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Bobrov DS, Rigin NV, Lychagin AV, Artemov KD, Slinjakov LJ, Kachesov AV. Surgical Treatment of Metatarsalgia and Severe Instability of Lesser Metatarsophalangeal Joints. J Foot Ankle Surg 2024; 63:85-91. [PMID: 37714290 DOI: 10.1053/j.jfas.2023.09.003] [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] [Received: 10/20/2022] [Revised: 06/27/2023] [Accepted: 09/04/2023] [Indexed: 09/17/2023]
Abstract
The main object of this prospective cohort study was to compare surgical treatment options for primary metatarsalgia and the severe instability of lesser metatarsophalangeal joints. The outcomes of triple Weil osteotomy combined with direct plantar plate repair and triple Weil osteotomy, performed with proximal interphalangeal joint arthrodesis, are analyzed and compared. One hundred thirteen patients (117 feet) were enrolled in the study. They were split into 2 groups. In the first group, undergoing Weil osteotomy, combined with the plantar plate repair, good results, including complete pain reduction, elimination of hyperkeratosis, and American Orthopedic Foot and Ankle Society Score improvement, were achieved in 84.7% of the cases. The second group, where the combination of Weil osteotomy and proximal interphalangeal joint K-wire arthrodesis was used, demonstrated good results in 52.4% of the cases. Weil osteotomy, combined with the plantar plate repair, achieves better results in comparison to osteotomy, performed with the interphalangeal joint arthrodesis.
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Affiliation(s)
- Dmitry S Bobrov
- The Department of Traumatology, Orthopedics and Disaster Surgery, Sechenov University, Botkin City Clinical Hospital, Moscow, Russian Federation
| | | | - Alexey V Lychagin
- The Department of Traumatology, Orthopedics and Disaster Surgery, Sechenov University, Botkin City Clinical Hospital, Moscow, Russian Federation
| | - Kirill D Artemov
- The Department of Traumatology, Orthopedics and Disaster Surgery, Sechenov University, Botkin City Clinical Hospital, Moscow, Russian Federation.
| | | | - Anton V Kachesov
- University clinic of Privolzhsky Research Medical University, Nizhny Novgorod, Russian Federation
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Piclet-Legré B, Darcel V. Toes Deformities in Cavovarus: How to Approach Them. Foot Ankle Clin 2023; 28:743-757. [PMID: 37863532 DOI: 10.1016/j.fcl.2023.06.005] [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: 10/22/2023]
Abstract
Sagittal lesser toe deformities (LTD) are the most common in cavus foot. They are mainly the result of muscular imbalance between intrinsic and extrinsic muscles. Surgery is the second-line treatment if medical treatment fails. The aim of the present study was to provide an update on classification and surgical management of LTD in cavus foot including percutaneous procedures with a special focus on sagittal deformities. Joint sparing procedures are preferred for reducible LTD, whereas lesser toe fusions are used for rigid one in association with tendon transfer or percutaneous procedures depending of surgeon's experience and patient's clinical examination.
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Affiliation(s)
| | - Véronique Darcel
- Department of Orthopaedics, Maison de Santé Protestante de Bordeaux Bagatelle, Bordeaux, France.
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Mohaddis M, Maqsood SA, Ago E, Singh S, Naim Z, Prasad S. Enhancing Functional Rehabilitation Through Orthotic Interventions for Foot and Ankle Conditions: A Narrative Review. Cureus 2023; 15:e49103. [PMID: 38024022 PMCID: PMC10659571 DOI: 10.7759/cureus.49103] [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] [Accepted: 11/19/2023] [Indexed: 12/01/2023] Open
Abstract
Non-surgical, conservative approaches to foot and ankle conditions are of important consideration. Orthotics play a significant role in treating these conditions, preventing progression, and alleviating pressure on affected areas, thereby promoting normal gait. This article aims to assess the utility and effectiveness of various orthotic treatments in different clinical scenarios. We reviewed 27 peer-reviewed articles using electronic databases, employing keywords such as "orthoses," "orthotic treatment," "arthritis," "neuropathy," and "foot and ankle trauma." Studies conducted in recent decades have explored the effectiveness of orthoses in various conditions, including connective tissue disorders, tendon and ligament injuries, foot arthritis, neuropathic and inflammatory wounds, and sports-related recurrent injuries. Orthotic management has proven effective across diverse foot and ankle conditions. Integrating orthotic treatment with systemic approaches benefits patients with foot and ankle disorders. We believe this review can be utilised by clinicians in the management of foot and ankle disorders.
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Affiliation(s)
- Momin Mohaddis
- Trauma and Orthopaedics, Warrington and Halton Hospitals NHS Trust, Liverpool, GBR
| | - Saad A Maqsood
- Trauma and Orthopaedics, Warrington and Halton Hospitals NHS Trust, Liverpool, GBR
| | - Emmanuel Ago
- Trauma and Orthopaedics, Warrington and Halton Hospitals NHS Trust, Liverpool, GBR
| | - Sushmit Singh
- Trauma and Orthopaedics, Warrington and Halton Hospitals NHS Trust, Liverpool, GBR
| | - Zahra Naim
- General Practice, Shadan Institute of Medical Sciences, Hyderabad, IND
| | - Seema Prasad
- Trauma and Orthopaedics, Warrington and Halton Hospitals NHS Trust, Liverpool, GBR
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Kakagia DD, Karadimas EJ, Stouras IA, Papanas N. The Ageing Foot. INT J LOW EXTR WOUND 2023:15347346231203279. [PMID: 37750199 DOI: 10.1177/15347346231203279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
Feet suffer significant stress throughout a lifetime and undergo ageing-associated problems due to gradual tissue degeneration affecting the skin, connective tissue, and nerves. Oxygen supply to the tissues may be diminished. The skin gets dry and calluses, ulcers and fungal infections of the skin and nails are not uncommon. Ligaments and tendons degenerate and, without proper prevention, deformities including claw toes, hammer toes, tendonitis, and bursitis may occur. Skeletal toe deformities such as bunions, bony spurs, and hallux valgus may increase discomfort, while stress fractures may have an adverse impact on the patients' quality of life. The ageing foot pathology may add up to common age-related problems, such as crystal deposition arthropathies, diabetes mellitus, peripheral circulatory disorders, and peripheral edema, increasing morbidity. This review summarizes ageing-related feet problems, focusing on prevention and treatment. Foot health has a paramount role in overall wellbeing, therefore prevention, proper foot care, and prompt diagnosis and management of ageing-related changes are vital for maintaining a healthy, active status.
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Affiliation(s)
- Despoina D Kakagia
- Department of Plastic Surgery, Democritus University of Thrace, Alexandroupolis, Greece
| | | | | | - Nikolaos Papanas
- Diabetes Centre-Diabetic Foot Clinic, Second Department of Internal Medicine, Democritus University of Thrace, Alexandroupolis, Greece
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Du W, Zhou W, Zhou L, Wang Y, Yan C, Al-Aroomi MA, Pang P, Sun C. Donor-site morbidity of free fibula flap in pediatric patients: A systematic review and meta-analysis. J Plast Reconstr Aesthet Surg 2023; 83:207-214. [PMID: 37276738 DOI: 10.1016/j.bjps.2023.04.048] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 04/01/2023] [Accepted: 04/11/2023] [Indexed: 06/07/2023]
Abstract
The morbidity of free fibula flap (FFF) in pediatric patients has gained attention. Thus, we aimed to evaluate donor-site morbidity after FFF harvesting in pediatric patients and its relationship with age. A systematic literature search of databases for cross-sectional studies related to pediatric donor-site morbidity after FFF harvesting was performed. Two independent reviewers evaluated relevant article titles and abstracts to extract data regarding donor-site morbidity from each article. Fifteen studies were included in the meta-analysis that evaluated the rate of complications. Individual cases of ankle instability were divided into the 0-13- and 13-17-year-old groups. The Chi-square test was used to compare ankle instability between both groups. A logistic regression model was created to analyze the relationships between age and ankle instability/claw toe. Sixteen English articles published between 2007 and 2021 were included in the systematic review. Information on morbidities of 294 cases in which FFF was used was collected. The mean incidence rate of complications, instability, claw toe, and nerve injury were 19.3%, 12.9%, 5.9%, and 5.1%, respectively. Bivariate analysis showed that age was significantly correlated with the incidence of ankle instability but not with the incidence of claw toe. The Chi-square test showed that the incidence rate of ankle instability between the age groups was significantly different. Therefore, we recommend 14 years of age as a new predictive factor for ankle instability. Nevertheless, there is limited evidence in this field, and more pediatric research is needed to clarify these findings.
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Affiliation(s)
- Weidong Du
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, China Medical University, No. 117, Nanjing Bei Street, Heping District, Shenyang, Liaoning 110002, People's Republic of China.
| | - Wanghang Zhou
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, China Medical University, No. 117, Nanjing Bei Street, Heping District, Shenyang, Liaoning 110002, People's Republic of China.
| | - Lu Zhou
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, China Medical University, No. 117, Nanjing Bei Street, Heping District, Shenyang, Liaoning 110002, People's Republic of China.
| | - Yao Wang
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, China Medical University, No. 117, Nanjing Bei Street, Heping District, Shenyang, Liaoning 110002, People's Republic of China.
| | - Cong Yan
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, China Medical University, No. 117, Nanjing Bei Street, Heping District, Shenyang, Liaoning 110002, People's Republic of China.
| | - Maged Ali Al-Aroomi
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, China Medical University, No. 117, Nanjing Bei Street, Heping District, Shenyang, Liaoning 110002, People's Republic of China.
| | - Pai Pang
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, China Medical University, No. 117, Nanjing Bei Street, Heping District, Shenyang, Liaoning 110002, People's Republic of China.
| | - Changfu Sun
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, China Medical University, No. 117, Nanjing Bei Street, Heping District, Shenyang, Liaoning 110002, People's Republic of China.
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Darcel V, Piclet-Legré B. Lesser-toe deformity. Orthop Traumatol Surg Res 2023; 109:103464. [PMID: 36942795 DOI: 10.1016/j.otsr.2022.103464] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 06/01/2022] [Accepted: 06/01/2022] [Indexed: 11/05/2022]
Abstract
Lesser-toe deformity is frequent and varied, with severe functional impact. In elderly subjects, it leads to loss of autonomy and increases the risk of falls. The aim of the present study was to provide an update on management, addressing 5 questions. What are the normal anatomy and pathophysiology? These acquired deformities mainly result from imbalance between the intrinsic and extrinsic muscles of the foot or from capsule-ligament stabilizer failure. How to analyze the deformity? It is important to identify the cause, site, reducibility and metatarsophalangeal joint stability. What are the main deformities and how should they be classified? Classifications used to be based on confusing terminology as the deformities were poorly defined. The French Foot Surgery Association (AFCP) therefore validated a classification with standardized, exhaustive and reproducible morphologic descriptions. What treatments are there? Treatment needs to take account of the cause. Footwear adaptation, physiotherapy and podologic measures are in first line, with surgery in second line. Surgery concerns soft tissues (tendon lengthening, tendon transfer, arthrolysis, plantar plate repair), bone (metatarsal and phalangeal osteotomy) and joints (replacement and fusion), with percutaneous and open approaches. What are the treatment strategies? Surgery is performed sequentially, from proximal to distal, if necessary. Options are set out in the decision-trees included in this article. LEVEL OF EVIDENCE: V, expert opinion.
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Affiliation(s)
- Véronique Darcel
- Service de chirurgie orthopédique et Traumatologique, maison de santé protestante de Bordeaux-Bagatelle, Bordeaux, France.
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Tobimatsu H, Ikari K, Yano K, Okazaki K. Radiographic factors associated with painful callosities after forefoot surgery in patients with rheumatoid arthritis. Mod Rheumatol 2023; 33:104-110. [PMID: 34939107 DOI: 10.1093/mr/roab131] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 12/03/2021] [Accepted: 12/21/2021] [Indexed: 01/05/2023]
Abstract
OBJECTIVES Operative procedures for rheumatoid forefoot deformities have gradually changed from arthrodesis or resection arthroplasty to joint-preserving surgery. Although joint-preserving arthroplasty has yielded good outcomes, painful plantar callosities may occur post-operatively. This study aimed to reveal the radiographic factors associated with painful callosities after joint-preserving surgery for forefoot deformities in patients with rheumatoid arthritis (RA). METHODS We retrospectively evaluated 166 feet in 133 patients with RA who underwent forefoot joint-preserving arthroplasty, including proximal rotational closing-wedge osteotomies of the first metatarsal, between January 2012 and December 2015. Logistic regression analysis was performed with the objective variable set as the presence/absence of painful plantar callosities at the final observation and the explanatory variables set as several radiographic factors, including post-operative relative first metatarsal length (RML), amount of dorsal dislocation of the fifth metatarsal (5DD), and arc failure of the lesser toes. RESULTS At the final follow-up, 42 of the 166 feet (25.3%) had painful callosities under the metatarsal heads post-operatively. Logistic regression analysis showed that the RML, 5DD, and lesser toes' arc failure were significantly associated with painful callosities. CONCLUSIONS We identified that RML, 5DD, and arc failure of the lesser toes were associated with painful plantar callosities after the surgery.
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Affiliation(s)
- Haruki Tobimatsu
- Department of Orthopedic Surgery, Tokyo Women's Medical University, Tokyo 162-8666, Japan.,Institute of Rheumatology, Tokyo Women's Medical University Hospital, Tokyo 162-8666, Japan
| | - Katsunori Ikari
- Department of Orthopedic Surgery, Tokyo Women's Medical University, Tokyo 162-8666, Japan.,Institute of Rheumatology, Tokyo Women's Medical University Hospital, Tokyo 162-8666, Japan.,Division of Multidisciplinary Management of Rheumatic Diseases, Tokyo Women's Medical University, Tokyo 162-8666, Japan
| | - Koichiro Yano
- Department of Orthopedic Surgery, Tokyo Women's Medical University, Tokyo 162-8666, Japan.,Institute of Rheumatology, Tokyo Women's Medical University Hospital, Tokyo 162-8666, Japan
| | - Ken Okazaki
- Department of Orthopedic Surgery, Tokyo Women's Medical University, Tokyo 162-8666, Japan
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Risks of injury in distal metatarsal minimally invasive osteotomy when comparing standard and modified techniques: A cadaveric study. Foot Ankle Surg 2022; 28:956-961. [PMID: 35153129 DOI: 10.1016/j.fas.2022.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 12/06/2021] [Accepted: 01/19/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND The objectives of the study were to evaluate the structures at risk in distal metatarsal mini-invasive osteotomy (DMMO) and to compare standard and intraosseous approaches. METHODS DMMO was performed on the second and fourth metatarsals of 11 fresh-frozen cadaveric specimens. The standard technique was performed in 11 metatarsals. It was then compared to a modified intraosseous technique that entails starting inside the bone in 11 other metatarsals. The cadavers were dissected to identify unintentional injury to soft tissue structures. RESULTS In the standard group the most injured structures were the metatarsal joint capsules (MJC) (27%), extensor digitorum longus (EDL) (18%), and extensor digitorum brevis (EDB) (9%). The modified intraosseous group injured the EDL (27%), not the MJC (0%) and the EDB (0%). Distances between osteotomies and the dorsal metatarsal head articular surface (DMHAS) were 6.08 ± 3.99 mm in the standard and 9.92 ± 3.42 mm in the modified (p = 0.02). CONCLUSION The DMMO techniques most frequently injured the EDL. Intra-articular positioning of the osteotomy was more observed in the standard. Overall, it appears the modified method could be an alternative to the standard DMMO. CLINICAL RELEVANCE The modified minimally invasive DMMO has a comparable rate of potential iatrogenic injuries. This intraosseous procedure may present as an option when planning surgery to the lesser metatarsals. LEVEL OF EVIDENCE Level III. Comparative Cadaveric Study.
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Flexor tenodesis procedure in the treatment of lesser toe deformities. Arch Orthop Trauma Surg 2022; 142:3125-3137. [PMID: 33974142 PMCID: PMC9522816 DOI: 10.1007/s00402-021-03942-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 05/03/2021] [Indexed: 11/16/2022]
Abstract
In this technical report study, we describe the use of a flexor tenodesis procedure in the treatment of lesser toe deformities (LTD). Using a specific implant, both the flexor digitorum longus and brevis tendons are attached to the plantar aspect of the proximal phalanx, allowing dynamic correction of flexible deformities of metatarsophalangeal and interphalangeal joints. Good clinical results and absence of complications were observed in a series of 3 patients, with considerable correction of the LTD, and absence of substantial residual floating toe or metatarsophalangeal joint stiffness. LEVEL OF EVIDENCE: V - Technical Report/Case Report/Expert Opinion.
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Ray J, Andrews NA, Dib A, Harrelson WM, Khurana A, Singh MS, Shah A. Management of acute lesser toe pain. Postgrad Med 2021; 133:320-329. [PMID: 33406375 DOI: 10.1080/00325481.2021.1873581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Patients with foot pain commonly present to their primary care physicians for their initial management and treatment. These patients and their respective foot or lesser toe pain can present the physician with a complex problem with a long differential list. Depending on the timing of the pain and underlying pathology, these differentials can be divided into acute and acute exacerbation of chronic conditions. This review categorizes the history, physical exam, radiological findings, conservative treatment, and surgical management for each major cause of lesser toe pain, whether acute or chronic. The acute conditions surrounding lesser toe pain in the adult population discussed are toe fractures, toe dislocations, and metatarsal head and neck fractures. The chronic pathologies surrounding lesser toe pain in the adult population evaluated in this review include metatarsalgia, Morton's neuroma, Freiberg infraction, brachymetatarsia, bunionettes, and lesser toe disorders.
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Affiliation(s)
- Jessyca Ray
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Nicholas A Andrews
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Aseel Dib
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Whitt M Harrelson
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ankit Khurana
- Department of Orthopaedic Surgery, Dr. BSA Medical College, Delhi, India
| | - Maninder Shah Singh
- Department of Orthopaedic Surgery, Indian Spinal Injuries Centre, Delhi, India
| | - Ashish Shah
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
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Wei RX, Ling SK, Lui TH, Yung PS. Ideal implant choice for proximal interphalangeal joint arthrodesis in hammer toe/claw toe deformity correction: A systematic review. J Orthop Surg (Hong Kong) 2020; 28:2309499020911168. [PMID: 32223520 DOI: 10.1177/2309499020911168] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Intramedullary devices have been developed to reduce the problems associated with Kirschner (K)-wire fixation in proximal interphalangeal joint (PIPJ) arthrodesis. The purpose of this systematic review is to compare the surgical outcomes of K-wires versus novel internal fixation devices in PIPJ arthrodesis in claw/hammer toe surgery. The databases searched were PubMed, Scopus, Cochrane, and Embase with keywords "claw toe OR hammer toe" AND "proximal interphalangeal OR PIP" AND "fusion OR arthrodesis." Clinical trials published in English with evidence levels I, II, and III were included. Five studies, including one randomized controlled trial and four case-controlled studies, were identified to meet the inclusion criteria. Overall, the studies showed promising results in union rates using the novel internal devices compared to K-wires. However, the novel internal devices seem not to present advantages in clinical parameters such as pain levels, patient satisfaction, foot-related function, or surgical complication rates.
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Affiliation(s)
- Rachel Xy Wei
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong SAR
| | - Samuel Kk Ling
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong SAR
| | - T H Lui
- Department of Orthopaedics and Traumatology, North District Hospital, Hong Kong SAR
| | - Patrick Sh Yung
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong SAR
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Splay Toe after Freiberg-Köhler's Osteonecrosis: A Case Report of a Successful Operative Treatment in a Rare Multiplanar Foot Deformity. Case Rep Orthop 2020; 2020:8830166. [PMID: 33294244 PMCID: PMC7700055 DOI: 10.1155/2020/8830166] [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: 08/26/2020] [Revised: 10/29/2020] [Accepted: 11/05/2020] [Indexed: 11/18/2022] Open
Abstract
"Splay toe" is a rare deformity of the forefoot and often causes the occurrence of metatarsalgia and dysfunction while walking or weight bearing. Since it involves a deviation in the sagittal and transversal planes, often combined with a malrotation, surgical correction can be challenging. We describe a case of splay toe deformity in the forefoot causing metatarsalgia in a 62-year-old female patient with a former avascular osteonecrosis of the 2 metatarsal head Smillie stage V of Freiberg-Köhler's disease causing a splay toe between the 2nd and the 3rd rays. There are only few reports in the literature, and a clear treatment strategy has not been defined, yet, although, it has been described that most of these patients are operated more than once. In the presented case, we performed a successful treatment by a combined surgical technique consisting in modified Weil's osteotomy and the transfer of the extensor brevis tendon. We sustain that for correction of a multiplanar deformity of lesser toe deformities osseous correction as well as tendon transfer lead to successful therapy.
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Abstract
Historically, metatarsalgia was approached as a forefoot condition, most often associated with hallux valgus. Consequently, surgical treatments were limited to that anatomic zone, disregarding more proximal structures. In order to assess this entity properly, it is necessary to consider anatomic and biomechanical factors, as well as general and local conditions of the affected patients. A thorough understanding of the multiple potential causal factors is essential to ensure selection of the optimal treatment.
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Affiliation(s)
- Valeria Lopez
- Department of Foot and Ankle Surgery, J Slullitel Institute of Orthopaedics, San Luis 2534, Rosario 2000, Santa Fe, Argentina.
| | - Gastón Slullitel
- Department of Foot and Ankle Surgery, J Slullitel Institute of Orthopaedics, San Luis 2534, Rosario 2000, Santa Fe, Argentina
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