Lengthening of short great toe and correction of all lesser toe deformities by distraction-lengthening

The versatility of the Lapidus arthrodesis

Lapidus Arthrodesis is probably the most versatile procedure of the foot and ankle surgeon. The procedure was conceived initially for the surgical treatment of met primus adductus associated with hallux valgus, but has also been used for the treatment of a variety of other conditions including hallux limitus, revision bunion surgery, medial column stabilization, and others. Although the use of the Lapidus in bunion surgery is well supported in the literature, surgeons have been expanding its indications to manage a variety of disorders affecting the foot. As more surgeons continue to gain experience with the procedure, additional studies will emerge, further supporting its versatility in the realm of foot surgery.

Restoration and preservation of first metatarsal length using the distraction scarf osteotomy

The authors reviewed the records of 8 patients who underwent a distraction scarf osteotomy of the first metatarsal, and report the radiographic outcomes achieved with this procedure. The osteotomy was used to reestablish or maintain the length of the first metatarsal, without the use of a structural bone graft. The osteotomy was used as part of a revisional procedure for a failed bunionectomy in 4 patients. In the remaining patients, the procedure was used to preserve the length of the first metatarsal in conjunction with a Lapidus arthrodesis. The first and second metatarsals were measured radiographically, and the length of the first metatarsal was expressed as a percentage of the length of the second metatarsal. The average proportional increase in first metatarsal length obtained in the patients undergoing correction of the shortened first metatarsal was 7.08%, and the difference between the pre- and postoperative length of the first metatarsal was statistically significant (P = .0013) in these patients. Relative shortening of the first metatarsal was avoided in those patients undergoing distraction scarf osteotomy in conjunction with Lapidus arthrodesis. ACFAS Level of Clinical Evidence: 4.

Management of soft tissue deficiency of the hallux: salvage in trauma, diabetes, and following surgical complications

Loss of the hallux can lead to significant gait problems and cause difficult biomechanical problems with weight bearing. Amputation of the first ray should be avoided when possible. Soft tissue defect of the hallux can be particularly difficult to manage because of the absence of local muscle tissue for coverage. In younger patients, soft tissue loss usually is related to trauma; an understanding of the techniques that are available for coverage are important to maintain length and function of the first ray. Diabetic neuropathy and resultant ulceration of the hallux or metatarsophalangeal joint is another common cause of soft tissue deficiency that may lead to deep infection and potentially result in amputation. Certain systemic problems, such as inflammatory diseases or gout, can cause significant degeneration of the local tissues which also can be problematic. Wound dehiscence or loss of skin flaps that are created during surgery represent further difficulties that may be encountered. This article reviews the common causes of amputation of the hallux and the principles that are necessary for salvage of the digit.