1
|
Mansur H, Lucas PPA, Maranho DA. Treatment of Dynamic Claw Toe Deformity Through Lengthening of the Flexor Tendons of the Hallux and Toes at the Midfoot Level. Foot Ankle Spec 2024; 17:6S-12S. [PMID: 38124260 DOI: 10.1177/19386400231218338] [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: 12/23/2023]
Abstract
The claw toe deformity is characterized by the flexion of interphalangeal joints (IPJs) with hyperextension of the metatarsophalangeal (MTP) joint. It can be flexible and reducible or rigid and irreducible, or dynamic. The most common cause of dynamic claw toes is a neurological disorder, like sequelae of an ischemic contracture of the muscle belly after a compartment syndrome. Most of the surgical techniques require multiple procedures and may be associated with complications such as toe stiffness, persisting metatarsalgia, and toe malalignment. The aim of this study is to present an option for the surgical treatment of the dynamic claw toe deformity, by simultaneous tenodesis and lengthening of the flexor hallucis longus (FHL) and flexor digitorum longus (FDL) tendons at Henry's knot through a single midfoot incision.Levels of Evidence: V; Therapeutic Study; Expert Opinion.
Collapse
Affiliation(s)
- Henrique Mansur
- Department of Orthopaedics Surgery, Hospital Santa Helena and Hospital Regional do Gama, Distrito Federal, Brazil; Instituto Montenegro, Distrito Federal, Brazil
| | | | | |
Collapse
|
2
|
Bastías GF, Sage K, Orapin J, Schon L. Diaphyseal Proximal Phalangeal Shortening Osteotomy for Correction of Hammertoe Deformity: Operative Technique and Radiological Outcomes. Foot Ankle Spec 2024; 17:29-38. [PMID: 34142594 DOI: 10.1177/19386400211012800] [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: 11/17/2022]
Abstract
BACKGROUND Correction of hammertoe deformities at the proximal interphalangeal (PIP) joint results in an inherent loss of motion that can be a concern for active patients who want to maintain toe function and grip strength. Diaphyseal proximal phalangeal shortening osteotomy (DPPSO) is a joint-sparing procedure resecting a cylindrical portion of the proximal phalanx on the middiaphysis. PATIENTS/METHODS This was a retrospective review including patients treated using DPPSO with at least a 1-year follow-up. Demographic, comorbidity, and Visual Analogue Scale (VAS) scores and complication data were obtained. Radiological assessment included union status and alignment. Medial frontal anatomical (mFAA), frontal proximal interphalangeal (mFIA), plantar lateral anatomical (pLAA), and medial and plantar lateral interphalangeal angles (pLIA) were measured. RESULTS A total of 31 patients (45 toes) were included, with a mean age of 59 years (range: 24-72) and follow-up of 35 months (range: 12-60; mean preoperative VAS score was 4.9 ± 1.72 improving to 1.62 ± 2.28; P < .01). Union occurred in all patients at an average of 11.2 weeks. Complications were present on 4 toes (8.8%), with no recurrences. The pLIA significantly changed from 44.9° to 17.9°. There were no significant differences in the preoperative and postoperative values of the mFAA, pLAA, and mFIA. CONCLUSIONS DPPSO provides adequate pain relief and corrects the PIP joint in the lateral plane without significantly affecting the coronal plane or the anatomical axis of the phalanx in the frontal and lateral views, nor producing secondary deformities. DPPSO is a safe, effective, and reproducible technique with a low complication rate. LEVELS OF EVIDENCE Level IV: Retrospective case series.
Collapse
Affiliation(s)
- Gonzalo F Bastías
- Department of Orthopedic Surgery, Foot and Ankle Unit Clinica Las Condes, Hospital del Trabajador Hospital San Jose-Universidad de Chile, Santiago, Chile
| | - Katherine Sage
- Foot and Ankle Specialists, Grand Rapids, Michigan ßaculty Michigan State University
| | - Jakrapong Orapin
- Department of Orthopaedics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Lew Schon
- Institute of Foot and Ankle Reconstruction, Mercy Medical Center; Faculty MedStar Union Memorial Hospital; and Johns Hopkins School of Medicine; Baltimore, Maryland; New York University Langone, New York; and Georgetown School of Medicine, Washington, District of Columbia
| |
Collapse
|
3
|
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.
Collapse
Affiliation(s)
| | - Véronique Darcel
- Department of Orthopaedics, Maison de Santé Protestante de Bordeaux Bagatelle, Bordeaux, France.
| |
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
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.
Collapse
Affiliation(s)
- Véronique Darcel
- Service de chirurgie orthopédique et Traumatologique, maison de santé protestante de Bordeaux-Bagatelle, Bordeaux, France.
| | | |
Collapse
|
6
|
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.
Collapse
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
| |
Collapse
|
7
|
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.
Collapse
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
| |
Collapse
|
8
|
Štalc J, Cicchinelli LD, Miller S, Richter M. Fiber-reinforced fixation implant for proximal interphalangeal joint arthrodesis shows implant bio-integration at 1-year follow-up. Foot Ankle Surg 2022; 28:418-423. [PMID: 34247921 DOI: 10.1016/j.fas.2021.06.004] [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: 04/23/2021] [Revised: 06/08/2021] [Accepted: 06/20/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND A new bio-integrative fiber-reinforced implant (OSSIOfiber® Hammertoe Fixation Implant, OSSIO Ltd., Caesarea, Israel) was developed for proximal interphalangeal joint (PIPJ) correction-arthrodesis. The main purpose of this clinical study was to assess implant bio-integration at 1-year follow-up. METHODS Twenty-four patients, previously treated for a Hammertoe deformity using the bio-integrative, fiber-reinforced implant, were enrolled in this follow-up study. One-year follow-up included clinical examination, patient reported outcomes, radiographs, Magnetic Resonance Imaging (MRI) and bio-integration scoring. RESULTS Proximal interphalangeal joint (PIPJ) radiographic fusion rate was 92% (n = 22). MRI was analyzed for 24 (100%) patients. In 100% of patients (n = 24), the border between implant and surrounding tissue was scored as partially visible. There were no cyst formation or fluid accumulation findings. Mild bone edema was detected in 29% (n = 7) and is attributed to the chronic distribution of forces due to chronic abnormal gait and pasture. None of the edema findings were considered as adverse implant-related finding. The mean bio-integration score was 7.71 ± 0.46. CONCLUSIONS This study demonstrates safe bio-integration of the newly developed fiber-reinforced implant at 1-year follow-up without negative side effects.
Collapse
Affiliation(s)
- Jurij Štalc
- Valdoltra Orthopedic Hospital, Ankaran, Slovenia.
| | | | - Stuart Miller
- Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD, USA
| | - Martinus Richter
- Department for Foot and Ankle Surgery, Rummelsberg and Nuremberg, Germany
| |
Collapse
|
9
|
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.
Collapse
|
10
|
New method of surgical correction of lesser toes deformity. ACTA BIOMEDICA SCIENTIFICA 2021. [DOI: 10.29413/abs.2021-6.5.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background. Patients’ dissatisfaction with the results of surgical correction of lesser toes deformities, the shortcomings of methods aimed at eliminating the lateral deviation of the toe in the metatarsophalangeal joint necessitated the development of a new surgical method.The aim. To evaluate short-term results of the new surgical method for the treatment of patients with lesser toes deformity, accompanied with deviation of the toe.Materials and methods. A method of surgical treatment of deviated deformity of the small toes is proposed. The method includes precise marking of the metatarsal osteotomy line according to the previously calculated parameters of optimal shortening and displacement of the metatarsal bone, performing oblique diaphyseal osteotomy of the metatarsal bone, displacing its distal part along the osteotomy plane. According to the proposed method, nine patients were operated on who had a syndrome of nonrigid hammer-like deformity of the second toe with lateral deviation of the toe in the metatarsophalangeal joint. In all patients, the deformity of the second toe was associated with hallux valgus.Results. As a result of the application of the proposed method, it was possible to achieve deformity correction, eliminate the lateral deviation of the second toe in the metatarsophalangeal joint, restore congruence in the joint, achieve consolidation of bone fragments without loss of correction, and improve the appearance and function of the foot. Three months after the operation, a statistically significant improvement was determined, according to the AOFAS LMIS scale, having reached 94.5 ± 4.64 points, which made it possible to speak about the achievement of a good functional result of treatment. Patients noted the opportunity to wear standard footwear, to carry out their labor activity, to engage in physical culture, were satisfied with the result.Conclusion. The use of the proposed new surgical method for deflected deformity of the lesser toes makes it possible to correct the deformity, eliminate lateral deviation of the toe, relieve pain syndrome, achieve a good cosmetic and functional result, restoring the patients’ ability to wear standard shoes.
Collapse
|
11
|
Lesser toe deformity classification: A simplified approach with treatment influence. Foot (Edinb) 2021; 48:101819. [PMID: 34332395 DOI: 10.1016/j.foot.2021.101819] [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] [Received: 12/10/2020] [Accepted: 04/30/2021] [Indexed: 02/04/2023]
Abstract
Deformities of the lesser toes are one of the most commonly treated conditions by foot and ankle surgeons. Despite their frequency, a standardized classification has yet to take hold among providers. Generic nomenclature with the addition of multiple adjunctive descriptors continues to be the standard leading to international confusion. A literature review was conducted to analyze any literature and/or textbooks pertaining to lesser toe deformity classification systems. Seven sources met the inclusion criteria and were analyzed consisting of novel, modified, and previously published systems. A simplified and treatment driven lesser toe deformity classification utilized at the University of Louisville is introduced, which categorizes these deformities into one of two groups. Type 1 deformities are those isolated to the toe only and Type 2 deformities are toe deformities that include metatarsal phalangeal joint involvement. The intent of the University of Louisville Lesser Toe Deformity Classification (LTDC) is to improve communication and documentation, as well as assist surgical planning. LEVEL OF CLINICAL EVIDENCE: 5.
Collapse
|
12
|
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.
Collapse
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
| |
Collapse
|
13
|
Park YH, Kim W, Kim JY, Choi GW, Kim HJ. Impact of crossover second toe on the postoperative outcome of distal chevron osteotomy for moderate to severe hallux valgus. Foot Ankle Surg 2020; 26:845-850. [PMID: 31839479 DOI: 10.1016/j.fas.2019.10.012] [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: 08/08/2019] [Revised: 10/28/2019] [Accepted: 10/29/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Crossover second toe is often presented in moderate to severe hallux valgus. However, its clinical impact on the postoperative outcome of hallux valgus is still unknown. METHODS Thirty-five patients who had moderate to severe hallux valgus with crossover second toe were matched with 35 controls who did not have crossover second toe, according to preoperative hallux valgus angle and first-second intermetatarsal angle. Radiological parameters, Foot Function Index (FFI), and Visual Analog Scale (VAS) were assessed as postoperative outcomes at 3, 6, and 12 months after surgery. RESULTS At 3 months, the FFI in the crossover second toe group was lower than in the control group (p=0.001), while other outcomes were similar. On the other hand, there were no significant differences between the groups at 6 and 12 months, in terms of radiological parameters, FFI, and VAS. CONCLUSIONS Patients who had moderate to severe hallux valgus with crossover second toe were at risk for slow functional recovery after surgical treatment in the short term, but, in the long-term, there was no difference in overall postoperative outcomes in patients with and without crossover second toe. LEVEL OF EVIDENCE Level III, retrospective comparative study.
Collapse
Affiliation(s)
- Young Hwan Park
- Department of Orthopaedic Surgery, Korea University Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul, 08308, South Korea.
| | - Woon Kim
- Department of Orthopaedic Surgery, Korea University Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul, 08308, South Korea.
| | - Jae Young Kim
- Department of Orthopaedic Surgery, Korea University Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul, 08308, South Korea.
| | - Gi Won Choi
- Department of Orthopaedic Surgery, Korea University Ansan Hospital, 123 Jeokgeum-ro, Danwon-gu, Ansan, 15355, South Korea.
| | - Hak Jun Kim
- Department of Orthopaedic Surgery, Korea University Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul, 08308, South Korea.
| |
Collapse
|
14
|
Cicchinelli LD, Štalc J, Richter M, Miller S. Prospective, Multicenter, Clinical and Radiographic Evaluation of a Biointegrative, Fiber-Reinforced Implant for Proximal Interphalangeal Joint Arthrodesis. FOOT & ANKLE ORTHOPAEDICS 2020; 5:2473011420966311. [PMID: 35097414 PMCID: PMC8564933 DOI: 10.1177/2473011420966311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: A novel biointegrative implant was developed for proximal interphalangeal joint (PIPJ) arthrodesis to treat hammertoe deformity. Composed of continuous reinforcing mineral fibers bound by bioabsorbable polymer matrix, the implant demonstrated quiescent, gradual degradation with complete elimination at 104 weeks in animal models. This prospective trial assessed the implant’s safety, clinical performance, and fusion rate of PIPJ arthrodesis for hammertoe correction. Methods: Twenty-five patients (mean age 63.9±7.5 years) who required PIPJ arthrodesis were enrolled at 3 centers. Outcomes included radiographic joint fusion, adverse events, pain visual analog scale (VAS) score, Foot and Ankle Ability Measure (FAAM) Activities of Daily Living (ADL) score, and patient satisfaction. Patients were evaluated 2, 4, 6, 12, and 26 weeks postoperatively. Results: Twenty-two patients (88%) achieved radiographic fusion at 26 weeks. All joints (100%) were considered clinically stable, with no complications or serious adverse events. Pain VAS improved from 5.3±2.5 preoperatively to 0.5±1.4 at 26 weeks postoperatively. FAAM-ADL total scores and level of functioning improved by mean 19.5±19.0 points and 24.4±15.7 percentage points, respectively, from preoperation to 26 weeks postoperation. Improvements in pain VAS and FAAM scores surpassed established minimal clinically important differences. All patients were very satisfied (84%) or satisfied (16%) with the surgery. Patient-reported postoperative results greatly exceeded (72%), exceeded (20%), or matched (8%) expectations. Conclusion: This prospective, multicenter, first-in-human clinical trial of a novel biointegrative fiber-reinforced implant in PIPJ arthrodesis of hammertoe deformity demonstrated a favorable rate of radiographic fusion at 12 and 26 weeks, with no complications and good patient-reported clinical outcomes. Level of Evidence: Level IV, prospective case series.
Collapse
Affiliation(s)
| | - Jurij Štalc
- Service for Foot and Ankle Orthopaedics, Valdoltra Orthopedic Hospital, Ankaran, Slovenia
| | - Martinus Richter
- Department for Foot and Ankle Surgery, Rummelsberg and Nuremberg, Germany
| | - Stuart Miller
- Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD, USA
| |
Collapse
|
15
|
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.
Collapse
|
16
|
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.
Collapse
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
| |
Collapse
|
17
|
Abstract
Minimally invasive distal metatarsal diaphyseal osteotomy (DMDO) is an effective procedure for the treatment of complicated chronic diabetic foot ulcers under the heads of all lateral metatarsal bones (including the fifth). Resistant toe ulcers and recurrent pressure ulcers can be treated effectively by DMDO. For diabetic patients, the main advantages of this method are minimal surgical scars and tissue damage, immediately postoperative weight bearing, absence of osteosynthesis and consequent potential infection of metal fixation, reduction of the previous high plantar pressures by the restoration of a harmonic balanced forefoot arch, and rapid ulcer healing.
Collapse
Affiliation(s)
- Carlo Biz
- Department of Surgery, Oncology and Gastroenterology DiSCOG, Orthopedic and Traumatologic Clinic, University of Padova, Via Giustiniani 2, Padova 35128, Italy; GRECMIP-MIFAS (Groupe de Recherche et d'Etude en Chirurgie Mini-Invasive du Pied-Minimally Invasive Foot and Ankle Society), Merignac, France.
| | - Pietro Ruggieri
- Department of Surgery, Oncology and Gastroenterology DiSCOG, Orthopedic and Traumatologic Clinic, University of Padova, Via Giustiniani 2, Padova 35128, Italy
| |
Collapse
|
18
|
Wei B, Yao R, Amendola A. Anatomy of the Distal End of Flexor Digitorum Longus Tendon and Percutaneous Release Technique: A Cadaveric Study. FOOT & ANKLE ORTHOPAEDICS 2019; 4:2473011419884274. [PMID: 35097346 PMCID: PMC8697276 DOI: 10.1177/2473011419884274] [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] [Indexed: 11/25/2022] Open
Abstract
Background: The transfer of flexor-to-extensor is widely used to correct lesser toe deformity and joint instability. The flexor digitorum longus tendon (FDLT) is percutaneously transected at the distal end and then routed dorsally to the proximal phalanx. The transected tendon must have enough mobility and length for the transfer. The purpose of this study was to dissect the distal end of FDLT and identify the optimal technique to percutaneously release FDLT. Methods: Eight fresh adult forefoot specimens were dissected to describe the relationship between the tendon and the neurovascular bundle and measure the width and length of the distal end of FDLT. Another 7 specimens were used to create the percutaneous release model and test the strength required to pull out FDLT proximally. The tendons were randomly released at the base of the distal phalanx (BDP), the space of the distal interphalangeal joint (SDIP), and the neck of the middle phalanx (NMP). Results: At the distal interphalangeal (DIP) joint, the neurovascular bundle begins to migrate toward the center of the toe and branches off toward the center of the toe belly. The distal end of FDLT can be divided into 3 parts: the distal phalanx part (DPP), the capsule part (CP), and the middle phalanx part (MPP). There was a significant difference in width and length among the 3 parts. The strength required to pull out FDLT proximally was about 168, 96, and 20 N, respectively, for BDP, SDIP, and NMP. Conclusion: The distal end of FDLT can be anatomically described at 3 locations: DPP, CP, and MPP. The tight vinculum brevis and the distal capsule are strong enough to resist proximal retraction. Percutaneous release at NMP can be performed safely and effectively. Clinical Relevance: Percutaneous release at NMP can be performed safely and effectively during flexor-to-extensor transfer.
Collapse
Affiliation(s)
- Baofu Wei
- Department of Foot and Ankle Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Shandong, China
- Division of Sports Medicine, Department of Orthopedic Surgery, Duke University, NC, USA
- Authors contributed equally to this article
| | - Ruoyu Yao
- Department of Orthopedic, Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Authors contributed equally to this article
| | - Annunziato Amendola
- Division of Sports Medicine, Department of Orthopedic Surgery, Duke University, NC, USA
| |
Collapse
|
19
|
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.
Collapse
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
| |
Collapse
|