martínez-Nova A, Canel-Pérez MDLÁ, López-Vigil M, Ferrer-Torregrosa J, Barrios C. Influence of Foot Type on the Clinical Outcome of Minimally Invasive Surgery for Metatarsalgia. A Prospective Pilot Study. Front Surg 2021; 8:748330. [PMID: 34621784 PMCID: PMC8490922 DOI: 10.3389/fsurg.2021.748330] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 08/24/2021] [Indexed: 11/30/2022] Open
Abstract
Background and aims: Surgical procedures for central metatarsalgia seek to harmonise the metatarsal parabola with osteotomies that can be performed by minimally invasive techniques. However, the possible relationship of the foot type and the mid-term postoperative outcome is poorly described. The objective of this prospective pilot study was therefore to determine whether the foot type (pronate, neutral, or supinate) conditions the postoperative mid-term functional outcome. Methods: A series of 28 patients (6 men, 22 women) were treated for primary central metatarsalgia by means of minimally invasive distal metaphyseal osteotomy (DMMO). Results: Their functional outcomes at 6 and 12 months were assessed by the self-reporting AOFAS scale. Pre-surgery, the patients' scores were 42.82 ± 15.60. Scores improved at 6 months to 86.50 ± 8.6 and to 92.93 ± 8.6 at 12 months (p < 0.001 in both cases). There were no differences either by sex or by foot type in these overall values, although there was only a slight limitation of interphalangeal mobility in the supinated feet (p = 0.03) at 6-month follow-up as compared to other foot types. Conclusion: Hence, DMMO provides an optimal clinical and functional outcome for the surgical treatment of metatarsalgia, regardless of the patient's foot posture. The occurrence of adverse events was minimal and clinically irrelevant. Trial registration: The study was authorised by the Research Ethics Committee of the Universidad Católica de Valencia San Vicente Mártir, with the registry UCV/2018-2019/019.
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Affiliation(s)
- Carmen Naranjo-Ruiz
- Doctorate School, Catholic University of Valencia "San Vicente Mártir", Valencia, Spain.,Podiatry Department, Catholic University of Valencia "San Vicente Mártir", Valencia, Spain
| | - Alfonso Martínez-Nova
- Nursing Department, Podiatric Clinic of the University of Extremadura, Plasencia, Spain
| | | | | | | | - Carlos Barrios
- Institute for Research on Musculoskeletal Disorders, Catholic University of Valencia "San Vicente Mártir", Valencia, Spain
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Michels F, Demeulenaere B, Cordier G. Consensus in percutaneous bunionette correction. Orthop Traumatol Surg Res 2021; 107:102642. [PMID: 33187868 DOI: 10.1016/j.otsr.2020.03.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 03/08/2020] [Accepted: 03/25/2020] [Indexed: 02/03/2023]
Abstract
PURPOSE The percutaneous treatment of bunionette deformity has been demonstrated as a reliable and satisfying technique with low risk of complications. However, there are some obvious variations in the surgical technique and perioperative protocol. The purpose of this study is to analyze the currently used techniques and to look for some agreements. HYPOTHESIS There are some points of agreement in surgical technique and perioperative protocol when using a percutaneous technique to treat bunionette deformity. METHODS A survey was sent to 50 orthopedic surgeons with specific experience in percutaneous techniques. The questions were related to different aspects of the surgical bunionette procedure and the perioperative protocol. RESULTS A response rate of 92.0% was obtained. Several points of agreement were found. A condylectomy is rarely used while an osteotomy is performed in almost all procedures. This osteotomy is single (95.7%), complete (66.2-72.7%) and performed with a Shannon long burr (73.9%). The location of the osteotomy depends of the deformity (63.0%). DISCUSSION This study demonstrates some consensus in the use of the surgical technique and the perioperative protocol. The percutaneous oblique osteotomy is the preferred technique while a condylectomy is only rarely used. LEVEL OF EVIDENCE V, Survey study.
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Affiliation(s)
- Frederick Michels
- Orthopaedic Department, AZ Groeninge, 8500 Kortrijk, Belgium; MIFAS by GRECMIP (Minimally Invasive Foot and Ankle Society), Mérignac, France.
| | - Blandine Demeulenaere
- Clinique Blomet, institut de la cheville et du pied, 136, bis rue Blomet, 75005 Paris, France; MIFAS by GRECMIP (Minimally Invasive Foot and Ankle Society), Mérignac, France
| | - Guillaume Cordier
- Orthopaedic Department, Mérignac sports clinic, 2, rue Georges-Negrevergne, 33700 Mérignac, France; MIFAS by GRECMIP (Minimally Invasive Foot and Ankle Society), Mérignac, France
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Kurashige T. Percutaneous Bunionette Correction Without Fixation: Clinical Results and Radiographic Evaluations Including Rotation of Metatarsal Head and Sagittal Angle Change of Fifth Metatarsal. J Foot Ankle Surg 2021; 60:1079-1087. [PMID: 34140201 DOI: 10.1053/j.jfas.2021.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 04/28/2021] [Accepted: 05/05/2021] [Indexed: 02/03/2023]
Abstract
Bunionette deformities have been treated as an analog of hallux valgus, and the surgical techniques are similar. Most commonly anteroposterior image is evaluated pre- and postoperatively. To our knowledge, only one study has evaluated changes on the lateral radiograph and no study has evaluated changes in rotation of the fifth metatarsal head postoperatively. In percutaneous bunionette correction using a burr for osteotomy, shortening of the fifth metatarsal and elevation of the metatarsal head are inevitable. Without fixation, there is also a possibility of rotational change to the metatarsal head. We measured parameters on anteroposterior and lateral weightbearing radiographs in 18 feet pre- and postoperatively. Rotation of the fifth metatarsal head was graded according to the medial tubercle location. We also evaluated angular change of the fifth metatarsal on weightbearing lateral radiographs. Percutaneous bunionette correction without fixation could achieve satisfactory clinical and radiographic results, with less complication, when compared with previously published outcomes of open and percutaneous surgery with fixation. In this surgical method, bunionette is corrected in 3 dimensions. To our knowledge, this is the first study to evaluate rotation of the metatarsal head and change in the sagittal angle of the fifth metatarsal after bunionette correction.
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Affiliation(s)
- Toshinori Kurashige
- Department of Orthopaedic Surgery, Chiba Aiyukai Memorial Hospital, Nagareyama City, Chiba, Japan.
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21
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Neufeld SK, Dean D, Hussaini S. Outcomes and Surgical Strategies of Minimally Invasive Chevron/Akin Procedures. Foot Ankle Int 2021; 42:676-688. [PMID: 33501844 DOI: 10.1177/1071100720982967] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Minimally invasive surgery (MIS) is increasingly being used for bunion correction, but limited patient outcome data have been reported for third-generation minimally invasive chevron/Akin (MICA) techniques. The aim of this study was to report on radiographic outcomes, pain control, satisfaction, learning curve, and complication rates in a consecutive series of 94 patients undergoing MICA procedures for hallux valgus. It also describes strategies for avoiding perioperative complications that may arise with MIS bunionectomies. METHODS The treating surgeon's first 94 MICA procedures were included in the study. Radiographs were reviewed to measure pre- and postoperative intermetatarsal angles (IMAs), hallux valgus angles (HVAs), and soft tissue/bony foot width. Outcome measures, including visual analog scale (VAS) scores and Coughlin satisfaction scores, were obtained. Complication rates were retrospectively assessed though chart review. Statistical analysis was performed using Student t test for continuous variables and χ2 test for categorical variables. Average patient follow-up was 11.2 months. RESULTS VAS scores dropped 1 week postoperatively, from 5.2 preoperatively to 2.4 (P < .001). IMA improved from 12.6 degrees to 5.7 degrees at final follow-up (P < .001), while HVA improved from 26.8 degrees to 10.3 degrees (P < .001). Bony foot width improved from 92.4 mm to 87.2 mm (P < .001), and soft tissue foot width improved from 104.1 mm to 100.1 mm (P < .001). The reoperation rate was 5%, including 3 hardware removals, 1 irrigation and debridement, and 1 neurolysis. Ninety-four percent of patients reported good or excellent satisfaction with the procedure. Complication rates and patient satisfaction scores were similar between the first and second half of patients (P > .05), suggesting the learning curve was not a factor. CONCLUSION In our experience, the MICA osteotomy was a safe and reproducible technique, associated with rapid improvement in pain scores, early weightbearing, significant deformity correction, high patient satisfaction, and low frequency of complications. In addition, the learning curve for the procedure was not as steep as previously reported. LEVEL OF EVIDENCE Level III, retrospective comparative series.
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Affiliation(s)
| | - Daniel Dean
- MedStar Georgetown University Hospital, Washington, D.C., USA
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Beldame J, Lalevée M, Regnard S, Marguet F, Csanyi-Bastien M, Masse M, Duparc F. Impact of intertendinous connections between the flexor digitorum brevis and longus on percutaneous tenotomy for the treatment of claw toes: an anatomic and ultrasound study. Surg Radiol Anat 2021; 43:1067-1073. [PMID: 33661354 DOI: 10.1007/s00276-021-02723-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 02/20/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE Selective percutaneous tenotomy of the flexor digitorum longus (FDL) is a treatment for claw toes that gives astonishingly good functional results despite tendon sacrifice. However, the involution of the FDL tendon stump after tenotomy is unknown. The aim of our study was to assess the involution of the tendon stump after selective percutaneous tenotomy of the FDL. METHODS The study included two parts. In the clinical part, an ultrasound analysis of 15 FDL tenotomies in 7 patients was carried out 3 months post-surgery. In the anatomic part, the feet of 10 bodies donated to science were dissected and examined anatomically. RESULTS The proximal stump of the FDL was located near the base of the proximal phalanx and moved synchronously with the flexor digitorum brevis (FDB).Separating the FDB and FDL revealed a large tissue connection between the plantar surface of the tendinous chiasm of the FDB and the dorsal part of the FDL. These connections had significant resistance ranging from 2 to 9 Newtons depending on the toe. Tenotomy of the FDL followed by proximal traction of it led to retraction of the stump up to the base of the proximal phalanx and transfer of its action to the FDB by tensioning the intertendinous structure. Histologically, these structures were mostly comprised of tendon connective tissue. Their vascular component was small. CONCLUSION The presence of this intertendinous connection leads, in the case of isolated tenotomy of the FDL, to equivalent transfer of the latter to the FDB.
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Affiliation(s)
- Julien Beldame
- Institut Clinique du Pied-Paris, Ramsay Santé, Clinique Blomet, 136 rue Blomet, 75015, Paris, France.
| | - Matthieu Lalevée
- Department of Orthopaedic Surgery, Rouen University Hospital, 37 Boulevard Gambetta, 76000, Rouen, France
| | - Sixtine Regnard
- Department of Orthopaedic Surgery, Rouen University Hospital, 37 Boulevard Gambetta, 76000, Rouen, France
| | - Florent Marguet
- Department of Orthopaedic Surgery, Rouen University Hospital, 37 Boulevard Gambetta, 76000, Rouen, France
| | - Marie Csanyi-Bastien
- Department of Orthopaedic Surgery, Rouen University Hospital, 37 Boulevard Gambetta, 76000, Rouen, France
| | - Marion Masse
- Clinique Mégival, Vivalto santé, 1328 Avenue Maison-Blanche, 76550, Saints Aubin sur Scie, France
| | - Fabrice Duparc
- Department of Orthopaedic Surgery, Rouen University Hospital, 37 Boulevard Gambetta, 76000, Rouen, France
- Laboratory of Anatomy, Faculty of Medicine-Pharmacy, Rouen Normandy University, 22 boulevard Gambetta, 76183, Rouen, France
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McGann M, Langan TM, Brandão RA, Berlet G, Prissel M. Structures at Risk During Percutaneous Extra-Articular Chevron Osteotomy of the Distal First Metatarsal. Foot Ankle Spec 2021; 14:19-24. [PMID: 31888386 DOI: 10.1177/1938640019895917] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background. Minimally invasive surgery of the forefoot has regained popularity as an alternative to traditional open procedures. Minimally invasive hallux valgus surgery has been shown to be effective and reproducible for the treatment of mild to moderate hallux valgus. The aim of this study is to identify vital structures that are at risk for iatrogenic damage while performing a minimally invasive distal chevron osteotomy due to limited direct visualization. Methods. Ten fresh-frozen below knee cadavers were used for this study. A minimally invasive distal chevron osteotomy and medial eminence resection with a 2.2 mm × 22 mm Shannon burr was performed on each cadaver. Each specimen was dissected to expose the potential structures at risk for injury during the procedure. Structures evaluated included the medial neurovascular bundle, first metatarsophalangeal joint capsule, extensor hallucis longus tendon, flexor hallucis longus tendon, abductor hallucis tendon, and the sesamoid apparatus. Results. Ten specimens were evaluated. The dorsal medial cutaneous nerve was directly injured in 5 of the 10 cadaver specimens and intact/uninjured in the remaining 5 specimens. The flexor hallucis longus, extensor hallucis longus, adductor tendon, sesamoid apparatus, and first metatarsophalangeal joint capsule were uninjured in all specimens. Conclusion. Minimally invasive chevron distal osteotomy and medial eminence resection has a high learning curve. The resection of the medial eminence may iatrogenically injure the dorsal medial cutaneous nerve. The incidence is higher in this study than prior reported cadaveric studies and may warrant extra care to protect vital structures.Level of Evidence: Level IV: Cadaver study.
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Affiliation(s)
- Maria McGann
- Romano Orthopaedic Center, Oak Park, Illinois (MM).,Orthopedic Foot and Ankle Center, Columbus, Ohio (TML).,The Centers for Advanced Orthopaedics, Orthopaedic Associates of Maryland Division, Catonsville, Maryland (RAB).,Orthopedic Foot and Ankle Center, Worthington, Ohio (GB, MP)
| | - Travis M Langan
- Romano Orthopaedic Center, Oak Park, Illinois (MM).,Orthopedic Foot and Ankle Center, Columbus, Ohio (TML).,The Centers for Advanced Orthopaedics, Orthopaedic Associates of Maryland Division, Catonsville, Maryland (RAB).,Orthopedic Foot and Ankle Center, Worthington, Ohio (GB, MP)
| | - Roberto A Brandão
- Romano Orthopaedic Center, Oak Park, Illinois (MM).,Orthopedic Foot and Ankle Center, Columbus, Ohio (TML).,The Centers for Advanced Orthopaedics, Orthopaedic Associates of Maryland Division, Catonsville, Maryland (RAB).,Orthopedic Foot and Ankle Center, Worthington, Ohio (GB, MP)
| | - Gregory Berlet
- Romano Orthopaedic Center, Oak Park, Illinois (MM).,Orthopedic Foot and Ankle Center, Columbus, Ohio (TML).,The Centers for Advanced Orthopaedics, Orthopaedic Associates of Maryland Division, Catonsville, Maryland (RAB).,Orthopedic Foot and Ankle Center, Worthington, Ohio (GB, MP)
| | - Mark Prissel
- Romano Orthopaedic Center, Oak Park, Illinois (MM).,Orthopedic Foot and Ankle Center, Columbus, Ohio (TML).,The Centers for Advanced Orthopaedics, Orthopaedic Associates of Maryland Division, Catonsville, Maryland (RAB).,Orthopedic Foot and Ankle Center, Worthington, Ohio (GB, MP)
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Robinson D, Heller E, Yassin M. Comparing the Temperature Effect of Dedicated Minimally Invasive Motor System to the Discontinuous Use of Rotatory Burrs in the Correction of Hallux Valgus. Foot Ankle Spec 2020; 13:478-487. [PMID: 31793329 DOI: 10.1177/1938640019890225] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The purpose of this study was to compare 2 motor systems for percutaneous osteotomy. The study consisted of 2 stages. In the first stage, bone temperatures during osteotomy using burrs or saw was measured using a thermal camera. In the second stage, the tissue and burr temperature elevation during surgery in 80 consecutive patients (96 feet) with hallux valgus undergoing distal first metatarsal and phalangeal osteotomies (hallux and in 61/96 feet lesser digits) were measured. The burr osteotomy procedure included the use of irrigated 2- or 4.1 mm rotary wedge burrs in discontinuous cutting bursts of less than 20 seconds. Tissue surface temperature was measured with a thermal camera. The temperature generated during the procedure was found to be significantly associated with the burr diameter used but was not affected by the type of motor. At the 6-week visit, thickness of the soft tissues over the first metatarsal head was similar in both groups. Temperature control using a noninvasive thermal camera is recommended to prevent tissue damage associated with heat generated during the use of rotary burrs. A dedicated low-speed high-torque system does not seem to be necessary and standard orthopaedic equipment can be used.Levels of Evidence: Level II: Comparative prospectively collected series.
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Affiliation(s)
- Dror Robinson
- Department of Orthopedics, Hasharon Hospital, Rabin Medical Center, affiliated with the Sackler School of Medicine, Tel Aviv University, Petah Tikwa, Israel
| | - Eyal Heller
- Department of Orthopedics, Hasharon Hospital, Rabin Medical Center, affiliated with the Sackler School of Medicine, Tel Aviv University, Petah Tikwa, Israel
| | - Mustafa Yassin
- Department of Orthopedics, Hasharon Hospital, Rabin Medical Center, affiliated with the Sackler School of Medicine, Tel Aviv University, Petah Tikwa, Israel
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Carlucci S, Santini-Araujo M, Conti L, Villena D, Parise A, Carrasco N, Sotelano P. Percutaneous hallux valgus surgery: Comparison between mini-invasive Chevron and Bosch osteotomies. Rev Esp Cir Ortop Traumatol (Engl Ed) 2020. [DOI: 10.1016/j.recote.2020.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Percutaneous hallux valgus surgery: comparison between mini-invasive Chevron and Bosch osteotomies. Rev Esp Cir Ortop Traumatol (Engl Ed) 2020; 64:401-408. [PMID: 32912712 DOI: 10.1016/j.recot.2020.06.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 06/15/2020] [Accepted: 06/20/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Through percutaneous approaches, hallux valgus corrections can be performed with minimal soft tissue injury, less postoperative pain and good cosmetic results. Bosch osteotomy and MICA (Minimally Invasive Chevron Akin) have shown to be effective techniques for the correction of hallux valgus, although there are currently no publications comparing each other. The aim of this study is to compare the radiological and functional results of both techniques. MATERIALS AND METHODS A retrospective, comparative study was carried out on patients with moderate hallux valgus. They were divided into two groups according to the percutaneous technique performed: Chevron osteotomy and Bosch osteotomy with screw fixation. The metatarsophalangeal, intermetatarsal, and distal articular veneer declination angles of the first metatarsal and the bone consolidation time were evaluated radiologically. The American Orthopaedic Foot and Ankle Surgery (AOFAS) score was used for functional assessment. Complications were registered during the first year. RESULTS Thirty-eight patients in each group were included for the study. In each of the groups, the radiological angles were compared preoperatively and at final follow-up, showing statistically significant changes in the three variables considered; but no differences were obtained by comparing them with each other. The time of consolidation was also similar in both groups. As for the AOFAS scale, an improvement was obtained with both techniques, but the difference was not significant when comparing them. CONCLUSIONS Both Bosch and MICA techniques showed comparable results at the end of the follow-up. Further work is needed to determine the advantages of each in the immediate postoperative time.
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Abstract
This article discusses the possible complications in minimally invasive surgery (MIS) for hallux valgus. The rate of complications and the outcomes are at least comparable with open techniques. A percutaneous technique provides the best conditions for undisturbed healing. Some possible complications exist in MIS that do not exist in open surgery, such as lesion of soft tissue structures that are not under direct visible control or skin burns. These complications usually result from technical mistakes in performing the operation. It is therefore crucial to get proper education from cadaver training and visiting experienced colleagues, as is done in open surgery.
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Abstract
Minimally invasive procedures to treat lesser toes deformities are among the main surgeries of percutaneous techniques and considered mature techniques due to technical versatility and high correction potential, with low rates of complications. Although they seem technically simple procedures, there are important technical details for each of them to obtain a reliable correction. To achieve success in lesser toes percutaneous treatment, it is imperative to follow minimally invasive basic principles, especially postoperative care with specific bandages for unfixed osteotomies. Practical training is mandatory before starting the experience; the foot surgeon must learn theoretic and practical aspects to master this surgery.
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Affiliation(s)
- Guillaume Cordier
- Clinique du Sport Bordeaux-Mérignac, France; GRECMIP-MIFAS (Groupe de Recherche en Chirurgie Mini-Invasive du Pied-Minimally Invasive Foot and Ankle Society), 2 rue Negrevergne, Merignac 33700, France.
| | - Gustavo Araujo Nunes
- GRECMIP-MIFAS (Groupe de Recherche en Chirurgie Mini-Invasive du Pied-Minimally Invasive Foot and Ankle Society), 2 rue Negrevergne, Merignac 33700, France; Hospital Ortopédico, Belo Horizonte, Minas Gerais, Brazil
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Minimally Invasive Chevron Akin (MICA) for Correction of Hallux Valgus. TECHNIQUES IN FOOT & ANKLE SURGERY 2020. [DOI: 10.1097/btf.0000000000000273] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Leucht AK, Younger A, Veljkovic A, Perera A. The Windswept Foot: Dealing with Metatarsus Adductus and Toe Valgus. Foot Ankle Clin 2020; 25:413-424. [PMID: 32736739 DOI: 10.1016/j.fcl.2020.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The windswept foot remains a reconstructive challenge. The hallux valgus associated with the medially displaced lesser metatarsal heads is hard to correct. Either the lesser metatarsal heads need to be displaced laterally or the deformity accepted. With the deformity, all the toes tend to be aligned into valgus with the position of the flexor and extensor tendons. Several treatment alternatives exist and may require a combination of open and percutaneous surgery. The authors think that, in severe metatarsus adductus, proximal correction of the first, second, and third metatarsals is required.
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Affiliation(s)
- Anna-Kathrin Leucht
- Footbridge Clinic, Unit 221, 181 Keefer Place, Vancouver, British Columbia V6B 6C1, Canada; Department of Orthopaedics and Traumatology, Cantonal Hospital of Winterthur, Switzerland
| | - Alastair Younger
- Footbridge Clinic, Unit 221, 181 Keefer Place, Vancouver, British Columbia V6B 6C1, Canada.
| | - Andrea Veljkovic
- Footbridge Clinic, Unit 221, 181 Keefer Place, Vancouver, British Columbia V6B 6C1, Canada
| | - Anthony Perera
- University Hospital of Wales Llandough, University Hospital of Wales Cardiff, Spire Cardiff Hospital, Croescadaran Road, Cardiff, Wales CF23 8XL, UK
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Liszka H, Gądek A. Percutaneous Transosseous Suture Fixation of the Akin Osteotomy and Minimally Invasive Chevron for Correction of Hallux Valgus. Foot Ankle Int 2020; 41:1079-1091. [PMID: 32659140 DOI: 10.1177/1071100720935036] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The objective of the study was evaluation of the clinical and radiologic outcomes and complications following the minimally invasive chevron procedure employing the Akin osteotomy with percutaneous transosseous suture as compared to screw fixation. METHODS Between 2018 and 2019, the authors performed 103 minimally invasive chevron (MIC) with Akin osteotomies. In 54 patients, the Akin osteotomy was performed with screw stabilization (group A), and in 49 with percutaneous transosseous suture (group B). Preoperatively and 1 year later, the authors employed anteroposterior and lateral weightbearing radiographs of the feet to evaluate interphalangeal angle (IPA), distal phalangeal articular angle (DPAA), proximal phalangeal articular angle (PPAA), intermetatarsal angle (IMA), hallux valgus angle (HVA), and functional result using the American Orthopaedic Foot & Ankle Society (AOFAS) hallux-metatarsophalangeal-interphalangeal scale. Furthermore, all additional procedures and complications were recorded. RESULTS Both groups demonstrated a statistically significant decrease of the value of HVA (group A: from 34.1° to 14.0°, group B: from 33.6° to 13.0°), DPAA (group A: from 12.1° to 4.0°, group B: from 11.5° to 3.4°), PPAA (group A: from 4.6° to 1.7°, group B: from 4.3° to 1.5°), IMA (group A: from 15.1° to 8.0°, group B: from 14.7° to 7.5°) and IPA (group A: from 14.1° to 6.3°, group B: from 12.9° to 5.1°). Functional improvement as measured using the AOFAS scale was achieved in both groups (group A: from 42 to 90 points, group B: from 40 to 89 points). No cases of bone nonunion or delayed union and permanent damage to the medial dorsal cutaneous nerve were seen. Two group B patients underwent conversion of the fixation of the Akin osteotomy to screws, 3 patients had their MICA screws and 1 Akin screw removed in the outpatient setting. CONCLUSION The minimally invasive chevron osteotomy with transosseous suture stabilization of the Akin osteotomy was a safe method with good functional results that were comparable to the outcomes achieved when using screw fixation. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Henryk Liszka
- Department of Anatomy, Medical College Jagiellonian University, Poland.,Department of Orthopedics and Traumatology, University Hospital, Krakow, Poland
| | - Artur Gądek
- Department of Orthopedics and Traumatology, University Hospital, Krakow, Poland.,Department of Orthopedics and Physiotherapy, Jagiellonian University Collegium Medicum, Krakow, Malopolska, Poland
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Abstract
A bunionette deformity is a painful prominence on the lateral aspect of the fifth metatarsal head. Surgical treatment can be considered if conservative treatment has failed to relieve the symptoms. The percutaneous approach consists of 2 steps: a condylectomy and an osteotomy of the fifth metatarsal. The learning curve is small and the final results are similar to the open techniques. The main advantages are the hardware-free technique and the minimally invasive approach. This percutaneous approach avoids complications related to hardware and soft tissue healing. Because of this low complication rate, the percutaneous technique may become the new gold standard.
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Affiliation(s)
- Frederick Michels
- Orthopaedic Department, AZ Groeninge, President Kennedylaan 4, Kortrijk 8500, Belgium; Ankle Instability Group; GRECMIP - MIFAS (Groupe de Recherche et d'Etude en Chirurgie Mini-Invasive du Pied - Minimally Invasive Foot and Ankle Society), Mérignac, France.
| | - Stéphane Guillo
- Ankle Instability Group; Orthopaedic Department, Merignac Sport Clinic, 4, Rue Georges Negrevergne, Merignac 33700, France
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Ferreira GF, Dos Santos TF, Oksman D, Pereira Filho MV. Percutaneous Oblique Distal Osteotomy of the Fifth Metatarsal for Bunionette Correction. Foot Ankle Int 2020; 41:811-817. [PMID: 32436745 DOI: 10.1177/1071100720917906] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Bunionette is a common foot disorder, and several types of corrective surgery have been described. With the popularization of minimally invasive surgeries, the forefoot region has become a suitable area for this type of technique. The aim of this study was to evaluate the results of oblique distal osteotomy of the fifth metatarsal adapted for a percutaneous approach. METHODS We prospectively evaluated 31 consecutive tailor's bunion patients who underwent operative correction on a total of 42 feet between 2017 and 2019 after failure of conservative treatment. Clinical outcomes such as pain (visual analog scale [VAS]), function (American Orthopaedic Foot & Ankle Society [AOFAS] Lesser Toe Metatarsophalangeal-Interphalangeal Scale scoring system), personal satisfaction, and complications were evaluated. Radiographic aspects were also examined. Shapiro and Mann-Whitney statistical tests were conducted. The average age of the patients was 69.5 years, and the average follow-up was 13.1 months. RESULTS After the operative procedure, there was a decrease of 6.6 points on the VAS for pain (P < .001) and an increase of 34.9 in the AOFAS score (P < .001). Radiographic correction was achieved for both the fifth metatarsophalangeal angle (P < .001) and the intermetatarsal angle (P < .001), which showed decreased values. There was 1 case of superficial infection and 2 cases of nonunion (asymptomatic). A large majority of patients regarded the procedure outcome as satisfactory. CONCLUSION This percutaneous oblique distal osteotomy of the fifth metatarsal for bunionette deformity produced improvements in pain and function and a high rate of satisfaction, with a low incidence of complications and a high capacity for correcting the deformity. LEVEL OF EVIDENCE Level II, prospective cohort study.
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Affiliation(s)
- Gabriel Ferraz Ferreira
- Foot and Ankle Surgery Group, Orthopaedics and Traumatology Unit, Prevent Senior, São Paulo, SP, Brazil
| | | | - Daniel Oksman
- Head of Orthopedics and Traumatology, Prevent Senior, São Paulo, SP, Brazil
| | - Miguel Viana Pereira Filho
- Head of Foot and Ankle Surgery Group, Orthopaedics and Traumatology Unit, Prevent Senior, São Paulo, SP, Brazil
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Schipper ON, Day J, Ray GS, Johnson AH. Percutaneous Techniques in Orthopedic Foot and Ankle Surgery. Orthop Clin North Am 2020; 51:403-422. [PMID: 32498959 DOI: 10.1016/j.ocl.2020.02.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
This article presents the indications, contraindications, preoperative surgical planning, surgical technique, and postoperative management of some of the most common percutaneous procedures in orthopedic foot and ankle surgery. The background of each procedure also is presented, supported by the latest in published literature to educate surgeons. Such topics include percutaneous bunionectomy, lesser toe deformity and bunionette correction, calcaneal osteotomy, cheilectomy, and first metatarsophalangeal joint arthrodesis.
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Affiliation(s)
- Oliver N Schipper
- Anderson Orthopaedic Clinic, 2445 Army Navy Drive, Arlington, VA 22206, USA.
| | - Jonathan Day
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Gabrielle S Ray
- Tufts University School of Medicine, 145 Harrison Avenue, Boston, MA, USA
| | - Anne Holly Johnson
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
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Intermediate-term results of isolated minimally invasive arthroscopic cheilectomy in the treatment of hallux rigidus. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2020; 30:1277-1283. [PMID: 32424474 DOI: 10.1007/s00590-020-02702-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 05/11/2020] [Indexed: 12/27/2022]
Abstract
AIM The aim of this study was to determine the intermediate-term results of minimally invasive cheilectomy of the first MTPJ using a high-torque low-speed burr and arthroscopic debridement. METHODS A consecutive series of patients who underwent isolated unilateral minimally invasive cheilectomy of the first MTPJ were contacted by telephone. A questionnaire was used to assess patient satisfaction and complications. Patients with less than 2 years of follow-up were excluded. RESULTS Thirty-six patients completed the study. Mean patient age at time of surgery was 50.0 years (range 24.5-67.0). Mean follow-up was 4.69 years (range 2.0-7.3). Thirty patients (83%) reported they would recommend the procedure. Mean postoperative improvement in pain was 69% (range 0-100). Twenty-seven (84%) of patients reported either no pain (28%) or mild pain (56%). For patients who reported any pain, the mean pain experienced was rated as 3.4 out of 10 (range 1-9). Twenty-nine (81%) patients reported they could wear a 'fashionable' shoe postoperatively. One patient experienced a delayed rupture of the extensor hallucis longus at 6 months postsurgery. One patient underwent further arthroscopic cheilectomy. No patient required conversion to fusion of the first MTPJ. CONCLUSION Minimally invasive cheilectomy of the first MTPJ using high-torque low-speed burr and arthroscopic debridement results in high patient satisfaction with a low rate of complications at intermediate follow-up.
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Stevens R, Bursnall M, Chadwick C, Davies H, Flowers M, Blundell C, Davies M. Comparison of Complication and Reoperation Rates for Minimally Invasive Versus Open Cheilectomy of the First Metatarsophalangeal Joint. Foot Ankle Int 2020; 41:31-36. [PMID: 31910054 DOI: 10.1177/1071100719873846] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Dorsal cheilectomy of the first metatarsophalangeal joint is an accepted treatment to alleviate dorsal impingement, pain, and reduced dorsiflexion in hallux rigidus. Traditionally performed via an open incision, this procedure has more recently been performed using minimally invasive techniques despite limited supportive published evidence. METHODS From December 2012 through December 2017, a retrospective analysis of all cheilectomies performed in our institution was done. The surgical technique was recorded along with any subsequent procedures performed for either persistent or recurrent pain, and complications were also noted. A comparison between open and minimally invasive outcomes was performed. In total, 171 cheilectomies were performed during this period. There were 38 open and 133 minimally invasive procedures. RESULTS At a mean 3-year follow-up, the reoperation rates of the 2 groups were different with only 1 (2.6%) of the open group requiring a fusion, while 17 (12.8%) of the minimally invasive surgical (MIS) group required further surgery (relative risk, 4.86; P = .059). In the open group, there was 1 (2.6%) complication, compared with 15 (11.3%) in the minimally invasive group (relative risk, 4.29; P = .076). CONCLUSION While patients may opt for MIS cheilectomy with a proposed faster recovery time and better cosmesis, they should be counseled about the risks and benefits of both methods, and that the technique of MIS cheilectomy utilized in this study appears to have an increased relative risk of requiring a further procedure. LEVEL OF EVIDENCE Level III, retrospective comparative series.
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Affiliation(s)
| | - Matthew Bursnall
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
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Siddiqui NA, LaPorta G, Walsh AL, Abraham JS, Beauregard S, Gdalevitch M. Radiographic Outcomes of a Percutaneous, Reproducible Distal Metatarsal Osteotomy for Mild and Moderate Bunions: A Multicenter Study. J Foot Ankle Surg 2019; 58:1215-1222. [PMID: 31679675 DOI: 10.1053/j.jfas.2019.04.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 02/14/2019] [Accepted: 04/26/2019] [Indexed: 02/03/2023]
Abstract
Hallux valgus is a prevalent condition. Many open surgical methods of correction have been described. We performed a percutaneous, extra-articular distal metatarsal osteotomy for mild to moderate bunion deformity. The minimally invasive technique was used in 217 feet (180 patients; age 49 ± 4.7 years, mean ± standard deviation) at 4 centers in North America (Center 1: November 2012 to March 2017; Center 2: January 2010 to May 2016; Center 3: October 2013 to June 2016; Center 4: January 2015 to June 2017). The procedure was used in simultaneous bilateral cases in 28 patients (15.6%) and in nonsimultaneous bilateral cases in 9 patients (5.0%). Immediate postoperative weightbearing was used in all cases. The mean preoperative intermetatarsal angle, hallux abductus angle, and tibial sesamoid position were 14.6° ± 3.5°, 30.7° ± 7.8°, and 5.4 ± 1.4, respectively. At final follow-up of 9.3 ± 6.1 months, the mean intermetatarsal angle, hallux abductus angle, and tibial sesamoid position were 4.7° ± 2.8°, 8.4° ± 6.1°, and 2.0 ± 1.0, respectively (p < .0001 for all comparisons). No major complications were noted. All 217 osteotomies achieved union; 3 feet (1.4%) in 3 patients (1.7%) experienced asymptomatic malunion. Superficial pin-site infection was seen in 42 (19.4%) of the 217 feet (39 patients, 21.7%). The radiographic results of this percutaneous technique appear to be reproducible across multiple centers, and the technique is useful when correcting intermetatarsal and hallux abductus angles. This percutaneous osteotomy for realignment of the first ray allows immediate postoperative weightbearing and, in this initial review, appears to be safe and effective, even in simultaneous bilateral cases.
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Affiliation(s)
- Noman A Siddiqui
- Director, Podiatric Surgery, International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD; Fellowship Director, International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD.
| | - Guido LaPorta
- Surgeon, Geisinger Community Medical Center, Scranton, PA; Director, Podiatric Medical Education, Lourdes Hospital, Binghamton, NY
| | - Amanda L Walsh
- Surgeon, The Foot and Ankle Clinic of Central Nebraska, Grand Island, NE
| | | | - Serge Beauregard
- First Assistant Nurse, Orthopedic Surgery Department, Verdun Hospital, Montreal, Quebec, Canada
| | - Marie Gdalevitch
- Surgeon, Orthopedic Surgery Department, Verdun Hospital, Montreal, Quebec, Canada
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Rivero-Santana A, Perestelo-Pérez L, Garcés G, Álvarez-Pérez Y, Escobar A, Serrano-Aguilar P. Clinical effectiveness and safety of Weil's osteotomy and distal metatarsal mini-invasive osteotomy (DMMO) in the treatment of metatarsalgia: A systematic review. Foot Ankle Surg 2019; 25:565-570. [PMID: 30321939 DOI: 10.1016/j.fas.2018.06.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 06/25/2018] [Accepted: 06/27/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND Weil's osteotomy (WO) is the most applied surgical treatment for metatarsalgia, a persistent pain in the lesser metatarsals' heads. We aim to review its effectiveness and safety compared to the percutaneous technique known as distal metatarsal mini-invasive osteotomy (DMMO). METHODS Systematic review in Medline, Pubmed, Embase, Cinahl and Cochrane Library. We included studies that directly compared WO and DMMO for the treatment of primary metatarsalgia. Data on pain, function, complications and patients' satisfaction were extracted and narratively synthesized. RESULTS Four retrospective studies were identified. There were no significant differences in clinical effectiveness or patients' satisfaction. Time to bone healing was significantly longer for DMMO, whereas WO showed more wound problems and metatarsophalangeal stiffness. Other complications were infrequent in the two procedures. CONCLUSION Evidence on the direct comparison of WO and DMMO is scarce and of low quality. Randomized studies are needed in order to control for potential confounders.
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Affiliation(s)
- Amado Rivero-Santana
- Canary Islands Foundation of Health Research, Bco. de la Ballena, s/n, 35019 Las Palmas de GC, Spain; Health Services Research on Chronic Patients Network, Camino Candelaria, 44, El Rosario, 38109 Tenerife, Spain; Center for Biomedical Research of the Canary Islands, Campus Ciencias de La Salud, s/n, 38071 San Cristobal de La Laguna, Spain.
| | - Lilisbeth Perestelo-Pérez
- Health Services Research on Chronic Patients Network, Camino Candelaria, 44, El Rosario, 38109 Tenerife, Spain; Center for Biomedical Research of the Canary Islands, Campus Ciencias de La Salud, s/n, 38071 San Cristobal de La Laguna, Spain; Evaluation Unit of the Canary Islands Health Service, Camino Candelaria, 44, El Rosario, 38109 Tenerife, Spain.
| | - Gerardo Garcés
- Department of Orthopedics, Hospital Perpetuo Socorro, C/León y Castillo, 407, 35007 Las Palmas de Gran Canaria, Spain; School of Medicine, University of Las Palmas de Gran Canaria, Paseo Blas Cabrera Felipe, s/n, 35016 Las Palmas de Gran Canaria, Spain.
| | - Yolanda Álvarez-Pérez
- Canary Islands Foundation of Health Research, Bco. de la Ballena, s/n, 35019 Las Palmas de GC, Spain; Health Services Research on Chronic Patients Network, Camino Candelaria, 44, El Rosario, 38109 Tenerife, Spain; Center for Biomedical Research of the Canary Islands, Campus Ciencias de La Salud, s/n, 38071 San Cristobal de La Laguna, Spain.
| | - Antonio Escobar
- Health Services Research on Chronic Patients Network, Camino Candelaria, 44, El Rosario, 38109 Tenerife, Spain; Research Unit, Hospital Basurto, Montevideo Etorb., 18, 48013 Bilbao, Spain.
| | - Pedro Serrano-Aguilar
- Health Services Research on Chronic Patients Network, Camino Candelaria, 44, El Rosario, 38109 Tenerife, Spain; Center for Biomedical Research of the Canary Islands, Campus Ciencias de La Salud, s/n, 38071 San Cristobal de La Laguna, Spain; Evaluation Unit of the Canary Islands Health Service, Camino Candelaria, 44, El Rosario, 38109 Tenerife, Spain.
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Nieto-García E, Ferrer-Torregrosa J, Ramírez-Andrés L, Nieto-González E, Martinez-Nova A, Barrios C. The impact of associated tenotomies on the outcome of incomplete phalangeal osteotomies for lesser toe deformities. J Orthop Surg Res 2019; 14:308. [PMID: 31511051 PMCID: PMC6739948 DOI: 10.1186/s13018-019-1353-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Accepted: 08/29/2019] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Partial or incomplete osteotomy (IO) of the phalanx is recently described in the literature. However, the clinical outcome and the rate of complications when applied to lesser toe deformities (LTD) have been never addressed. This study aims to find out if the association of tenotomies to incomplete or partial phalanx osteotomies has a significant impact on the clinical outcomes, the occurrence of complications, and the recovery time after surgery. METHODS A retrospective review of two cohorts of cases operated in our institution for hallux abductus valgus (HAV) and associated LTD from 2008 to 2014 was carried out. The surgical correction of both HAV and the associated LTD was always performed by minimally invasive techniques. The study included a total of 223 patients (723 IO in 556 toes). In 129 cases, the IO for LTD correction was performed without tenotomies, and in 94, the procedure was combined with flexor and/or extensor tenotomies. Patients were assessed with the American Orthopaedic Foot and Ankle Society (AOFAS) questionnaire before surgery and at 6- and 12-month follow-up. RESULTS The mean preoperative AOFAS score before surgery was similar in both cohorts. At 12-month follow-up, the cohort without tenotomies showed better recovery (95.7 ± 2.8 versus 92.5 ± 6.8; p < 0.01). AOFAS scores decreased as the number of associated LTD increased (r = - 0.814; p < 0.001). Cases operated on by PO + tenotomy showed a high rate of complications such as delayed union of the osteotomy (p < 0.01), hypertrophic callus (p < 0.01), phalangeal fracture at the osteotomy site (p < 0.01), and lack of correction (p < 0.05). The overall occurrence of adverse events was 38.6% in cases operated by PO + tenotomy and 13.9% in cases receiving PO alone (p < 0.0001). Cases operated on without tenotomy showed a shorter time to complete recovery for daily life activities (37.4 ± 2.3 versus 43.0 ± 1.7 days; p < 0.01). CONCLUSION The performance of associated tenotomies to incomplete phalanx osteotomies provides worse clinical outcomes, higher complication rates, and longer recovery time as compared to similar forefoot surgeries without tenotomies. TRIAL REGISTRATION The study was based on retrospectively registered data starting on May 24, 2008.
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Affiliation(s)
- Eduardo Nieto-García
- Doctorate School, Valencia Catholic University San Vicente Martir, Valencia, Spain
| | - Javier Ferrer-Torregrosa
- School of Physiotherapy and Podiatry, Valencia Catholic University, Ramiro Maeztu 14, 46900 Torrent, Valencia, Spain
| | - Leonor Ramírez-Andrés
- School of Physiotherapy and Podiatry, Valencia Catholic University, Ramiro Maeztu 14, 46900 Torrent, Valencia, Spain
| | - Elena Nieto-González
- School of Physiotherapy and Podiatry, Valencia Catholic University, Ramiro Maeztu 14, 46900 Torrent, Valencia, Spain
| | | | - Carlos Barrios
- Institute for Research on Musculoskeletal Disorders, Valencia Catholic University, Valencia, Spain
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Redfern D, Vernois J. Letter Regarding: Stiffness and Range of Motion After Minimally Invasive Chevron-Akin and Open Scarf-Akin Procedures. Foot Ankle Int 2019; 40:987-989. [PMID: 31361976 DOI: 10.1177/1071100719863710] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Frigg A, Maquieira G, Pellegrino A. Response to "Letter Regarding: Stiffness and Range of Motion After Minimally Invasive Chevron-Akin and Open Scarf-Akin Procedures". Foot Ankle Int 2019; 40:990-994. [PMID: 31361974 DOI: 10.1177/1071100719862209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Frigg A, Zaugg S, Maquieira G, Pellegrino A. Stiffness and Range of Motion After Minimally Invasive Chevron-Akin and Open Scarf-Akin Procedures. Foot Ankle Int 2019; 40:515-525. [PMID: 30688526 DOI: 10.1177/1071100718818577] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Stiffness after open hallux valgus surgery affects 7% to 38% of patients. Minimally invasive surgery (MIS) is thought to decrease this rate by reducing soft tissue trauma. MIS, now in its third generation, is advertised as delivering results superior to open surgery. However, no studies have reported stiffness or range of motion (ROM). METHODS Between January 2014 and December 2015, a total of 50 patients received open scarf-Akin surgery and 48 received minimally invasive Chevron Akin (MICA) surgery. The endpoints were American Orthopaedic Foot & Ankle Society (AOFAS) score, range of motion, visual analog scale for pain, scar length, and subjective foot value. The minimal follow-up time was 2 years. RESULTS Moderate stiffness occurred in 3 cases in both groups. In MICA, extension increased by 10 degrees while it remained unchanged in scarf. Both groups showed similar improvements in AOFAS score, pain, and subjective foot value. Radiographic evidence of correction was comparable, except for an increased shortening of the first metatarsal by 3 mm in MICA. The scars were smaller in MICA (1.2 cm) than in scarf (5 cm). Wound problems included delayed healing in 10% in scarf and wound infections in 4% in MICA. The rate of recurrence and other complications were comparable, except for reoperations, which were higher in MICA (27% mainly for protruding screws) than in scarf (8% mainly for stiffness). In MICA, 14% were intraoperatively converted to open surgery. CONCLUSION MICA showed no advantages over scarf other than a shorter scar. The observed gain in extension could be related to the increased shortening of the first metatarsal because of the size of the burr. LEVEL OF EVIDENCE Level II, prospective cohort (nonrandomized, comparative) study.
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Affiliation(s)
- Arno Frigg
- 1 Orthopedic Department, University Hospital Basel, Switzerland.,2 Center for Foot and Ankle Surgery, Hirslanden Clinic Zürich, Switzerland.,3 Private University of the Principality of Liechtenstein, Triesen, Liechtenstein
| | - Sandrine Zaugg
- 1 Orthopedic Department, University Hospital Basel, Switzerland
| | - Gerardo Maquieira
- 2 Center for Foot and Ankle Surgery, Hirslanden Clinic Zürich, Switzerland
| | - Alex Pellegrino
- 2 Center for Foot and Ankle Surgery, Hirslanden Clinic Zürich, Switzerland
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Díaz Fernández R. Use of a percutaneous osteotomy with plate fixation in hallux valgus correction. Foot Ankle Surg 2019; 25:106-112. [PMID: 29409298 DOI: 10.1016/j.fas.2017.09.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 08/30/2017] [Accepted: 09/08/2017] [Indexed: 02/04/2023]
Abstract
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. Additional surgical procedures included DMMO's (Distal Metatarsal Minimally-Invasive Osteotomies) in 12 of the operated feet (44.44%); minor digits were corrected in 7 cases (25.9%). An Akin procedure was performed in 81% of cases and all cases underwent an adductor hallucis tenotomy. All patients were clinically assessed using the AOFAS score. Radiographic measures included the preoperative and postoperative values of the Hallux Valgus Angle (HVA), Intermetatarsal Angle (IMA), and the Distal Metatarsal Articular Angle (DMAA). RESULTS The mean correction achieved improved for AHV from 36.57±7.1 to 12.22±8.69°, for IMA from 13.8±1.59 to 7.08±2.72 and for DMAA from 13.98±7.38 to 6.07±4.99. Clinically, scores on the AOFAS scale improved from a 45.8±9.6 to 91.29±9.8. Although healing of the osteotomies was observed radiographically within 6 to 12 weeks, two cases (8.3%) exhibited delayed healing. There were no cases of nonunion. There were no superficial or deep infections or wound healing problems. Plate had to be removed in 3 cases (12.5%). CONCLUSION This technique modification is an acceptable procedure to correct hallux valgus in patients with a moderate level of deformity. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Rodrigo Díaz Fernández
- Servicio de Cirugía Ortopédica y Traumatología, Hospital de Manises, Valencia, Spain; Unidad de Pie y Tobillo, Hospital Quirónsalud, Valencia, Spain.
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Teoh KH, Tan WT, Atiyah Z, Ahmad A, Tanaka H, Hariharan K. Clinical Outcomes Following Minimally Invasive Dorsal Cheilectomy for Hallux Rigidus. Foot Ankle Int 2019; 40:195-201. [PMID: 30282465 DOI: 10.1177/1071100718803131] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND: Following failure of conservative treatment, a dorsal cheilectomy can be performed for patients in early stages of hallux rigidus by a traditional open approach or by a minimally invasive technique. We report our clinical outcomes following minimally invasive dorsal cheilectomy (MIDC). METHODS: Eighty-nine patients (98 feet) with symptomatic hallux rigidus treated between 2011 and 2016 were included in this study. The average age was 54 years. Manchester-Oxford Foot Questionnaire (MOxFQ) scores and visual analog scale (VAS) pain scores were collected. The mean follow-up was 50 months. RESULTS: The average VAS score improved from 8.0 preoperatively to 3 postoperatively. The mean MOxFQ summary index score decreased from 58.6 preoperatively to 30.5 postoperatively. All 3 MOxFQ domains also improved. Swelling took an average of 5.3 weeks to settle. There were 2 wound infections and 2 delayed wound healings. Two patients had transient nerve paraesthesia, while 2 patients had permanent numbness in the dorsomedial cutaneous nerve distribution. Twelve patients (12%) underwent reoperation, of which 7 had a first metatarsophalangeal joint arthrodesis for ongoing pain, 4 had repeat cheilectomy for residual impingement, and 1 had an open removal of loose bone. CONCLUSION: Our results suggest that MIDC resulted in improvement in patient-reported outcome measures and was a safe technique with minimal complications. The complications were similar to open cheilectomy. There was an associated learning curve as 5 of our reoperations were due to incomplete cheilectomy. Coughlin grade 1 did well with MIDC as with open cheilectomy as none went onto an arthrodesis. However, 10% (7/65) of our grade 2 and 3 cases went on to an arthrodesis. LEVEL OF EVIDENCE: Level IV, retrospective case series.
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Affiliation(s)
- Kar Hao Teoh
- 1 Foot and Ankle Unit, Royal Gwent Hospital, Newport, UK
| | - Wei Teen Tan
- 1 Foot and Ankle Unit, Royal Gwent Hospital, Newport, UK
| | - Zeid Atiyah
- 1 Foot and Ankle Unit, Royal Gwent Hospital, Newport, UK
| | - Aziz Ahmad
- 1 Foot and Ankle Unit, Royal Gwent Hospital, Newport, UK
| | - Hiro Tanaka
- 1 Foot and Ankle Unit, Royal Gwent Hospital, Newport, UK
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Teoh KH, Haanaes EK, Alshalawi S, Tanaka H, Hariharan K. Minimally Invasive Dorsal Cheilectomy of the First Metatarsal: A Cadaveric Study. Foot Ankle Int 2018; 39:1497-1501. [PMID: 30079773 DOI: 10.1177/1071100718791588] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND: Minimally invasive dorsal cheilectomy (MIDC) for hallus rigidus is gaining in popularity. The optimal position for the stab incision for MIDC is dorsomedial to allow an ergonomic sweeping movement of the burr, potentially putting the dorsomedial cutaneous nerve (DMCN) to the hallux at risk. We aimed to quantify the risk of using this minimally invasive technique with a cadaveric study. METHODS: A total of 13 fresh-frozen cadaveric specimens amputated below the knee were obtained for this study. After the procedure, the specimens were dissected, and structures were inspected for damage. RESULTS: The DMCN to the hallux was cut completely in 2 specimens (15%). All the extensor hallucis longus tendons were intact, although in 1 specimen, the tendon showed some fraying on the underside of the tendon. The average distance of the stab incision from the first metatarsophalangeal (MTP) joint was 17.7 (range, 10-23) mm. The relationship of the DMCN to the stab incision was variable. The average distance of the DMCN to the incision was 3.8 (range, 0-7) mm. The danger zone for damaging the DMCN was at one-third the length of the first metatarsal proximal to the first MTP joint. CONCLUSION: The DMCN has been well studied by several authors and has a variable course. This nerve was damaged in 15% of our specimens following MIDC. CLINICAL RELEVANCE: We believe patients should be made aware of this risk when considering surgery. A carefully made working capsular pocket for the burr and marking this nerve before making the incision if palpable could mitigate this risk.
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Affiliation(s)
- Kar Hao Teoh
- 1 Foot and Ankle Unit, Ysbyty Ystrad Fawr, Ystrad Mynach, Hengoed, UK
| | | | - Saud Alshalawi
- 3 Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Hiro Tanaka
- 1 Foot and Ankle Unit, Ysbyty Ystrad Fawr, Ystrad Mynach, Hengoed, UK
| | - Kartik Hariharan
- 1 Foot and Ankle Unit, Ysbyty Ystrad Fawr, Ystrad Mynach, Hengoed, UK
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Severyns M, Carret P, Brunier-Agot L, Debandt M, Odri GA, Rouvillain JL. Reverdin-Isham procedure for mild or moderate hallux valgus: clinical and radiographic outcomes. Musculoskelet Surg 2018; 103:161-166. [PMID: 30151785 DOI: 10.1007/s12306-018-0563-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 08/21/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND In the last decade, interests in minimal incision surgery have been growing. Theoretically, this kind of procedure could decrease time to recovery and rehabilitation, with a reduction in morbidity. The present study assessed clinical and radiological outcomes and complications of percutaneous surgery for mild-to-moderate hallux valgus using Reverdin-Isham and Akin osteotomies without fixation after 60 months of follow-up. METHODS A series of 48 patients (57 cases) with medium-to-moderate hallux valgus underwent the same percutaneous surgery, between 2003 and 2011. Data collection involved preoperative dorsal flexion, plantar flexion, M1P1, M1M2, DMAA angles, AOFAS scale score, and subjective satisfaction. RESULTS AOFAS scale score rose from a preoperative median of 55.9-89.2/100 postoperatively (p < 0.001); 51 surgical procedures (89.5%) were considered as satisfactory or very satisfactory by patients at the end of follow-up. Hallux valgus and distal metatarsal articular angle (DMAA) were significantly reduced (29.3° and 14.1°-15.4° and 7.7°, p < 0.001, respectively). There was a significant increase in MTPJ 1 stiffness (p < 0.001). DISCUSSION Percutaneous correction by Reverdin-Isham and Akin osteotomies seems to be effective in isolated medium-to-moderate hallux valgus. Stiffness observed is comparable to other percutaneous and open procedures but needs to be compared in a randomized controlled clinical trial to extra-articular percutaneous procedures without capsule detachment in association with an internal fixation which allows an early mobilization. LEVEL OF CLINICAL EVIDENCE IV.
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Affiliation(s)
- M Severyns
- Department of Orthopedic and Traumatology Surgery, University Hospital of Martinica, BP 632, 97200, Fort-de-France, France.
| | - P Carret
- Department of Orthopedic and Traumatology Surgery, University Hospital of Martinica, BP 632, 97200, Fort-de-France, France
| | - L Brunier-Agot
- Department of Rheumatology, University Hospital of Martinica, BP 632, 97200, Fort-de-France, France
| | - M Debandt
- Department of Rheumatology, University Hospital of Martinica, BP 632, 97200, Fort-de-France, France
| | - G A Odri
- Orthopaedic and Traumatologic Department, Lariboisière University Hospital, Rue Ambroise Paré, 75010, Paris, France
| | - J-L Rouvillain
- Department of Orthopedic and Traumatology Surgery, University Hospital of Martinica, BP 632, 97200, Fort-de-France, France
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47
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Krenn S, Albers S, Bock P, Mansfield C, Chraim M, Trnka HJ. Minimally Invasive Distal Metatarsal Metaphyseal Osteotomy of the Lesser Toes: Learning Curve. Foot Ankle Spec 2018; 11:263-268. [PMID: 29298501 DOI: 10.1177/1938640017750251] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Minimally invasive surgery has a shorter surgical time, and in this study we focus on minimally invasive distal metatarsal metaphyseal osteotomy (DMMO). The operation seems to be less complex but requires a high learning curve. We report on our first patients to underline the need for extensive training and great awareness for the risks in the early learning stages. METHODS We evaluated 27 patients (mean age = 60.9 years) with a mean follow-up time of 7.2 months. Indication was metatarsalgia, intractable plantar keratosis, and the (sub-)luxation of the metatarsophalangeal joint. Clinical results were evaluated with the 12-item Short Form (SF-12), Foot Function Index (FFI), Foot and Ankle Ability Measure (FAAM), and the American Orthopaedic Foot and Ankle Score (AOFAS). Radiographs and pedobarographic analysis were obtained. RESULTS Scores ranged closely to standard value (AOFAS 88.07 points; FFI 93%; FAAM 36.4 points; SF-12 31.27 points). Pedobarography showed significant differences in several forefoot areas. We encountered nonunion/malunion and necrosis of the metatarsal head. CONCLUSIONS The aim of this study was to demonstrate the need for intensive training before practicing DMMO. Results show that minimally invasive DMMO requires a high learning curve. Correct handling of the burr is associated with a lot of training. Wrong handling can lead to nonunion/malunion or necrosis. LEVELS OF EVIDENCE Therapeutic, Level IV: Case series.
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Affiliation(s)
- Sabine Krenn
- Orthopaedic Hospital Speising Vienna, Vienna, Austria (SK, PB, CM, MC, HJT).,Fußzentrum Vienna, Vienna, Austria (SA, HJT)
| | - Sascha Albers
- Orthopaedic Hospital Speising Vienna, Vienna, Austria (SK, PB, CM, MC, HJT).,Fußzentrum Vienna, Vienna, Austria (SA, HJT)
| | - Peter Bock
- Orthopaedic Hospital Speising Vienna, Vienna, Austria (SK, PB, CM, MC, HJT).,Fußzentrum Vienna, Vienna, Austria (SA, HJT)
| | - Clemens Mansfield
- Orthopaedic Hospital Speising Vienna, Vienna, Austria (SK, PB, CM, MC, HJT).,Fußzentrum Vienna, Vienna, Austria (SA, HJT)
| | - Michel Chraim
- Orthopaedic Hospital Speising Vienna, Vienna, Austria (SK, PB, CM, MC, HJT).,Fußzentrum Vienna, Vienna, Austria (SA, HJT)
| | - Hans-Joerg Trnka
- Orthopaedic Hospital Speising Vienna, Vienna, Austria (SK, PB, CM, MC, HJT).,Fußzentrum Vienna, Vienna, Austria (SA, HJT)
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Walther M, Chomej P, Kriegelstein S, Altenberger S, Röser A. [Minimally invasive cheilectomy]. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2018; 30:161-170. [PMID: 29696322 DOI: 10.1007/s00064-018-0543-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Revised: 11/26/2017] [Accepted: 11/27/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Treatment of hallux rigidus by minimally invasive resection of the dorsal osteophytes, synovectomy and resection of the dorsal part of the metatarsal head. INDICATIONS Hallux rigidus grades II and III CONTRAINDICATIONS: End-stage osteoarthritis of the first metatarsophalangeal joint with beginning ankylosis. SURGICAL TECHNIQUE Osteophytes around the metatarsophalangeal joint are removed using a 1 cm incision dorsomedial, approximately 3 cm proximal of the joint space. The dorsal third of the metatarsal head is resected with a burr to improve dorsiflexion. The extent of bone resection is checked with an image intensifier. Loose bone fragments removed with a rangeur. An arthroscopy can be performed to check the completeness of bone resection, the irrigation of the joint and, if needed, to extend the synovectomy. POSTOPERATIVE MANAGEMENT Removal of the sutures after 2 weeks. Depending on pain, the patient can change from the postoperative shoe to a normal soft, comfortable and wide shoe after 1-2 weeks. Nonsteroidal drugs can be prescribed as needed. Active and passive mobilization of the metatarsophalangeal joint is also recommended. RESULTS The technique allows a soft-tissue-preserving resection of the osteophytes and a partial resection of the metatarsal head. The main advantages are limited soft-tissue trauma and rapid rehabilitation. In all, 21 women and 17 men with hallux rigidus stages II and III (Vanore) underwent surgery. Minimum follow-up was 12 months. In 1 patient, injury of the extensor hallucis longus tendon was observed. Two patients underwent revision surgery. One patient was converted to a metatarsophalangeal fusion, while another patient received a resection arthroplasty. At the latest follow-up, the AOFAS (American Orthopaedic Foot & Ankle Society) score averaged 88.7 points.
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Affiliation(s)
- M Walther
- Zentrum für Fuß- und Sprunggelenkchirurgie, Schön Klinik München Harlaching - FIFA Medical Centre, Harlachinger Straße 51, 81547, München, Deutschland.
| | - P Chomej
- St. Elisabeth-Krankenhaus Leipzig, Leipzig, Deutschland
| | - S Kriegelstein
- Zentrum für Fuß- und Sprunggelenkchirurgie, Schön Klinik München Harlaching - FIFA Medical Centre, Harlachinger Straße 51, 81547, München, Deutschland
| | - S Altenberger
- Zentrum für Fuß- und Sprunggelenkchirurgie, Schön Klinik München Harlaching - FIFA Medical Centre, Harlachinger Straße 51, 81547, München, Deutschland
| | - A Röser
- Zentrum für Fuß- und Sprunggelenkchirurgie, Schön Klinik München Harlaching - FIFA Medical Centre, Harlachinger Straße 51, 81547, München, Deutschland
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Abstract
Many different distal metatarsal osteotomies have been described in the surgical treatment of metatarsalgia. The surgeon should use such osteotomies judiciously, and indeed, in the author's experience, they are infrequently required and are certainly not a first port of call. In cases where nonoperative treatments have failed, a thorough understanding of the causes of metatarsalgia and a detailed clinical assessment of the patient are essential if good surgical outcomes are to be achieved. If using distal metatarsal osteotomies as part of the surgical plan, then the author favors extra-articular percutaneous osteotomies to minimize postoperative stiffness.
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50
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Malagelada F, Dalmau-Pastor M, Fargues B, Manzanares-Céspedes MC, Peña F, Vega J. Increasing the safety of minimally invasive hallux surgery-An anatomical study introducing the clock method. Foot Ankle Surg 2018; 24:40-44. [PMID: 29413772 DOI: 10.1016/j.fas.2016.11.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 10/24/2016] [Accepted: 11/06/2016] [Indexed: 02/04/2023]
Abstract
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 26.2° medial to the medial border of the EHL tendon. (SD 11.26, range 14.5-45.5), whereas the average distance of the DLDN was 32.3° lateral to the medial border of the EHL tendon. (SD 6.29, range 13.5-40). CONCLUSIONS Using the clock method the DMDN and DLDN were found consistently between 10 o'clock and 2 o'clock in either right and left feet. The clock method may facilitate avoiding the area where these nerves are located serving as a valuable tool in minimally invasive foot surgery.
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Affiliation(s)
- Francesc Malagelada
- Foot and Ankle Unit, Orthopaedic and Trauma Surgery, Heatherwood and Wexham Park Hospitals, Frimley Health NHS Trust, Ascot, Berkshire, UK; Laboratory of Arthroscopic and Surgical Anatomy, Human Anatomy and Embryology Unit, Department of Pathology and Experimental Therapeutics, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain.
| | - Miki Dalmau-Pastor
- Laboratory of Arthroscopic and Surgical Anatomy, Human Anatomy and Embryology Unit, Department of Pathology and Experimental Therapeutics, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain; Faculty of Health Sciences at Manresa, University of Vic-Central University of Catalonia, Manresa, Barcelona, Spain.
| | - Betlem Fargues
- Laboratory of Arthroscopic and Surgical Anatomy, Human Anatomy and Embryology Unit, Department of Pathology and Experimental Therapeutics, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain.
| | - Maria Cristina Manzanares-Céspedes
- Laboratory of Arthroscopic and Surgical Anatomy, Human Anatomy and Embryology Unit, Department of Pathology and Experimental Therapeutics, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain.
| | - Fernando Peña
- Department of Orthopaedic Surgery, Foot and Ankle Unit, University of Minnesota, Minneapolis, MN, USA.
| | - Jordi Vega
- Laboratory of Arthroscopic and Surgical Anatomy, Human Anatomy and Embryology Unit, Department of Pathology and Experimental Therapeutics, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain; Foot and Ankle Unit, Hospital Quiron Barcelona, Barcelona, Spain.
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