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Watanabe K, Kubota M, Tanaka H, Nishiyama T, Hirao M, Fukushi JI, Kakihana M, Nozawa D, Okuda R. Japanese Orthopaedic Association (JOA) Clinical Practice Guidelines on the Management of Hallux Valgus - Secondary publication. J Orthop Sci 2024; 29:1-26. [PMID: 37451976 DOI: 10.1016/j.jos.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 06/14/2023] [Indexed: 07/18/2023]
Affiliation(s)
- Kota Watanabe
- Committee of Clinical Practice Guideline on Hallux Valgus, Japan; Department of Physical Therapy, Sapporo Medical University School of Health Sciences, Sapporo, Japan.
| | - Makoto Kubota
- Committee of Clinical Practice Guideline on Hallux Valgus, Japan; Department of Orthopaedic Surgery, Katsushika Medical Center, The Jikei University School of Medicine, Tokyo, Japan
| | - Hirofumi Tanaka
- Committee of Clinical Practice Guideline on Hallux Valgus, Japan; Hyakutake Orthopedic Surgery and Sports Clinic, Saga, Japan
| | - Takayuki Nishiyama
- Committee of Clinical Practice Guideline on Hallux Valgus, Japan; Department of Orthopaedic Surgery, Kakogawa Central City Hospital, Kakogawa, Japan
| | - Makoto Hirao
- Committee of Clinical Practice Guideline on Hallux Valgus, Japan; Department of Orthopaedics, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Jun-Ichi Fukushi
- Committee of Clinical Practice Guideline on Hallux Valgus, Japan; Department of Orthopaedic Surgery, Clinical Research Center, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Masataka Kakihana
- Committee of Clinical Practice Guideline on Hallux Valgus, Japan; Department of Orthopaedic Surgery, Dokkyo Medical University, Saitama Medical Center, Koshigaya, Japan
| | - Daisuke Nozawa
- Committee of Clinical Practice Guideline on Hallux Valgus, Japan; Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Ryuzo Okuda
- Committee of Clinical Practice Guideline on Hallux Valgus, Japan; Department of Orthopaedic Surgery, Rakusai-Shimizu Hospital, Kyoto, Japan
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Sharpe BD, Ebaugh MP, Philbin TM, Prissel MA, Hyer CF, Berlet GC, Goss DA. Direct Plantar Approach to Plantar Plate Repair and Associated Wound Complications. Foot Ankle Spec 2022:19386400221118500. [PMID: 36004609 DOI: 10.1177/19386400221118500] [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] [Indexed: 11/17/2022]
Abstract
BACKGROUND Lesser toe metatarsophalangeal joint (MTPJ) instability, secondary to plantar plate tear, has been the focus of numerous recent publications, the majority reporting on repair through a dorsal approach. A plantar approach has been described with the advantage of direct ligamentous repair or repair to bone, which follows conventional techniques employed throughout the body. Previous clinical studies have shown success in deformity correction and the longevity of both approaches. The proponents of the dorsal approach advocate that indirect repair of the plantar plate avoids perceived risks of complications with a plantar incision without evidence of superior outcomes. The purpose of this study was to investigate the safety and efficacy of the direct plantar approach to plantar plate repairs (PPRs) by reporting the rate of specific complications in a large clinical series. METHODS This was the institutional review board (IRB) approved retrospective study of 204 PPRs in 185 patients (194 lesser MTP, 10 hallux MTP) with an average age of 56 and a mean body mass index (BMI) of 28. Surgical technique involved repair with absorbable braided suture (88%) versus suture anchor (12%) with or without MTPJ pinning (80%). Mean follow up was 53 weeks (range 5-170). Patients were screened for associated risk factors, including diabetes mellitus (8%), tobacco use (5%), neuropathy (1%), and additional concurrent procedures (96%). Complications were defined as superficial or deep infection, painful scars, and reoperation. Analysis was conducted using the Wilcoxon-Mann-Whitney test or Fisher's exact tests for continuous and categorical variables, respectively. Risk factors were analyzed using univariate logistic analysis to produce odds ratios (OR) with a 95% confidence interval (CI) and an inclusion criterion of a P-value, P > .2 for multivariate analysis as determined by Wald tests (significance at P < .05 for final modeling). RESULTS Overall, there were 31 total complications (15%) demonstrated by 14 superficial infections (6.8%) and 17 painful scars (8.3%) along with three reoperations (1.4%). All reoperations were performed for deformity or instability, not scar revision. There were no deep infections. No increased odds of complications were found with suture anchor repair, MTPJ pinning, neuropathy, or diabetes. Patients that used tobacco had 7.5 (CI 1.66, 34.06) the odds of developing any wound complication compared with nonsmokers. Tobacco use was also found to significantly increase the odds of superficial infection by 9.8 (CI 2.08, 46.15). There was no increase in painful scars or reoperation in tobacco users. This study did not find an increased complication rate with additional ipsilateral procedures performed at the time of surgery. CONCLUSION To our knowledge, this is the largest study evaluating the direct plantar approach to PPR as well as the evaluation of associated complications with the plantar incision. With low complication and minimal reoperation rates, the results of this study have demonstrated the clinical viability of plantar-based incisions. Previous studies have demonstrated the success of PPR and correction of deformity with a direct approach. This case series further demonstrates the safety and efficacy of plantar-based incisions, particularly for direct PPRs. LEVEL OF EVIDENCE IV Retrospective Case Series. CATEGORY Lesser Toes.
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Affiliation(s)
- B Dale Sharpe
- University of Virginia Health Systems, Charlottesville, Virginia
| | - M Pierce Ebaugh
- Department of Orthopedics, Jewett Orthopedic Institute at Orlando Health, Orlando, Florida
| | | | | | | | | | - David A Goss
- Associates in Orthopedics and Sports Medicine, Dalton, Georgia
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Marcoux JT, Tong L. Fibrocartilaginous Tissue: Why Does It Fail to Heal? Clin Podiatr Med Surg 2022; 39:437-450. [PMID: 35717061 DOI: 10.1016/j.cpm.2022.02.005] [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: 11/29/2022]
Abstract
Tendons and ligaments are critical components in the function of the musculoskeletal system, as they provide stability and guide motion for the biomechanical transmission of forces into bone. Several common injuries in the foot and ankle require the repair of ruptured or attenuated tendon or ligament to its osseous insertion. Understanding the structure and function of injured ligaments and tendons is complicated by the variability and unpredictable nature of their healing. The healing process at the tendon/ligament to bone interface is challenging and often frustrating to foot and ankle surgeons, as they have a high failure rate necessitating the need for revision.
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Affiliation(s)
- John T Marcoux
- Division of Podiatry, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 185 Pilgrim Road, Span 3, Boston, MA 02215, USA.
| | - Lowell Tong
- Division of Podiatry, Department of Surgery, Beth Israel Deaconess Medical Center, 185 Pilgrim Road, Span 3, Boston, MA 02215, USA
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4
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Operative Management: Plantar Plate. Clin Podiatr Med Surg 2022; 39:489-502. [PMID: 35717065 DOI: 10.1016/j.cpm.2022.02.009] [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: 11/23/2022]
Abstract
The plantar plate is a vital structure for maintaining lesser metatarsophalangeal joint (MPJ) stability. Its primary role is to provide static stabilization of the MPJs, working in conjunction with the long and short flexor and extensor tendons. When insufficiency or attenuation of the plantar plate occurs, a sagittal plane deformity will slowly develop, eventually leading to a "crossover toe" transverse plane deformity. Coughlin coined this descriptive term to describe the later stages of deformity, most commonly affecting the second MPJ. Shortly after, Yu and Judge elaborated on this condition describing it as "predislocation syndrome," an inflammatory condition affecting the plantar plate causing pain and instability, which could progress to subluxation at the MPJ.
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Cooke R, Manning C, Palihawadana D, Zubairy AI, Khan SH. Metatarsalgia: anatomy, pathology and management. Br J Hosp Med (Lond) 2021; 82:1-8. [PMID: 34601927 DOI: 10.12968/hmed.2021.0348] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Metatarsalgia is a common presentation, particularly in middle-aged women. This review discusses the anatomical basis and classifies the different pathologies into primary, secondary and iatrogenic. The key elements to differentiate the pathologies within each classification which could cause a patient to suffer with metatarsalgia are outlined. Further investigations are briefly covered, but a linked article discusses the investigations of metatarsalgia in more detail. The article gives an overview of metatarsalgia to help clinicians to investigate and manage these symptoms.
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Affiliation(s)
- Robert Cooke
- Department of Trauma and Orthopaedics, East Lancashire Hospitals NHS Trust, Blackburn, UK
| | - Christopher Manning
- Department of Trauma and Orthopaedics, East Lancashire Hospitals NHS Trust, Blackburn, UK
| | - Dhanushka Palihawadana
- Department of Trauma and Orthopaedics, East Lancashire Hospitals NHS Trust, Blackburn, UK
| | - Aamir I Zubairy
- Department of Trauma and Orthopaedics, East Lancashire Hospitals NHS Trust, Blackburn, UK
| | - Shah Hm Khan
- Department of Radiology, East Lancashire Hospitals NHS Trust, Blackburn, UK
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Viyasar T, Manning C, Cooke R, Zubairy AI, Khan SH. Imaging in metatarsalgia. Br J Hosp Med (Lond) 2021; 82:1-7. [PMID: 34601938 DOI: 10.12968/hmed.2021.0353] [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: 11/11/2022]
Abstract
Metatarsalgia is a common clinical conundrum that requires careful assessment. There are a variety of causes and understanding these can help manage the pain. These causes have different imaging characteristics and require specific imaging. By understanding core imaging principles and how they apply to causes of metatarsalgia, pathology can be more efficiently investigated. This article covers primary, secondary and iatrogenic causes of metatarsalgia with the most appropriate imaging modalities for each and the salient imaging findings. This article reviews the common forefoot pathologies and how they may be optimally radiologically investigated, with an emphasis on the key imaging findings.
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Affiliation(s)
- Thevarajah Viyasar
- Department of Radiology, East Lancashire Hospitals NHS Trust, Blackburn, UK
| | - Christopher Manning
- Department of Orthopaedics, East Lancashire Hospitals NHS Trust, Blackburn, UK
| | - Robert Cooke
- Department of Orthopaedics, East Lancashire Hospitals NHS Trust, Blackburn, UK
| | - Aamir I Zubairy
- Department of Orthopaedics, East Lancashire Hospitals NHS Trust, Blackburn, UK
| | - Shah Hm Khan
- Department of Radiology, East Lancashire Hospitals NHS Trust, Blackburn, UK
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Is Second Metatarsal Protrusion Related to Metatarsophalangeal Plantar Plate Rupture? AJR Am J Roentgenol 2020; 216:132-140. [PMID: 33236946 DOI: 10.2214/ajr.19.22563] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE. The purpose of this study was to determine whether the relative length of protrusion of the second metatarsal, measured on MRI and weight-bearing foot radiography, predicts the diagnosis of second metatarsophalangeal (MTP) joint plantar plate (PP) tear on MRI. MATERIALS AND METHODS. We retrospectively evaluated 166 consecutive patients (211 feet). Patients had undergone weight-bearing foot radiography and forefoot MRI. Using the Coughlin method, two independent observers measured second meta-tarsal protrusion length on radiography and MRI. MRI findings were classified as normal PP, complete PP tear, or degenerative or partial PP tear. RESULTS. Patients had a mean age of 47 ± 14.6 (SD) years, and 131 (78.9%) were women. MRI measurements were highly correlated with radiographic measurements (r = 0.882; 95% CI, 0.866-0.898; p < 0.001). A significant correlation was found between length of protrusion and cases classified as either normal PP or PP tear. Patients with a normal PP had a mean protrusion length of 4.11 ± 1.35 mm on radiographs and 2.61 ± 1.31 mm on MR images, whereas those with a PP tear had a mean protrusion length of 4.75 ± 1.53 and 3.05 ± 1.34 mm, respectively. ROC curve analysis showed that protrusion length cutoff values of 5.47 mm measured on radiographs and 3.17 mm on MR images were correlated with MTP PP tear. CONCLUSION. We identified a linear correlation between second metatarsal protrusion measured on MRI and that measured on radiography, with values about 35% higher for the latter. Our study showed an association between length of protrusion of the second metatarsal and PP rupture and identified a cutoff value for the second meta-tarsal overlength that is associated with these tears.
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Kindred KB, Rusher A, Baker A, Groh CN, Fink BR. Outcomes Study of an Innovative Method of Direct Repair of Metatarsophalangeal Joint Instability With an Angiocatheter Needle. J Foot Ankle Surg 2020; 59:178-183. [PMID: 31753575 DOI: 10.1053/j.jfas.2019.07.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 07/18/2019] [Accepted: 07/21/2019] [Indexed: 02/03/2023]
Abstract
Plantar plate tears are a common cause of forefoot pain and digital deformity. Repair of the plantar plate has been described from both a dorsal and plantar approach, each with its own benefits and drawbacks. Many of the approaches use costly devices. Our innovative repair method uses low-cost materials available in most operating room settings. We undertook a retrospective case series study to evaluate outcomes in patients who had undergone plantar plate repair with our method of repair. A review was performed to identify patients with plantar plate disruptions treated with this approach by a single surgeon. Clinical position and patient satisfaction of the involved joints were evaluated. Six patients (9 joints) underwent plantar plate repair using this innovative method and were evaluated at a median follow-up time of 19 (range 19 to 39) months. The mean visual analog scale pain score at final follow up was 0.8 ± 2.0. The median sagittal plane position of the toe was 2 mm (range 0 to 6) from the plantar skin of the digit to the ground. Five of the 6 patients (83%) stated that they would have the procedure again. We were able to obtain satisfactory outcomes with good alignment by repairing the plantar plate with this innovative method. Our data suggest that the described method of plantar plate repair can be used as an effective way to treat metatarsal phalangeal joint instability.
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Affiliation(s)
- Kristin B Kindred
- Resident, Postgraduate Year 3, Podiatric Surgical Residency, Podiatry, Community Health Network, Indianapolis, IN.
| | - Anthony Rusher
- Resident, Postgraduate Year 3, Podiatric Surgical Residency, Podiatry, Community Health Network, Indianapolis, IN
| | - Andrew Baker
- Resident, Postgraduate Year 3, Podiatric Surgical Residency, Podiatry, Community Health Network, Indianapolis, IN
| | - Corey N Groh
- Surgeon, The South Bend Clinic, Podiatry Foot and Ankle Surgery, South Bend, IN
| | - Brett R Fink
- Surgeon and Faculty, Podiatric Surgical Residency, Podiatry, Community Health Network, Indianapolis, IN
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Kinter CW, Hodgkins CW. Lesser Metatarsophalangeal Instability: Diagnosis and Conservative Management of a Common Cause of Metatarsalgia. Sports Health 2020; 12:390-394. [PMID: 32223694 DOI: 10.1177/1941738120904944] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
CONTEXT Lesser metatarsophalangeal (MTP) instability is a common condition that can become debilitating and require surgery. EVIDENCE ACQUISITION An extensive literature review was performed through MEDLINE and Google Scholar for publications relating to the etiology, diagnosis, and treatment of lesser MTP instability using the keywords metatarsophalangeal instability, athlete, forefoot pain, and metatarsalgia from database inception to 2019. STUDY DESIGN Clinical review. LEVEL OF EVIDENCE Level 4. RESULTS Lesser MTP instability is a common condition, especially in the active and aging populations. It is frequently misdiagnosed, causing delays in treatment that allow for progressive pain and deformity, which prevents an active lifestyle. Fortunately, MTP instability can be diagnosed easily with the drawer test. Magnetic resonance imaging is helpful when still in doubt. Conservative treatment entails joint immobilization and gradual return to play with taping and offloading metatarsal pads. CONCLUSION Lesser MTP instability is a common diagnosis. Its early detection and conservative treatment can help the patient regain their previous level of activity and avoid surgery.
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López-López D, Martínez-Vázquez M, Losa-Iglesias ME, Calvo-Lobo C, Rodríguez-Sanz D, Palomo-López P, Becerro-de-Bengoa-Vallejo R. Foot health-related quality of life among elderly with and without lesser toe deformities: a case-control study. Patient Prefer Adherence 2018; 12:251-255. [PMID: 29483771 PMCID: PMC5813943 DOI: 10.2147/ppa.s152269] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
PURPOSE The aim of this study was to compare the health-related quality of life impact related to foot health and health in general in older adults with lesser toe deformities (LTD) and without any foot conditions. METHODS A case-control observational study was carried out following the Strengthening the Reporting of Observational Studies in Epidemiology criteria. A total of 100 older adults with a mean age of 74.39±6.02 years were recruited at an outpatient clinic; 50 of these subjects had LTD (case group) and 50 subjects were without any foot conditions (control group). Presence of LTD was determined in both feet using the Kelikian push-up test, and the Foot Health Status Questionnaire scores were self-reported. RESULTS The case group showed lower scores in quality of life in relation to health in general and to foot health specifically. Statistically significant differences (p<0.05) between case and control groups were shown by means of the Wicoxon test. CONCLUSION A negative impact in quality of life in relation to foot health should be considered in older adults with LTD, regardless of gender.
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Affiliation(s)
- Daniel López-López
- Research, Health and Podiatry Unit, Department of Health Sciences, Faculty of Nursing and Podiatry, Universidade da Coruña, Ferrol, Spain
| | - María Martínez-Vázquez
- Research, Health and Podiatry Unit, Department of Health Sciences, Faculty of Nursing and Podiatry, Universidade da Coruña, Ferrol, Spain
| | | | - César Calvo-Lobo
- Nursing and Physical Therapy Department, Institute of Biomedicine (IBIOMED), Universidad de León, Ponferrada, León, Spain
| | - David Rodríguez-Sanz
- School of Sports Science, European University, Villaviciosa de Odón, Madrid, Spain
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Escudero MI, Seebach K, Parekh SG, Pellegrini MJ. Treatment of postaxial polydactyly with plantar plate and medial collateral ligament reconstruction after supernumerary excision: A case report. SAGE Open Med Case Rep 2017; 5:2050313X17737197. [PMID: 29085641 PMCID: PMC5648087 DOI: 10.1177/2050313x17737197] [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] [Received: 04/20/2017] [Accepted: 09/25/2017] [Indexed: 11/16/2022] Open
Abstract
Introduction: Polydactyly is the most common congenital foot anomaly and consists of partial or complete duplication of a toe. Traditionally, surgical treatment has been amputation. There is little evidence when surgical treatment requires repairing the stabilizing structures of the metatarsophalangeal joint Objective: Assess the functional and radiologic outcomes of a case of postaxial polydactyly requiring plantar plate plate and medial collateral ligament reconstruction. Methods: A 59-year-old female presented at clinic complaining from bilateral fifth toe polydactyly and metatarsalgia. A rudimentary extra toe with bony structures poorly developed was observed in the left foot. An excision was performed on the left foot. In the right foot, a fully developed extra digit was observed with medial and downwards deviation underneath the fourth metatarsal. Results: Medial fifth-toe excision, plantar plate repair and medial collateral ligament reconstruction were performed due to malformation and widening of the distal surface of the plantar plate. Patient satisfaction and adequate functional status were observed at one-year follow-up. Conclusion: The plantar plate is the principal stabilizer of the MTP joint; therefore its reconstruction is of paramount importance for forefoot biomechanics.
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Affiliation(s)
- Mario I Escudero
- Department of Orthopedics, Hospital Clinico, University of Chile, Santiago, Chile
| | - Klaus Seebach
- Department of Orthopedics, Hospital Clinico, University of Chile, Santiago, Chile
| | - Selene G Parekh
- Department of Orthopaedic Surgery, North Carolina Orthopaedic Clinic, Durham, NC, USA.,Duke Fuqua School of Business, Durham, NC, USA
| | - Manuel J Pellegrini
- Department of Orthopedics, Hospital Clinico, University of Chile, Santiago, Chile
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LiMarzi GM, Scherer KF, Richardson ML, Warden DR, Wasyliw CW, Porrino JA, Pettis CR, Lewis G, Mason CC, Bancroft LW. CT and MR Imaging of the Postoperative Ankle and Foot. Radiographics 2017; 36:1828-1848. [PMID: 27726748 DOI: 10.1148/rg.2016160016] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
A variety of surgical procedures exist for repair of both traumatic and degenerative osseous and soft-tissue pathologic conditions involving the foot and ankle. It is necessary for the radiologist to be familiar with these surgical procedures, so as to assess structural integrity, evaluate for complicating features, and avoid diagnostic pitfalls. Adequate interpretation of postoperative changes often requires access to surgical documentation to evaluate not only the surgery itself but the expected timeline for resolution of normal postoperative changes versus progressive disease. Appropriate use of surgical language in radiology reports is another important skill set to hone and is instrumental in providing a high-quality report to the referring surgeons. The pathophysiology of a myriad of surgical complaints, beginning from the Achilles tendon and concluding at the plantar plate, are presented, as are their common appearances at computed tomography and magnetic resonance imaging. Commonly encountered entities include Achilles tendon tear, spastic equinus, nonspastic equinus, talar dome osteochondral defect, tarsal tunnel syndrome, plantar fasciitis, pes planovalgus, pes cavovarus, peroneal tendinosis, lateral ligament complex pathology, Morton neuroma, plantar plate tear, and metatarsophalangeal joint instability. Computer-generated three-dimensional models are included with many of the procedures to provide a more global view of the surgical anatomy. Correlation with intraoperative photographs is made when available. When appropriate, discussion of postoperative complications, including entities such as infection and failure of graft integration, is presented, although a comprehensive review of postoperative complications is beyond the scope of this article. Notably absent from the current review are some common foot and ankle procedures including hallux valgus and hammertoe corrections, as these are more often evaluated radiographically than with cross-sectional imaging. ©RSNA, 2016.
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Affiliation(s)
- Gary M LiMarzi
- From the Department of Radiology, Florida Hospital, 601 E Rollins St, Orlando, FL 32803 (G.M.L., K.F.S., D.R.W., C.W.W., C.R.P., L.W.B.); Department of Radiology, University of Washington, Seattle, Wash (M.L.R., J.A.P.); Department of Podiatry, University of Central Florida, Orlando, Fla (G.L.); and Department of Podiatry, Florida Foot and Ankle Specialist, Lake Mary, Fla (C.C.M.)
| | - Kurt F Scherer
- From the Department of Radiology, Florida Hospital, 601 E Rollins St, Orlando, FL 32803 (G.M.L., K.F.S., D.R.W., C.W.W., C.R.P., L.W.B.); Department of Radiology, University of Washington, Seattle, Wash (M.L.R., J.A.P.); Department of Podiatry, University of Central Florida, Orlando, Fla (G.L.); and Department of Podiatry, Florida Foot and Ankle Specialist, Lake Mary, Fla (C.C.M.)
| | - Michael L Richardson
- From the Department of Radiology, Florida Hospital, 601 E Rollins St, Orlando, FL 32803 (G.M.L., K.F.S., D.R.W., C.W.W., C.R.P., L.W.B.); Department of Radiology, University of Washington, Seattle, Wash (M.L.R., J.A.P.); Department of Podiatry, University of Central Florida, Orlando, Fla (G.L.); and Department of Podiatry, Florida Foot and Ankle Specialist, Lake Mary, Fla (C.C.M.)
| | - David R Warden
- From the Department of Radiology, Florida Hospital, 601 E Rollins St, Orlando, FL 32803 (G.M.L., K.F.S., D.R.W., C.W.W., C.R.P., L.W.B.); Department of Radiology, University of Washington, Seattle, Wash (M.L.R., J.A.P.); Department of Podiatry, University of Central Florida, Orlando, Fla (G.L.); and Department of Podiatry, Florida Foot and Ankle Specialist, Lake Mary, Fla (C.C.M.)
| | - Christopher W Wasyliw
- From the Department of Radiology, Florida Hospital, 601 E Rollins St, Orlando, FL 32803 (G.M.L., K.F.S., D.R.W., C.W.W., C.R.P., L.W.B.); Department of Radiology, University of Washington, Seattle, Wash (M.L.R., J.A.P.); Department of Podiatry, University of Central Florida, Orlando, Fla (G.L.); and Department of Podiatry, Florida Foot and Ankle Specialist, Lake Mary, Fla (C.C.M.)
| | - Jack A Porrino
- From the Department of Radiology, Florida Hospital, 601 E Rollins St, Orlando, FL 32803 (G.M.L., K.F.S., D.R.W., C.W.W., C.R.P., L.W.B.); Department of Radiology, University of Washington, Seattle, Wash (M.L.R., J.A.P.); Department of Podiatry, University of Central Florida, Orlando, Fla (G.L.); and Department of Podiatry, Florida Foot and Ankle Specialist, Lake Mary, Fla (C.C.M.)
| | - Christopher R Pettis
- From the Department of Radiology, Florida Hospital, 601 E Rollins St, Orlando, FL 32803 (G.M.L., K.F.S., D.R.W., C.W.W., C.R.P., L.W.B.); Department of Radiology, University of Washington, Seattle, Wash (M.L.R., J.A.P.); Department of Podiatry, University of Central Florida, Orlando, Fla (G.L.); and Department of Podiatry, Florida Foot and Ankle Specialist, Lake Mary, Fla (C.C.M.)
| | - Gideon Lewis
- From the Department of Radiology, Florida Hospital, 601 E Rollins St, Orlando, FL 32803 (G.M.L., K.F.S., D.R.W., C.W.W., C.R.P., L.W.B.); Department of Radiology, University of Washington, Seattle, Wash (M.L.R., J.A.P.); Department of Podiatry, University of Central Florida, Orlando, Fla (G.L.); and Department of Podiatry, Florida Foot and Ankle Specialist, Lake Mary, Fla (C.C.M.)
| | - Christopher C Mason
- From the Department of Radiology, Florida Hospital, 601 E Rollins St, Orlando, FL 32803 (G.M.L., K.F.S., D.R.W., C.W.W., C.R.P., L.W.B.); Department of Radiology, University of Washington, Seattle, Wash (M.L.R., J.A.P.); Department of Podiatry, University of Central Florida, Orlando, Fla (G.L.); and Department of Podiatry, Florida Foot and Ankle Specialist, Lake Mary, Fla (C.C.M.)
| | - Laura W Bancroft
- From the Department of Radiology, Florida Hospital, 601 E Rollins St, Orlando, FL 32803 (G.M.L., K.F.S., D.R.W., C.W.W., C.R.P., L.W.B.); Department of Radiology, University of Washington, Seattle, Wash (M.L.R., J.A.P.); Department of Podiatry, University of Central Florida, Orlando, Fla (G.L.); and Department of Podiatry, Florida Foot and Ankle Specialist, Lake Mary, Fla (C.C.M.)
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15
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Jordan M, Thomas M, Fischer W. Nonoperative Treatment of a Lesser Toe Plantar Plate Tear with Serial MRI Follow-up: A Case Report. J Foot Ankle Surg 2017. [PMID: 28633792 DOI: 10.1053/j.jfas.2017.02.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
With the current data concentrating on different operative treatment options for plantar plate tears, few data can be found on possible nonoperative treatment strategies for this entity and the specifics of such treatment. In the present case report, the successful nonoperative treatment of a patient with a rupture of the plantar plate in a lesser toe metatarsophalangeal joint is presented. The patient was followed up using repeat clinical examinations and high-resolution magnetic resonance imaging scans for 1 year after the imitation of therapy to provide information on the different stages of the healing process.
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Affiliation(s)
- Martin Jordan
- Surgeon, Department of Foot and Ankle Surgery, Hessingpark-Clinic, Augsburg, Germany.
| | - Manfred Thomas
- Surgeon, Department of Foot and Ankle Surgery, Hessingpark-Clinic, Augsburg, Germany
| | - Wolfgang Fischer
- Radiologist, Department of Radiology, Hessingpark-Clinic, Augsburg, Germany
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Pascual Huerta J, Arcas Lorente C, García Carmona FJ. La osteotomía de Weil: una revisión comprensiva. REVISTA ESPAÑOLA DE PODOLOGÍA 2017. [DOI: 10.1016/j.repod.2017.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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[Malalignment of the first ray : Clinical and radiological diagnostics]. DER ORTHOPADE 2017; 46:388-394. [PMID: 28361192 DOI: 10.1007/s00132-017-3409-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Clinical and radiological examination of the foot are mandatory before surgical correction of the forefoot. The clinical examination includes leg axis, position of the hind foot, deformity of the first ray as well as skin conditions, pulse status and possible sensitive deficits. A shortening of the gastrocnemius muscle can be identified using the Silfverskiöld test. Discomfort in the midfoot can indicate pathologies of the tarsometatarsal joint and the same applies for osteophyte infiltration around the Lisfranc joint line, whereby the second tarsometatarsal joint often shows more advanced degenerative arthritis than the first tarsometatarsal joint. Callosities under the second and third metatarsal heads correlate with a faulty load transmission of the first ray. A limitation of the range of movement of the first metatarsophalangeal joint is usually associated with degenerative arthritis in X‑ray imaging. Under weight bearing, X‑rays of the foot in two planes represent the standard imaging examination. In addition to the intermetatarsal angle, the hallux valgus angle and the interphalangeal angle as well as the width of the first metatarsal bone influence the therapy decision. The same applies to degenerative changes or an obvious instability of the first tarsometatarsal joint. In many cases, initial signs of degenerative arthritis can be found in the metatarsophalangeal joint and around the sesamoid bones, although these often do not correlate to clinical symptoms.
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Lui TH, LiYeung LL. Modified double plantar plate tenodesis. Foot Ankle Surg 2017; 23:62-67. [PMID: 28159046 DOI: 10.1016/j.fas.2016.05.313] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2015] [Revised: 02/25/2016] [Accepted: 05/03/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND Metatarsophalangeal joint instability of the lesser toe can cause acquired toe deformity. Plantar plate deficiency is the major pathology. Plantar plate repair can stabilize the joint but may result in iatrogenic transverse plane toe deformity in correction of claw toe deformity. Limited toe extension can be resulted after correction of crossover toe deformity by plantar plate tenodesis and extensor digitorum brevis transfer. A modification of the technique is proposed. MATERIALS AND METHODS The clinical outcomes of 10 patients with the modified procedure performed were assessed. RESULTS The correction was full in all toes with no recurrence. CONCLUSION The modified technique can stabilize the metatarsophalangeal joint and correct lesser toe deformity without the need of tendon transfer, osteotomy or sophisticated instrumentation.
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Affiliation(s)
- T H Lui
- Department of Orthopaedics and Traumatology, North District Hospital, 9 Po Kin Road, Sheung Shui, NT, Hong Kong Special Administrative Region.
| | - L L LiYeung
- Department of Orthopaedics and Traumatology, North District Hospital, 9 Po Kin Road, Sheung Shui, NT, Hong Kong Special Administrative Region.
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Flint WW, Macias DM, Jastifer JR, Doty JF, Hirose CB, Coughlin MJ. Plantar Plate Repair for Lesser Metatarsophalangeal Joint Instability. Foot Ankle Int 2017; 38:234-242. [PMID: 27852647 DOI: 10.1177/1071100716679110] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [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 Lesser metatarsophalangeal (MTP) joint instability is a common cause of forefoot pain. Advances in operative technique and instrumentation have made it possible to anatomically treat plantar plate tears through a dorsal approach. Our goal was to evaluate the subjective, functional, and radiographic outcomes of plantar plate repair (PPR) from a dorsal approach. METHODS A prospective case series was performed evaluating the results of PPR in 97 feet with 138 plantar plate tears. Patients underwent PPR from a dorsal approach with a Weil osteotomy. We followed patients at regular intervals for 12 months and collected data preoperatively and postoperatively with respect to visual analog scale (VAS) scores, MTP range of motion (ROM), paper pull-out test, American Orthopaedic Foot & Ankle Society (AOFAS) scores, satisfaction, and radiographic measures. RESULTS Eighty percent of patients scored "good" to "excellent" satisfaction scores at 12 months. The mean VAS pain score preoperatively was 5.4/10, and postoperatively was 1.5/10. The mean AOFAS scores increased from 49 to 81 points following surgery. The mean MTP ROM preoperatively was 43 degrees and postoperatively 31 degrees. Forty-two percent of toes passed the paper pull out test prior to surgery and 54% at 12 months. Mean metatarsal shortening was 2.4/3.1/1.2 mm for the second, third, and fourth metatarsals, respectively. The mean MTP joint angles preoperatively were 2/4.9/-1.3 degrees and postoperatively were 7.4/9.6/0.2 degrees, respectively, for the second, third, and fourth MTP joints. CONCLUSION We found that the plantar plate could be repaired through a dorsal approach with reliable outcomes. PPR was a viable option to anatomically restore the ligamentous support in the unstable lesser MTP joint. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Wesley W Flint
- 1 Orthopaedic Institute of Henderson, Henderson, NV, USA
| | | | | | - Jesse F Doty
- 4 University of Tennessee Erlanger Foot and Ankle Institute, Chattanooga, TN, USA
| | - Christopher B Hirose
- 5 Coughlin Foot and Ankle Clinic, Saint Alphonsus Regional Medical Center, Boise, ID, USA
| | - Michael J Coughlin
- 5 Coughlin Foot and Ankle Clinic, Saint Alphonsus Regional Medical Center, Boise, ID, USA
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Nery C, Baumfeld D, Umans H, Yamada AF. MR Imaging of the Plantar Plate. Magn Reson Imaging Clin N Am 2017; 25:127-144. [DOI: 10.1016/j.mric.2016.08.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Prissel MA, Hyer CF, Donovan JK, Quisno AL. Plantar Plate Repair Using a Direct Plantar Approach: An Outcomes Analysis. J Foot Ankle Surg 2017; 56:434-439. [PMID: 28139400 DOI: 10.1053/j.jfas.2016.12.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Indexed: 02/03/2023]
Abstract
Direct plantar plate repair using a plantar approach has been described previously, but with few reports of the outcomes or clinical results. The purpose of the present study was to determine the outcomes of this technique. We performed a retrospective analysis of patients who had undergone direct plantar plate repair with or without concomitant Weil osteotomy and a prospective patient-reported subjective outcomes analysis. Ultimately, 131 patients (144 toes) were included, and the response rate for the mailed surveys was 53.5% (77 of 144 toes). The clinical outcomes reported a well-aligned toe in 87.1% of cases, with a recurrence rate of 7.6% (11 of 144) and a revision rate of 2.8% (4 of 144). Statistically significant improvement in the overall modified Foot Function Index (p < .001) and subscale scores for pain (p < .001), disability (p < .001), and activity limitation (p = .001) were noted postoperatively compared with the preoperative data. The median postoperative visual analog pain scale level reported at survey completion was 2.0 (range 0.0 to 10.0; mean ± standard deviation 2.3 ± 2.6). Despite the modified Foot Function Index scores, the patient satisfaction questionnaire data reported mixed results. Our modified Foot Function Index results demonstrated that this approach provides excellent postoperative pain relief, improvement of associated disability, and improvement in activity limitations. The importance of managing patient expectations is acknowledged secondary to the discrepancy with the patient satisfaction data and the modified Foot Function Index results. Further prospective study is warranted to compare this technique with alternate dorsal approaches for plantar plate repair with and without associated commercially available suture passing systems.
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Affiliation(s)
- Mark A Prissel
- Attending Physician, Orthopedic Foot and Ankle Center, Westerville, OH
| | - Christopher F Hyer
- Attending Physician and Fellowship Director, Orthopedic Foot and Ankle Center, Westerville, OH.
| | - Jacqueline K Donovan
- Resident, Medical Education Department, Postgraduate Year 3, Grant Podiatric Medicine and Surgery Residency, Columbus, OH
| | - Amanda L Quisno
- Resident, Medical Education Department, Postgraduate Year 3, Grant Podiatric Medicine and Surgery Residency, Columbus, OH
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Lui TH. Correction of Crossover Toe Deformity by Arthroscopically Assisted Plantar Plate Tenodesis. Arthrosc Tech 2016; 5:e1273-e1279. [PMID: 28149725 PMCID: PMC5263059 DOI: 10.1016/j.eats.2016.07.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Accepted: 07/20/2016] [Indexed: 02/03/2023] Open
Abstract
Plantar plate deficiency is the major pathology causing metatarsophalangeal joint instability. As the joint subluxates dorsally, the lumbrical is tethered at the medial side of the joint by the deep metatarsal ligament and becomes a deforming force for the development of crossover toe deformity. Plantar plate repair or reconstruction is a logical surgical treatment option. This can be performed through a dorsal or plantar approach. The purpose of this technical note is to report a minimally invasive technique of crossover toe deformity correction by suturing the plantar plate to the extensor tendon. It is indicated for symptomatic crossover toe deformity that is not responsive to nonsurgical treatment. It is contraindicated if the metatarsophalangeal joint is degenerated, destructed, or dislocated, or there is interdigital neuroma at the sides of the deformed toe, or the deformity is caused by bony deformities of the metatarsal head or the proximal phalanx.
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Affiliation(s)
- Tun Hing Lui
- Address correspondence to Tun Hing Lui, M.B.B.S.(HK), F.R.C.S.(Edin), F.H.K.A.M., F.H.K.C.O.S., Department of Orthopaedics and Traumatology, North District Hospital, 9 Po Kin Road, Sheung Shui, NT, Hong Kong SAR, China.Department of Orthopaedics and TraumatologyNorth District Hospital9 Po Kin RoadSheung Shui, NTHong Kong SARChina
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Nery C, Coughlin M, Baumfeld D, Raduan F, Mann TS, Catena F. How to classify plantar plate injuries: parameters from history and physical examination. Rev Bras Ortop 2016; 50:720-8. [PMID: 27218086 PMCID: PMC4868080 DOI: 10.1016/j.rboe.2015.10.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Accepted: 05/27/2014] [Indexed: 11/29/2022] Open
Abstract
Objective To find the best clinical parameters for defining and classifying the degree of plantar plate injuries. Method Sixty-eight patients (100 metatarsophalangeal joints) were classified in accordance with the Arthroscopic Anatomical Classification for plantar plate injuries and were divided into five groups (0 to IV). Their medical files were reviewed and the incidence of each parameter for the respective group was correlated. These parameters were: use of high heels, sports, acute pain, local edema, Mulder's sign, widening of the interdigital space, pain in the head of the corresponding metatarsal, touching the ground, “drawer test”, toe grip and toe deformities (in the sagittal, coronal and transversal planes). Results There were no statistically significant associations between the degree of injury and use of high-heel shoes, sports trauma, pain at the head of the metatarsal, Mulder's sign, deformity in pronation or displacement in the transversal and sagittal planes (although their combination, i.e. “cross toe”, showed a statistically significant correlation). Positive correlations with the severity of the injuries were found in relation to initial acute pain, progressive widening of the interdigital space, loss of “touching the ground”, positive results from the “drawer test” on the metatarsophalangeal joint, diminished grip strength and toe deformity in supination. Conclusions The “drawer test” was seen to be the more reliable and precise tool for classifying the degree of plantar plate injury, followed by “touching the ground” and rotational deformities. It is possible to improve the precision of the diagnosis and the predictions of the anatomical classification for plantar plate injuries through combining the clinical history and data from the physical examination.
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Affiliation(s)
- Caio Nery
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | | | | | - Fernando Raduan
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Tania Szejnfeld Mann
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Fernanda Catena
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
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Evaluation of lesser metatarsophalangeal joint plantar plate tears with contrast-enhanced and fat-suppressed MRI. Skeletal Radiol 2016; 45:635-44. [PMID: 26887801 DOI: 10.1007/s00256-016-2349-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2015] [Revised: 01/29/2016] [Accepted: 02/08/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To present findings of plantar plate (PP) lesions from MRI with administration of gadolinium and to differentiate PP lesions from others causes of metatarsalgia. MATERIALS AND METHODS Two musculoskeletal radiologists reviewed 249 contrast-enhanced forefoot MRI scans from patients with metatarsalgia between June 2012 and June 2013. Evaluations focused on hyper-vascularized/fibrous tissue and other findings associated with PP tears. RESULTS Fifty-nine patients had PP tears, 59 % were female. Most of these patients, 48/59 (81.4 %), had a single metatarsophalangeal (MTP) PP lesion in one foot, although 7/59 patients had one lesion in each foot, 3/59 (5.1 %) had two in one foot, and 1/59 (1.7 %) had three lesions in one foot. The second MTP joint was the most common location for PP tears (n = 56), followed by the third (n = 12) and fourth (n = 3) MTP joints. Lateral (n = 33) and full thickness (n = 28) PP lesions were the most frequent, and central (n = 3) and lateral/central (n = 7) tears were less prevalent. Fifty (70.5 %) PP lesions showed pericapsular fibrosis in pre-contrast sequences, and 21 (29.5 %) were visible only after administration of gadolinium. All PP lesions had collateral ligament involvement. Others findings included interosseous tendon lesions (n = 29), interosseous tendon rupture (n = 29), synovitis (n = 49), flexor tenosynovitis (n = 28), crossover toe (n = 2), hammertoe (n = 1), intermetatarsal space (IS) neuromas (n = 11), and third IS neuromas (n = 12). CONCLUSION PP tears are a common cause of metatarsalgia, accounting for more than 20 % of cases in our sample. A substantial portion of the lesions (29.5 %) became visible only after the administration of gadolinium.
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Nery C, Raduan FC, Catena F, Mann TS, de Andrade MAP, Baumfeld D. Plantar plate radiofrequency and Weil osteotomy for subtle metatarsophalangeal joint instablity. J Orthop Surg Res 2015; 10:180. [PMID: 26584658 PMCID: PMC4653840 DOI: 10.1186/s13018-015-0318-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 11/08/2015] [Indexed: 11/24/2022] Open
Abstract
Background To the present day, literature has only discussed how to treat extensive plantar plate and collateral ligament lesions, with gross joint subluxation and obvious clinical instability. The treatment options for early stages of the disease with minor injuries and subtle instabilities have not been described. The main purpose of this prospective study is to evaluate the efficacy of the combination of the arthroscopic radiofrequency shrinkage and distal Weil osteotomy in the treatment of subtle metatarsophalangeal joint instability. Method Prospective data (clinical, radiological, and arthroscopic findings) of 19 patients, with a total of 35 slightly unstable joints, was collected. The physical examination defined the hypothesis for plantar plate lesions (grades 0 and 1), which was confirmed during the diagnostic step of the arthroscopic procedure. Results Among our patients, 73 % were females and 63 % reported wearing high heels. The average age was 59 years and post-operative follow-up was 20 months. In the initial sample frame, 62 % of joints showed spread-out toes with increased interdigital spacing. The mean American Orthopedic Foot and Ankle Society score rose from 53 points pre-operatively to 92 points post-operatively and a visual-analog pain scale average value of eight points pre-operatively decreased to zero post-operatively. During the pre-operative evaluation, none of the patients had stable joints and over 97 % were classified as having grade 1 instability (<50 % subluxation). After treatment, 83 % of the joints became stable (degree of instability 0) and over 97 % were congruent. All studied parameters showed statistically significant improvements in the post-operative period (p < 0.001) showing the efficiency of the treatment in pain relief, while restoring the joint stability and congruity. Conclusion Arthroscopic radiofrequency shrinkage in combination with distal Weil osteotomy promotes functional improvement, pain relief, and restores the joint stability in the plantar plate lesion grades 0 and 1.
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Affiliation(s)
- Caio Nery
- UNIFESP-Escola Paulista de Medicina, São Paulo, SP, Brazil.
| | | | | | | | | | - Daniel Baumfeld
- UFMG-Federal University of Minas Gerais, Juvenal dos Santos St, 325, Belo Horizonte, MG, 30380 5030, Brazil.
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Clement RC, Eskildsen SM, Tennant JN. Technical tip and cost analysis for lesser toe plantar plate repair with a curved suture needle. Foot Ankle Int 2015; 36:330-4. [PMID: 25367248 DOI: 10.1177/1071100714558510] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- R Carter Clement
- Department of Orthopaedic Surgery, University of North Carolina, Chapel Hill, NC, USA
| | - Scott M Eskildsen
- Department of Orthopaedic Surgery, University of North Carolina, Chapel Hill, NC, USA
| | - Joshua N Tennant
- Department of Orthopaedic Surgery, University of North Carolina, Chapel Hill, NC, USA
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Abstract
Disorders affecting the forefoot are common in the clinical practice. Accurate history and physical examination are the mainstays of diagnosis but imaging modalities are frequently obtained to confirm the clinical suspicion and plan appropriate treatment. In this article we will present the ultrasound (US) technique of examination of the forefoot followed by a brief description of the normal US anatomy and of US appearance of the most frequent forefoot disorders; rheumatoid arthritis, osteoarthritis, overuse arthropathy, Morton neuromas, bursitis, mucoid cysts, foreign bodies, bone disorders.
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Affiliation(s)
- Stefano Bianchi
- CIM SA, Cabinet d'Imagerie Médical, route de Malagnou 40A, 1208 Geneva, Switzerland
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