1
|
Plapler PG, Ling D. Treatment of Lesser Toe Deformities Based on Physical Therapy. Foot Ankle Clin 2024; 29:605-615. [PMID: 39448174 DOI: 10.1016/j.fcl.2024.03.005] [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: 10/26/2024]
Abstract
Forefoot problems are highly relevant in the general population. It leads to a loss of autonomy and increases the risk of falls. Treatment needs to consider the underlying cause, and conservative measures are generally instituted before surgical intervention. Nonsurgical approaches must be focused on pressure relief and deformity correction. Corrective devices may be indicated for reducible deformities. Physiotherapy based on exercises and the use of specific orthoses are indicated. The new concept with an emphasis on strengthening the intrinsic muscles of the foot appears to be quite effective in correcting less severe deformities and preventing the deformities from worsening.
Collapse
Affiliation(s)
- Pérola Grinberg Plapler
- Divisão de Medicina Física Do Instituto de Ortopedia e Traumatologia Do Hospital Das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil; Instituto de Ortopedia e Traumatologia da FMUSP. Rua Dr. Ovídio Pires de Campos, 333 - Cerqueira César - São Paulo/SP ZIP Code 05403010, Brazil
| | - Dai Ling
- Divisão de Medicina Física Do Instituto de Ortopedia e Traumatologia Do Hospital Das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil; Instituto de Ortopedia e Traumatologia da FMUSP. Rua Dr. Ovídio Pires de Campos, 333 - Cerqueira César - São Paulo/SP ZIP Code 05403010, Brazil.
| |
Collapse
|
2
|
Brodsky JW, Kim J. Principles of Lesser Toe and Metatarsophalangeal Joint Reconstruction for Complex and Revision Surgery of the Forefoot. Foot Ankle Clin 2024; 29:767-790. [PMID: 39448187 DOI: 10.1016/j.fcl.2024.07.001] [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: 10/26/2024]
Abstract
Successful lesser toes and metatarsophalangeal (MTP) joint reconstruction must withstand substantial biomechanical loads from standing, walking, and exercise. While complications following lesser toe and MTP reconstruction are common, limited literature addresses revision surgeries for complications including recurrence. Numerous complications of surgery for toes and lesser MTP joints can be managed or improved through revision surgery, but not all complications can be prevented or resolved. This review focuses on understanding the general principles and surgical techniques for hammer toe and lesser MTP reconstruction to apply effectively in both primary and revision surgeries.
Collapse
Affiliation(s)
- James W Brodsky
- Department of Orthopaedic Surgery, Baylor University Medical Center, 3900 Junius Street, Suite 500, Dallas, TX 75246, USA; Orthopaedic Surgery, Texas A & M University HSC College of Medicine; Foot and Ankle Surgery Fellowship Program, Baylor University Medical Center, Dallas, TX, USA; University of Texas Southwestern Medical School, Dallas, USA.
| | - Jaeyoung Kim
- Department of Orthopaedic Surgery, Baylor University Medical Center, 3900 Junius Street, Suite 500, Dallas, TX 75246, USA; Foot and Ankle Surgery Fellowship Program, Baylor University Medical Center, Dallas, TX, USA
| |
Collapse
|
3
|
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
|
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
|
Connors JC, Zulauf EE, Manji AA. Novel Extramedullary Fixation Device for Hammertoe Correction: A Retrospective Review of 100 patients. J Foot Ankle Surg 2023:S1067-2516(23)00038-8. [PMID: 36997364 DOI: 10.1053/j.jfas.2023.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 02/07/2023] [Accepted: 02/15/2023] [Indexed: 04/01/2023]
Abstract
Classically, one of the more common treatment options for rigid hammertoe correction consists of end-to-end arthrodesis stabilized by temporary Kirschner wire (K-wire) fixation maintained until osseous consolidation or complication necessitating premature removal. However, single K-wire fixation allows for axial rotation which results in loss of compression at the arthrodesis site. To counteract this, intramedullary implants were designed to provide fusion site stability in all planes negating extra-skeletal extension of the wire. Nevertheless, manual pressfit implants arguably offer less reliable positioning of the fusion site in a true end to end orientation due to variation in intramedullary stem placement compared to direct visualization with dorsal plating. Larger diameter implants create an osseous void at the bony interface reducing the potential of true bony union. Hammertoe implant failure poses a unique and challenging salvage scenario which can ultimately end in amputation. Extramedullary fixation is uniquely designed to merge both benefits of K-wires and intramedullary implants while eliminating inadequacies of each. A total of 100 patients who underwent 150 rigid hammertoe corrections with an extramedullary implant were retrospectively reviewed. The mean postoperative follow-up was 12.6 months (range 12-18 months). Overall, 94 of 100 patients (94%) achieved radiographic union, defined by 2 or more bridged cortices at the arthrodesis site without signs of hardware breakage or signs of lucency across one or more fusion sites at a mean 8.8 weeks (range 7-10 weeks). This study demonstrated excellent results in regards to postoperative arthrodesis when utilizing an extramedullary implant for hammertoe deformity correction. This device minimizes osseous deficit by extramedullary application, all while augmenting intramedullary K-wire fixation.
Collapse
Affiliation(s)
- James C Connors
- Associate Professor, Division of Foot and Ankle Surgery, Kent State University College of Podiatric Medicine, Independence, OH.
| | - Emily E Zulauf
- Fellow, Alexander Orthopedic Associates, St. Petersburg, FL
| | - Ali A Manji
- Podiatric Surgery Resident, Mercy Regional Medical Center, Lorain, OH
| |
Collapse
|
6
|
Fitzke TM, Chong ACM, Barth TA, Patel SH, Uglem TP. Symptomatic Hammertoes Treatment Comparison: Peg-in-Hole Arthrodesis Versus End-to-End Screw Fixation. J Foot Ankle Surg 2023; 62:543-547. [PMID: 36697330 DOI: 10.1053/j.jfas.2022.12.011] [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: 06/16/2022] [Revised: 12/12/2022] [Accepted: 12/27/2022] [Indexed: 01/11/2023]
Abstract
Proximal interphalangeal (PIP) arthrodesis technique utilizing the peg-in-hole arthrodesis was founded to avoid the use of retained internal fixation implants and thereby potentially decrease the concern of hardware complication. The specific aim of this study was to report the complication rates of the modified peg-in-hole arthrodesis technique and the end-to-end arthrodesis with single screw fixation technique for correcting symptomatic hammertoe deformities in lesser digits. This retrospective chart review included patients who underwent surgical hammertoe correction of lesser digits between the dates of January 2012 and December 2019. Patient demographic data and charts were reviewed to evaluate need for revision including screw/pin removal and complications related to corrective surgery. Five hundred ninety-three symptomatic hammertoe deformity cases (443 female, 150 male) were identified, with 113 cases (88 female, 25 male) treated with peg-in-hole arthrodesis technique and 480 cases (355 female, 125 male) treated with end-to-end arthrodesis with a single screw technique. The deformity recurrence rate was not significantly different between the two techniques (peg-in-hole: 10%, end-to-end: 13%, p = .428). There were 97 cases with postoperative complications that required re-operation (peg-in-hole: 7 cases, end-to-end: 90 cases) with the majority detected at <6 months. There was no statistically significant difference in reoperation rate between the peg-in-hole technique and the end-to-end arthrodesis technique reoperated with reasons excluding simple screw removal (p = .068). This study tended to show these two arthrodesis techniques have equivalent risks and similar success in bone healing; however, the peg-in-hole arthrodesis technique offers an advantage that does not result in retained hardware.
Collapse
Affiliation(s)
- Travis M Fitzke
- Sanford Health Podiatry Medicine and Surgery Residency, Fargo, ND
| | - Alexander C M Chong
- Sanford Health Podiatry Medicine and Surgery Residency, Fargo, ND; Department of Graduate Medical Education, Sanford Health, Fargo, ND; University of North Dakota, School of Medicine & Health Sciences, Grand Forks, ND.
| | - Tiffany A Barth
- University of North Dakota, School of Medicine & Health Sciences, Grand Forks, ND
| | - Shivam H Patel
- University of North Dakota, School of Medicine & Health Sciences, Grand Forks, ND
| | - Timothy P Uglem
- Sanford Health Podiatry Medicine and Surgery Residency, Fargo, ND
| |
Collapse
|
7
|
Rajan L, Kim J, An T, Fuller R, Zhu J, Pinney SJ, Ellis SJ. The influence of concomitant hammertoe correction on postoperative outcomes in patients undergoing hallux valgus correction. Foot Ankle Surg 2022; 28:1100-1105. [PMID: 35346594 DOI: 10.1016/j.fas.2022.03.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 02/13/2022] [Accepted: 03/15/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Patients with hallux valgus often develop secondary hammertoe deformities of the lesser toes. Operative management of bunions with hammertoe can be more extensive; however, it is unclear whether this affects patient-reported outcomes. The aim of this study was to compare postoperative patient-reported outcome measures and radiographic outcomes between patients who underwent isolated bunion correction and patients who underwent simultaneous bunion and hammertoe correction. METHODS Preoperative, postoperative, and change in Patient-Reported Outcomes Measurement Information System (PROMIS) scores were compared between patients who underwent isolated hallux valgus correction and those who underwent concomitant hammertoe correction. Radiographic measures including hallux valgus angle (HVA), intermetatarsal angle (IMA), distal metatarsal-articular angle (DMAA), and Meary's angle were also compared. Targeted minimum-loss estimation (TMLE) was used for statistical analysis to control for confounders. RESULTS A total of 221 feet (134 isolated bunion correction, 87 concomitant hammertoe correction) with a minimum of 12 months follow-up were included in this study. Both cohorts demonstrated significant improvements in the physical function, pain interference, pain intensity, and global physical health PROMIS domains (all p < 0.001). However, patients in the concomitant hammertoe cohort had significantly less improvements in pain interference and pain intensity (p < 0.01, p < 0.05 respectively). The concomitant hammertoe cohort also had significantly higher postoperative pain interference scores than the isolated bunion cohort (p < 0.01). Radiographic outcomes did not differ between the two groups. CONCLUSION While both isolated bunion correction and concomitant hammertoe correction yielded clinically significant improvements in patient reported outcomes and normalized radiographic parameters, patients undergoing simultaneous bunion and hammertoe correction experienced substantially less improvement in postoperative pain-related outcomes than those who underwent isolated bunion correction.
Collapse
Affiliation(s)
- Lavan Rajan
- Hospital for Special Surgery, 532 East 72nd Street, 5th Floor, New York, NY 10021, United States.
| | - Jaeyoung Kim
- Hospital for Special Surgery, 532 East 72nd Street, 5th Floor, New York, NY 10021, United States.
| | - Tonya An
- Hospital for Special Surgery, 532 East 72nd Street, 5th Floor, New York, NY 10021, United States.
| | - Robert Fuller
- Hospital for Special Surgery, 532 East 72nd Street, 5th Floor, New York, NY 10021, United States.
| | - Jiaqi Zhu
- Hospital for Special Surgery, 532 East 72nd Street, 5th Floor, New York, NY 10021, United States.
| | - Stephen J Pinney
- Hospital for Special Surgery, 532 East 72nd Street, 5th Floor, New York, NY 10021, United States.
| | - Scott J Ellis
- Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, United States.
| |
Collapse
|
8
|
Complications of Lesser Toe Surgery: How To Avoid Them before Surgery and How To Assess and Treat Them When They Have Occurred. Foot Ankle Clin 2022; 27:233-251. [PMID: 35680286 DOI: 10.1016/j.fcl.2021.11.021] [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: 02/02/2023]
Abstract
Complications following lesser toe surgery are challenging to manage. The keys to treatment of any of these conditions are, first, to try to avoid them through identification of patient- and surgeon-related variables that contribute to their development and, second, following the occurance of a complication, to understand what can and cannot be corrected with surgical and nonsurgical management. This review provides a comprehensive assessment of current literature, demonstrates best practices and approaches to lesser toe complications, and provides an illustration of clinical examples.
Collapse
|
9
|
Scheidt S, Nowak V, Mittag F, Götze M, Wülker N, Hofmann UK. Comparison of Lesser Toe Proximal Interphalangeal Joint Arthrodesis Versus Resection Arthroplasty: A Randomized Controlled Study. Orthopedics 2022; 45:86-90. [PMID: 35021029 DOI: 10.3928/01477447-20220105-08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The goal of this study was to compare operative outcomes after lesser toe deformity correction with either proximal interphalangeal (PIP) joint arthrodesis or PIP joint resection arthroplasty. A prospective randomized controlled trial was performed with 37 patients (48 toes) operated on with one of these two procedures. Evaluation of the numeric rating scale score, the American Orthopedic Foot and Ankle Society score, osseous consolidation, and clinical outcome was performed preoperatively and at 6 weeks and 6 months postoperatively. Both study groups showed significant improvement at 6 months postoperatively. Although osseous consolidation was significantly higher for the arthrodesis group (P=.001), this difference did not affect clinical outcomes, and at 6 months postoperatively, pain on the numeric rating scale was 0 (range, 0-7) for the arthroplasty group and 0 (range, 0-5) for the arthrodesis group (P=.669). The American Orthopedic Foot and Ankle Society score was 83 (range, 39-95) and 80 (range, 59-95), respectively (P=.879). No difference was observed for signs of inflammation or axis correction. Even a direct comparison of toes with radiologically osseous fusion (n=16) with those without fusion (n=32) did not show any clinical differences. This randomized controlled study showed no clinical differences in outcome between PIP joint arthrodesis and PIP joint resection arthroplasty for correction of lesser toe deformities, with good to excellent outcomes for both groups. [Orthopedics. 2022;45(2):86-90.].
Collapse
|
10
|
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
|
11
|
Lunati MP, Manz WJ, Maidman SD, Kukowski NR, Mignemi D, Bariteau JT. Effect of Age on Complication Rates and Outcomes Following First Metatarsophalangeal Arthrodesis for Hallux Rigidus. Foot Ankle Int 2020; 41:1347-1354. [PMID: 32791854 DOI: 10.1177/1071100720942140] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Hallux rigidus is one of the most common toe pathologies in patients greater than 50 years old. Although metatarsophalangeal (MTP) arthrodesis is used to improve pain and function, older patients are often considered to be higher-risk operative candidates. There are minimal data on outcomes of MTP fusion and no studies comparing outcomes between geriatric and younger patients. METHODS This is a single-center, prospective study of all patients who underwent MTP fusion between August 1, 2015, and July 1, 2018. Patient-reported outcomes were assessed using the Short Form Health Survey (SF-36), Life-Space Assessment survey (LSA), and visual analog scale (VAS) for pain administered preoperatively as well as 6 months and 1 year postoperatively. Baseline characteristics and operative outcomes were collected from the electronic medical record. Clinical and patient-reported outcomes were compared between patients <65 years old and ≥65 years old. Of 143 included patients, 79 were in the younger group (mean of 56.5 years) and 64 were in the older group (mean of 72.0 years). RESULTS Compared with the younger group, the older group was more predominantly female (95.3% older group, 77.2% younger group, P = .002). More patients in the older group had hypertension (73.4% older group, 50.6% younger group, P = .005) and coronary artery disease (9.4% older group, 0.0% younger group, P = .005). Both age groups had similar rates of postoperative wound complications requiring operative irrigation and debridement, deep vein thrombosis, deformity recurrence, and revision surgery. No differences were detected in SF-36, LSA, and VAS surveys administered at baseline, 6 months postoperation, or 1 year postoperation between younger and older patients. CONCLUSION Despite more comorbidities, older patients had similar rates of postoperative complications and reported similar outcomes for pain, function, and mobility following MTP fusion. These findings support increased implementation of MTP fusion surgery for older patients with hallux rigidus. LEVEL OF EVIDENCE Level II, prospective cohort.
Collapse
Affiliation(s)
- Matthew P Lunati
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Wesley J Manz
- Emory University School of Medicine, Atlanta, GA, USA
| | | | - Nathan R Kukowski
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | | | - Jason T Bariteau
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, GA, USA
| |
Collapse
|
12
|
Maidman SD, Nash AE, Manz WJ, Spencer CC, Fantry A, Tenenbaum S, Brodsky J, Bariteau JT. Comorbidities Associated With Poor Outcomes Following Operative Hammertoe Correction in a Geriatric Population. FOOT & ANKLE ORTHOPAEDICS 2020; 5:2473011420946726. [PMID: 35097407 PMCID: PMC8702909 DOI: 10.1177/2473011420946726] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background: Although complications following hammertoe correction surgery are rare, older patients with comorbid conditions are often considered poorer operative candidates compared with younger, healthier patients because of a suspected increased risk of adverse outcomes. The aim of this study was to determine if the presence of multiple comorbidities was associated with increased complications or unsuccessful patient-reported outcomes following operative hammertoe correction in geriatric patients. Methods: Prospectively collected data was reviewed on 78 patients aged 60 years or older who underwent operative correction of hammertoe deformity. Patient demographics, comorbidities, and postoperative complications were recorded. Patient-reported outcomes were assessed using preoperative and postoperative visual analog scale for pain and Short Form Health Survey Physical and Mental Component Summary with 1 year of follow-up. Patients were divided into 2 groups based on number of comorbidities (0 or 1 vs > 2) and then compared. The average age of patients was 69.4 years and the prevalence of comorbidities in the study population was as follows: 11.5% smokers, 25.6% on blood thinners, 15.4% with rheumatoid arthritis, 7.7% with diabetes mellitus, 2.6% with peripheral arterial disease, 6.4% with chronic obstructive pulmonary disease, 11.5% with coronary artery disease, and 23.1% with osteoporosis. Results: Fifty-three patients (67.9%) had 0 or 1 comorbidity and 25 (32.1%) had 2 or more comorbidities. Compared to the 0 or 1 comorbidity group, the presence of multiple comorbidities was associated with an adjusted odds ratio (OR) for superficial wound infection of 4.18 (P = .045) and deformity recurrence requiring surgery OR of 23.15 (P = .032). Patient-reported outcomes were similar between comorbidity groups. Conclusions: This study further informs foot and ankle specialists to maintain increased surveillance for postoperative complications and unsuccessful outcomes in patients with multiple comorbidities. Although geriatric patients still report significant improvements in both pain and function, patients with underlying medical conditions should be counseled about their increased risks when pursuing operative hammertoe correction. Level of Evidence: Level III, retrospective comparative series.
Collapse
Affiliation(s)
| | - Amalie E Nash
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA, USA
| | - Wesley J Manz
- Emory University School of Medicine, Atlanta, GA, USA
| | - Corey C Spencer
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA, USA.,Emory Orthopaedics and Spine Center, Atlanta, GA, USA
| | | | - Shay Tenenbaum
- Chaim Sheba Medical Center at Tel HaShomer, affiliated to Sackler Faculty of Medicine, Tel Aviv University, Israel
| | | | - Jason T Bariteau
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA, USA.,Emory Orthopaedics and Spine Center, Atlanta, GA, USA
| |
Collapse
|
13
|
Maidman SD, Nash AE, Fantry A, Tenenbaum S, Daoud Y, Brodsky J, Bariteau JT. Effect of Psychotropic Medications on Hammertoe Reconstruction Outcomes. FOOT & ANKLE ORTHOPAEDICS 2020; 5:2473011420944133. [PMID: 35097400 PMCID: PMC8697102 DOI: 10.1177/2473011420944133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background: Hammertoe deformities can seriously affect activity level and footwear. The use of prescription, mood-altering medications is very common, with some estimates as high as 25% of the population. Mood disorders, especially depression, negatively affect the results of medical and operative treatments. This study assessed the relationship of mood-altering medication use with the outcomes and complications of operative reconstruction of hammertoes. Methods: Data were prospectively collected from 116 patients who underwent hammertoe reconstruction, including demographic information, medical history, the use of mood-altering psychotropic medications (antidepressants, anxiolytics, hypnotics, and mood stabilizers), and postoperative complications. Preoperative patient-reported outcomes were measured using the visual analog scale (VAS) for pain and Short Form Health Survey (SF-36), which were repeated at 1-year follow-up. Results: A total of 36.2% of patients were taking psychotropic medications. Medication and nonmedication groups had similar pain VAS and SF-36 Physical Component Summary (PCS) scores before and after surgery. Compared with nonmedication patients, patients on psychotropic medications had significantly lower SF-36 Mental Component Summary (MCS) scores preoperatively (P = .001) and postoperatively (P = .006), but no significant difference in the change in MCS (ΔMCS) from preoperative to postoperative. Psychotropic medication use was associated with superficial wound infections (P = .048), but not other complications. Conclusions: Patients taking psychotropic medications were equally likely to benefit from forefoot reconstruction as nonmedication patients. Preoperative and postoperative PCS and VAS were not significantly different between medication and nonmedication groups. Although the medication group had lower absolute MCS, they reported the same magnitude of improvement in MCS (ΔMCS) as the nonmedication group. Level of Evidence: Level II, prospective cohort study.
Collapse
Affiliation(s)
| | - Amalie E Nash
- Emory University School of Medicine, Atlanta, GA, USA.,Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA, USA
| | | | - Shay Tenenbaum
- Chaim Sheba Medical Center at Tel HaShomer, affiliated to Sackler Faculty of Medicine, Tel Aviv University, Ramat Gan, Israel
| | - Yahya Daoud
- Baylor University Medical Center, Dallas, TX, USA
| | | | - Jason T Bariteau
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA, USA.,Emory Orthopaedics and Spine Center, Atlanta, GA, USA
| |
Collapse
|
14
|
de Cesar Netto C, Godoy-Santos AL, Cabe TN, Roberts LE, Harnroongroj T, Deland J, Drakos M. The use of polyvinyl alcohol hydrogel implants in the lesser metatarsal heads. Is it safely doable? A cadaveric study. Foot Ankle Surg 2020; 26:128-137. [PMID: 30655193 DOI: 10.1016/j.fas.2018.12.009] [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: 10/16/2018] [Revised: 12/19/2018] [Accepted: 12/27/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND The use of synthetic polyvinyl alcohol hydrogel (PVAH) implants for treatment of lesser toe metatarsophalangeal joint (MTPJ) arthritis is promising and currently limited by the size of implants available. The primary objective of this cadaveric study was to investigate the maximum drilling size and largest PVAH implant dimension that could be safely introduced while still preserving an intact bone rim of the lesser metatarsal heads. METHODS Height and width of all lesser metatarsals were measured on CT and during anatomic dissection. Sequential reaming of the second to fourth metatarsals was performed. Maximum reaming size, largest implant inserted, and failure of the metatarsal head were recorded. Metatarsal head sizes were compared and a multiple regression analysis evaluated measurements that influenced maximum drilling and implant size. RESULTS CT and anatomical measurements demonstrated significant correlation (ICC range, 0.-0.85). Mean values for height and width of the metatarsal heads were respectively: second (14.9 mm and 9.9 mm), third (14.8 mm and 8.8 mm), fourth (14.0 mm and 8.7 mm) and fifth (12.3 mm and 9.3 mm). All the second, third and fourth metatarsal heads could be safely drilled up to 7.5 mm, preserving an intact bone rim. At 80% of the time, the heads could be safely drilled up to 8.0 mm. Height of the metatarsal heads was the only factor to significantly influence the size of maximum reaming and implant introduced. In respectively 20%, 40% and 50% of the second, third, and fourth metatarsal heads, neither 8 mm nor 10 mm PVAH implants could be used. CONCLUSIONS Our cadaveric study found that the even though the majority of the lesser metatarsal heads could be safely drilled up to 8 mm, the smallest PVAH implant size currently available in most countries (8 mm) could be inserted in most of the second, but only in about half of the third and fourth metatarsal heads. The remaining bone rim around inserted implants was considerably thin, usually measuring less than 1 mm. In order to optimize the use PVAH in lesser metatarsal heads, smaller implant options are needed.
Collapse
Affiliation(s)
- Cesar de Cesar Netto
- Department of Orthopaedics, Foot and Ankle Surgery, Hospital for Special Surgery, 523 East 72nd Street, New York, NY 10023, USA.
| | - Alexandre Leme Godoy-Santos
- Department of Orthopaedics, Foot and Ankle Surgery, University of Sao Paulo (USP), St. Ovidio Pires de Campos 333, Sao Paulo, SP, Brazil.
| | - Taylor N Cabe
- Department of Orthopaedics, Foot and Ankle Surgery, Hospital for Special Surgery, 523 East 72nd Street, New York, NY 10023, USA.
| | - Lauren E Roberts
- Department of Orthopaedics, Foot and Ankle Surgery, Hospital for Special Surgery, 523 East 72nd Street, New York, NY 10023, USA.
| | - Thos Harnroongroj
- Department of Orthopaedics, Foot and Ankle Surgery, Hospital for Special Surgery, 523 East 72nd Street, New York, NY 10023, USA.
| | - Jonathan Deland
- Department of Orthopaedics, Foot and Ankle Surgery, Hospital for Special Surgery, 523 East 72nd Street, New York, NY 10023, USA.
| | - Mark Drakos
- Department of Orthopaedics, Foot and Ankle Surgery, Hospital for Special Surgery, 523 East 72nd Street, New York, NY 10023, USA.
| |
Collapse
|