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Guo Z, Xiong B, Zhang L, Cao X, Sun X, Sun W. Advances in the Causes and Treatment of Floating Toes after the Weil Osteotomy: A Scoping Review. Orthop Surg 2024; 16:1257-1268. [PMID: 38693601 PMCID: PMC11144501 DOI: 10.1111/os.14061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 03/23/2024] [Accepted: 03/24/2024] [Indexed: 05/03/2024] Open
Abstract
The floating toe deformity is classified as a forefoot deformity wherein the distal portion of the toe does not establish touch with the ground, resulting in a suspended or elevated position while the finger is in a relaxed state. At first, it garnered considerable interest as a complication It is worth noting that this condition is particularly common in children under the age of 8, which usually disappears as the individual reaches maturity. Studies have shown that with the aggravation of floating toe deformity, its adverse effects on patients' gait and overall quality of life also increase. Despite the prevalence of floating toe deformity in clinical settings, there is a lack of comprehensive literature investigating its underlying causes and potential preventive strategies. This scope review follows the preferred reporting items for systematic reviews and meta-analyses extension for scoping reviews (PRISMA-ScR) statement guidelines for scope reviews. The literature was obtained from various full-text databases, including China National Knowledge Infrastructure Database (CNKI), Wanfang Database, PubMed, and Web of Science Database. Our search focused on published literature related to floating toes, Weil osteotomy, and distal metatarsal osteotomy, up until March 1, 2023. The literature search and data analysis are conducted by two independent reviewers. If there are any disagreements, a third researcher will participate in the discussion and negotiate a decision. Furthermore, two experienced foot and ankle surgeons conducted a thorough literature analysis for this review. Sixty-two articles were included. Through the clinical analysis of the structural changes of the forefoot before and after operation, the classification of floating toe was described, the causes of pathological floating toe were summarized, and the possible intervention measures for the disease were put forward under the advice of foot and ankle surgery experts. We comprehensively summarize the current knowledge system about the etiology of floating toe and put forward the corresponding intervention strategy. We recommend that future studies will focus on the improvement of surgical procedures, such as the combination of Weil osteotomy, proximal interphalangeal (PIP) arthrodesis and flexor tendon arthrodesis.
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Affiliation(s)
- Ziyan Guo
- Wangjing HospitalChina Academy of Chinese Medical SciencesBeijingChina
| | - Binglang Xiong
- Wangjing HospitalChina Academy of Chinese Medical SciencesBeijingChina
| | - Longwei Zhang
- Advanced ChemistrySchool of Science Xi'an Jiaotong‐liverpool UniversitySuzhouChina
| | - Xuhan Cao
- Wangjing HospitalChina Academy of Chinese Medical SciencesBeijingChina
| | - Xudong Sun
- Wangjing HospitalChina Academy of Chinese Medical SciencesBeijingChina
| | - Weidong Sun
- Wangjing HospitalChina Academy of Chinese Medical SciencesBeijingChina
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Stavrakakis IM, Magarakis GE, Kapsetakis P, Tsatsoulas C, Tsioupros A, Datsis G. Weil's osteotomy versus distal metatarsal metaphyseal osteotomy for the treatment of metatarsalgia. A metaanalysis of outcome and complications. Foot (Edinb) 2024; 60:102101. [PMID: 38821005 DOI: 10.1016/j.foot.2024.102101] [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: 05/07/2023] [Revised: 03/14/2024] [Accepted: 05/12/2024] [Indexed: 06/02/2024]
Abstract
BACKGROUND Weil's osteotomy (WO) and distal metatarsal metaphyseal osteotomy (DMMO) are considered to be the gold standard of managing metatarsalgia. Stiffness and floating toe are the main disadvantages of the WO, whereas delayed union or malunion and prolonged swelling are the main complications of the DMMO. The purpose of this study is to compare these two methods, in terms of outcome and complications, through a metaanalysis of the literature. MATERIALS AND METHODS Pubmed, Google Scholar and Mendeley databases were searched for studies comparing directly the outcome of DMMO and Weil's osteotomy, with a minimum follow up of six months. The random effects model was used for the metaanalysis. The quality of studies was assessed using the MINORS criteria. RESULTS Four studies were eligible for the analysis including 211 patients in total. The mean difference of the postoperative American Orthopaedic Foot and Ankle Society (AOFAS) score and the visual analogue scale (VAS) among the two techniques was - 1,04 (C.I.: -3,50 - 1,43) and - 0,39 (CI: -0,83 - 0,08) respectively. The risk difference regarding postoperative stiffness, swelling and residual metatarsalgia was - 0,09 (95% C.I.: -0,23 - 0,06), - 0,17 (95% C.I.: -0,62 - 0,29) and - 0,06 (95% C.I.: -0,20 - 0,08) respectively. CONCLUSION Based on the existing literature, Weil's osteotomy and DMMO are equally safe and effective for the treatment of metatarsalgia. More studies of better quality are required, in order to extract safer and absolute conclusions regarding this topic.
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Affiliation(s)
- Ioannis M Stavrakakis
- General Hospital of Heraklion "Venizeleio and Pananio", Leoforos Knossou 44, 71409 Heraklion Crete, Greece.
| | | | - Petros Kapsetakis
- General Hospital of Heraklion "Venizeleio and Pananio", Leoforos Knossou 44, 71409 Heraklion Crete, Greece
| | - Chrysostomos Tsatsoulas
- General Hospital of Heraklion "Venizeleio and Pananio", Leoforos Knossou 44, 71409 Heraklion Crete, Greece
| | - Alexandros Tsioupros
- General Hospital of Heraklion "Venizeleio and Pananio", Leoforos Knossou 44, 71409 Heraklion Crete, Greece
| | - Georgios Datsis
- Creta Interclinic Hospital, Leoforos Minoos 63, 71304, Greece
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Cavalcanti NA, Martini K, Götschi T, Krähenbühl N, Schöni M, Waibel FWA. Second Metatarsal Length and Transfer Ulcers After First Metatarsal Amputation in Diabetic Foot Infections. Foot Ankle Int 2024; 45:474-484. [PMID: 38497521 PMCID: PMC11083743 DOI: 10.1177/10711007241232970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
BACKGROUND Plantar transfer ulcers (TUs) underneath the second metatarsal head are frequent after first metatarsal ray amputations due to diabetic foot infections. Whether the second metatarsal length (2ML) is associated with TU occurrence in these patients is unclear. This study evaluated whether 2ML is associated with TU occurrence after first-ray amputations and whether ulcer-free survival is shorter in patients with "excess" 2ML. METHODS Forty-two patients with a mean age of 67 (range 33-93) years, diabetes, and first metatarsal ray amputation (first amputation at the affected foot) were included. Two independent readers measured the 2ML using the Coughlin method. A protrusion of more than 4.0 mm of the second metatarsal was defined as "excess" 2ML. The effect of 2ML on ulcer occurrence was analyzed using a multivariate Cox regression model. A Kaplan-Meier curve for TU-free survival was constructed comparing the 2 groups of "normal" (n = 21) and "excess" 2ML (n = 21). RESULTS Interrater reliability was excellent. TUs underneath the second metatarsal occurred in 15 (36%) patients. In agreement with our hypothesis, 2ML was nonsignificantly different in patients with TUs, recording a mean of 5.3 (SD 2.5) mm, compared to patients without 4.0 (SD 2.3) mm (hazard ratio [HR] 1.12, 95% CI 0.89-1.41), whereas insulin dependence was associated with ulcer occurrence (HR 0.33, 95% CI 0.11-0.99). CONCLUSION In our relatively small study population with a cutoff level of 4 mm for excess 2ML, ulcer-free survival was similar in patients with "normal" and "excess" 2ML. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
| | - Katharina Martini
- Department of Radiology, Balgrist University Hospital, Zurich, Switzerland
| | - Tobias Götschi
- Department of Orthopaedics, Balgrist University Hospital, Zurich, Switzerland
- Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
| | - Nicola Krähenbühl
- Department of Orthopaedics, University Hospital Basel, Basel, Switzerland
| | - Madlaina Schöni
- Department of Orthopaedics, Balgrist University Hospital, Zurich, Switzerland
| | - Felix W. A. Waibel
- Department of Orthopaedics, Balgrist University Hospital, Zurich, Switzerland
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Nagamoto H, Okunuki T, Takahashi S, Wakamiya K, Liu Z, Maemichi T, Katsutani H, Yamada Y, Takahashi H, Tanaka H, Aizawa T, Kumai T. Are floating toes associated with lifestyle in children? A cross-sectional study. J Foot Ankle Res 2023; 16:90. [PMID: 38087348 PMCID: PMC10717254 DOI: 10.1186/s13047-023-00685-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 11/14/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Floating toes are a condition and deformity in which some of the toes are afloat. Many functional impairments in floating toes have been previously studied lately and several factors related to floating toes have also been reported. However, no reports have considered the relationship between lifestyle and floating toes among children. The purpose of this study was to reveal the prevalence of floating toes among school children and reveal its relationship with lifestyle. METHODS In total, 138 young male baseball players were recruited. Lifestyle was evaluated by using a questionnaire and chosen whether the main lifestyle was Japanese or Western, if the bedding was futons or beds, and if the toilet was Japanese style (a squat toilet) or Western style. Floating toes were defined as toes that were not in contact with the mat. Ankle dorsiflexion in the knee-flexed and knee-extended positions was measured in a weight-bearing position. The relationship between the floating toes and lifestyles, and the comparison of ankle dorsiflexion range of motion between the lifestyles were statistically analyzed. RESULTS Players living in a Western style showed a significantly higher prevalence of floating toes on both feet compared with the players living in a Japanese style (throwing side; 39% vs. 19%, p = 0.04, and non-throwing side; 43% vs. 19%, p = 0.01). Players living in a Western style with beds showed a significantly smaller range of motion on both sides of ankle dorsiflexion in the knee-flexed position compared with those who were not (throwing side; 37.2 ± 5.7° vs. 39.0 ± 6.6°, p = 0.04, and non-throwing side; 36.8 ± 5.8° vs. 38.6 ± 6.1°, p = 0.04). CONCLUSION Children mainly living in a Western lifestyle showed a significantly higher prevalence of floating toes on both feet compared to those mainly living in a Japanese lifestyle. The prevalence of floating toes may be related to lifestyles among children. TRIAL REGISTRATION The study was approved by the institutional review board of the Waseda University Graduate School of Sport Sciences (IRB number 2021-185).
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Affiliation(s)
- Hideaki Nagamoto
- Graduate School of Sport Sciences, Waseda University, 2-579-15 Mikajima, Tokorozawa, Saitama, 359-1192, Japan.
- Department of Orthopaedic Surgery, Tohoku University, Sendai, Miyagi, Japan.
- Department of Rehabilitation, Faculty of Medical Science and Welfare, Tohoku Bunka Gakuen University, Sendai, Miyagi, Japan.
- Specified Non-Profit Organization, Network for Sports Medicine and Science, Sendai, Miyagi, Japan.
| | - Takumi Okunuki
- Japan Society for the Promotion of Sciences, Tokyo, Japan
- Institute of Life Innovation Studies, Toyo University, Tokyo, Japan
| | - Shimpei Takahashi
- Specified Non-Profit Organization, Network for Sports Medicine and Science, Sendai, Miyagi, Japan
- Department of Physical Medicine and Rehabilitation, Tohoku University Graduate School, Sendai, Miyagi, Japan
| | - Kazuki Wakamiya
- Graduate School of Sport Sciences, Waseda University, 2-579-15 Mikajima, Tokorozawa, Saitama, 359-1192, Japan
| | - Zijian Liu
- Graduate School of Sport Sciences, Waseda University, 2-579-15 Mikajima, Tokorozawa, Saitama, 359-1192, Japan
| | - Toshihiro Maemichi
- Institute of Life Innovation Studies, Toyo University, Tokyo, Japan
- Faculty of Sport Sciences, Waseda University, Tokorozawa, Saitama, Japan
| | - Hirofumi Katsutani
- Graduate School of Sport Sciences, Waseda University, 2-579-15 Mikajima, Tokorozawa, Saitama, 359-1192, Japan
| | - Yoshiyasu Yamada
- Department of Rehabilitation, Faculty of Medical Science and Welfare, Tohoku Bunka Gakuen University, Sendai, Miyagi, Japan
- Specified Non-Profit Organization, Network for Sports Medicine and Science, Sendai, Miyagi, Japan
| | - Hiroyuki Takahashi
- Specified Non-Profit Organization, Network for Sports Medicine and Science, Sendai, Miyagi, Japan
- Department of Orthopaedic Surgery, Kesen-Numa City Hospital, Kesen-Numa, Miyagi, Japan
| | - Hirofumi Tanaka
- Graduate School of Sport Sciences, Waseda University, 2-579-15 Mikajima, Tokorozawa, Saitama, 359-1192, Japan
| | - Toshimi Aizawa
- Department of Orthopaedic Surgery, Tohoku University, Sendai, Miyagi, Japan
| | - Tsukasa Kumai
- Faculty of Sport Sciences, Waseda University, Tokorozawa, Saitama, Japan
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Wako M, Koyama K, Furuya N, Shinohara R, Otawa S, Kobayashi A, Horiuchi S, Kushima M, Yamagata Z, Haro H. Relationship between floating toes condition and lower limb muscle weight in 8-year-old children: the Yamanashi adjunct study of the Japan Environment and Children's Study (JECS-Y). J Phys Ther Sci 2023; 35:252-256. [PMID: 36866014 PMCID: PMC9974319 DOI: 10.1589/jpts.35.252] [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: 11/11/2022] [Accepted: 12/14/2022] [Indexed: 03/04/2023] Open
Abstract
[Purpose] Floating toe is a condition in which the toes make insufficient contact with the ground. Weak muscle strength is reportedly one cause of floating toe. However, little evidence exists regarding the relationship between foot muscle strength and floating toe. Here we examined the relationship between foot muscle strength and floating toe by investigating the children' lower extremity muscle mass and floating toe conditions. [Participants and Methods] This cohort study enrolled 118 8-year-old children (62 females, 56 males) with recorded footprints and muscle mass evaluations using dual-energy X-ray absorptiometry. We calculated the floating toe score using the footprint. We measured the muscle weights and the muscle weights divided by the lengths of the lower limbs separately on the left and right sides using dual-energy X-ray absorptiometry. [Results] No significant correlations were observed between the floating toe score and muscle weights or muscle weights divided by lower-limb lengths for either gender or side. [Conclusion] In this study, no significant correlation was found between floating toe degree and lower limb muscle mass, suggesting that lower limb muscle strength is not the primary cause of floating toe, at least in children.
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Affiliation(s)
- Masanori Wako
- Department of Orthopedic Surgery, Faculty of Medicine,
University of Yamanashi: 1110 Shimokato, Chuo-shi, Yamanashi 409-3898, Japan,Corresponding author. Masanori Wako (E-mail: )
| | - Kensuke Koyama
- Department of Orthopedic Surgery, Faculty of Medicine,
University of Yamanashi: 1110 Shimokato, Chuo-shi, Yamanashi 409-3898, Japan
| | - Naoto Furuya
- Department of Orthopedic Surgery, Faculty of Medicine,
University of Yamanashi: 1110 Shimokato, Chuo-shi, Yamanashi 409-3898, Japan
| | - Ryoji Shinohara
- Center for Birth Cohort Studies, Interdisciplinary Graduate
School of medicine, University of Yamanashi, Japan
| | - Sanae Otawa
- Center for Birth Cohort Studies, Interdisciplinary Graduate
School of medicine, University of Yamanashi, Japan
| | - Anna Kobayashi
- Center for Birth Cohort Studies, Interdisciplinary Graduate
School of medicine, University of Yamanashi, Japan
| | - Sayaka Horiuchi
- Center for Birth Cohort Studies, Interdisciplinary Graduate
School of medicine, University of Yamanashi, Japan
| | - Megumi Kushima
- Center for Birth Cohort Studies, Interdisciplinary Graduate
School of medicine, University of Yamanashi, Japan
| | - Zentaro Yamagata
- Center for Birth Cohort Studies, Interdisciplinary Graduate
School of medicine, University of Yamanashi, Japan
| | - Hirotaka Haro
- Department of Orthopedic Surgery, Faculty of Medicine,
University of Yamanashi: 1110 Shimokato, Chuo-shi, Yamanashi 409-3898, Japan
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The Conventional Weil Osteotomy Does Not Require Screw Fixation. J Clin Med 2023; 12:jcm12020428. [PMID: 36675357 PMCID: PMC9862780 DOI: 10.3390/jcm12020428] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 12/30/2022] [Accepted: 01/03/2023] [Indexed: 01/06/2023] Open
Abstract
The Weil osteotomy is an established procedure to reduce plantar pressure in chronic metatarsalgia. Historically, the refixation of the displaced metatarsal head is performed by screw fixation. We aimed to demonstrate that screw fixation is not always necessary. Between 2016 and 2021, 155 patients with 278 Weil osteotomies (20 males and 135 females, mean age: 63 years) were retrospectively enrolled. Group A (n = 96) underwent 195 Weil osteotomies with screw fixation; group B (n = 59), 83 without screw fixation. Demographic, Visual Analog Scale Foot and Ankle (VAS-FA), SF-12 questionnaire, and toe mobility data were recorded. The mean follow-up period was 4.5 years. The mean VAS-FA was 75.5; mean SF-12 physical component summary, 42.0; and mean SF-12 mental component summary, 51.0. The overall revision rate was 20% (group A: 25%, group B: 10.2%), primarily for arthrolysis of the metatarsophalangeal joint in group A. Clinical comparisons showed no significant difference between the groups (p > 0.05). The revision rate was significantly higher in group A (p < 0.05), with equal satisfaction in clinical outcomes. Based on the available data, the need for regular screw fixation after a Weil osteotomy cannot be justified.
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Park JV, Finney FT, Singer NV, Saunders NE, Walley KC, Holmes JR, Walton DM, Talusan PG. Proximal Plantar Plate of Lesser Toe Metatarsophalangeal Joint Vascular Supply. Foot Ankle Int 2023; 44:75-80. [PMID: 36539967 PMCID: PMC9918344 DOI: 10.1177/10711007221140043] [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: 12/24/2022]
Abstract
BACKGROUND The plantar plate is a major stabilizing structure of the metatarsophalangeal (MTP) joint with instability frequently occurring after a tear or attenuation of this structure. Commonly, a McGlamry elevator is used to strip the plantar plate from the plantar surface of the metatarsal to improve exposure of the MTP joint. The anatomy of the proximal plantar plate and vascular consequence of stripping the plantar plate from the metatarsal is not yet well understood. The purpose of this study is to describe the proximal attachment of the plantar plate anatomically and quantify the relative contribution of blood supply to the proximal plantar plate from both the metatarsal and the plantar fascia. METHODS For anatomic evaluation, 6 lower extremity cadaver specimens without any gross evidence of foot and ankle deformity were utilized. For imaging analysis, 16 fresh frozen human adult cadaveric lower extremity specimens were used for this study, resulting in 35 MTP joints without deformity and 11 lesser MTP joints with cockup and/or crossover deformities. The specimens were prepared as described previously by Finney et al.5. RESULTS From gross anatomic dissection, the plantar plate origin consists of a stout fibrous pedicle distinct from the surrounding synovial-type tissue that firmly anchors the plantar plate to the metatarsal. Based on nano-computed tomographic imaging, an average of 63.5% of the vascular supply to the proximal portion of the plantar plate entered from the metatarsal pedicle. The remaining 36.5% of the vascular supply entered from the plantar fascia. CONCLUSION The proximal attachment of the plantar plate includes a stout fibrous pedicle anchoring the proximal portion of the plantar plate to the notch between the medial and lateral plantar condyles of the metatarsal head. The vascular supply of the proximal plantar plate is supplied from both the metatarsal pedicle and plantar fascia. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Jiwon V. Park
- University of Michigan Medical School, Ann Arbor, MI
| | - Fred T. Finney
- Department of Orthopaedic Surgery, Michigan Medicine, Ann Arbor, MI
| | | | - Noah E. Saunders
- The University of Toledo College of Medicine and Life Sciences, Toledo, OH
| | | | - James R. Holmes
- Department of Orthopaedic Surgery, Michigan Medicine, Ann Arbor, MI
| | - David M. Walton
- Department of Orthopaedic Surgery, Michigan Medicine, Ann Arbor, MI
| | - Paul G. Talusan
- Department of Orthopaedic Surgery, Michigan Medicine, Ann Arbor, MI
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de César PC, Torres AC, Oliani CHP, de Abreu MR. Influence of the Length Ratio Between Second and Third Metatarsals After Modified Weil Osteotomy on Clinical Outcomes. J Foot Ankle Surg 2022; 61:1007-1012. [PMID: 35183453 DOI: 10.1053/j.jfas.2022.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 05/15/2021] [Accepted: 01/10/2022] [Indexed: 02/03/2023]
Abstract
Metatarsalgia is a frequent foot disorder. The objective was to evaluate whether the length ratio between the second and the third metatarsals after Weil osteotomy influences clinical outcomes. This retrospective study included 37 patients (53 feet). Preoperative planning consisted of keeping the second metatarsal greater than or equal to the third metatarsal after Weil osteotomy of the second metatarsal or the second and third metatarsals. Based on postoperative weightbearing and digital AP radiographs after Weil osteotomy, we divided the patients into 2 groups: group 1, the second metatarsal was longer than or equal to the third metatarsal; and group 2, the second metatarsal was shorter than the third metatarsal. We investigated whether there were differences between the groups. In 35 (66%) feet, the second metatarsal was longer than or equal to the third metatarsal (group 1), and in 18 (34%) feet, the second metatarsal was shorter than the third metatarsal (group 2). Postoperative American Orthopaedic Foot and Ankle Society scores were 86.2 and 82.7, respectively (p = .32). Postoperative Visual Analog Scale scores were 1.26 and 1.67, respectively (p = .39). The sample showed 11.3% of transfer metatarsalgia to the third metatarsal. Group 1 had 9% of transfer metatarsalgia, whereas group 2 had 17% of transfer metatarsalgia (p = .40). The presence of a second metatarsal shorter than the third metatarsal, after Weil osteotomy of the second metatarsal or the second and third metatarsals, does not influence outcomes or incidence of transfer metatarsalgia to the third metatarsal.
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Bougiouklis D, Tyllianakis M, Deligianni D, Panagiotopoulos E. Comparison of the Weil and Triple Weil Osteotomies: A Clinical Retrospective Study. Cureus 2022; 14:e22220. [PMID: 35340462 PMCID: PMC8927858 DOI: 10.7759/cureus.22220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction: The Weil and triple Weil osteotomies are two widely used procedures in the surgical treatment of metatarsalgia. The aim of this comparative retrospective study was to evaluate the functional results and determine the complications of the two types of osteotomies in a series of patients who underwent surgery due to third rocker metatarsalgia. Material and methods: In this paper, 71 patients were included between September 2015 and October 2020. The average age was 58 years old (age range: 28-72). Of all the patients, 27 suffered from metatarsalgia due to systemic (extra-regional) or regional diseases were excluded. The remaining 44 patients, after six months of unsuccessful conservative treatment, underwent surgery. Based on the preoperative planning to restore the peripheral parabolic curve of the metatarsals, when a shortening of less than or equal to 3 mm was required, a Weil osteotomy was performed. However, when a shortening of more than 3 mm was required, a triple Weil osteotomy was performed. Therefore, two groups of patients were formed, and a total of 90 osteotomies were performed. During the postoperative period, all the patients were clinically and radiographically assessed. The American Orthopedic Foot and Ankle Society (AOFAS) score was used for the assessment of the functional result, while the pain was assessed using the Visual Analogue Scale (VAS). Results: The mean follow-up was 24 months. The average operative time for the Weil and the triple Weil osteotomies was 22.8 minutes and 31.5 minutes, respectively. In group A, preoperatively, the average AOFAS score was 31/100, and postoperatively, it was 89/100. In group B, the corresponding values were 30/100 and 93/100, respectively. In group A, the preoperative VAS score was 7.8/10, while the postoperative VAS score was 1.3/10. In group B, the corresponding values were 8.2/10 and 1.7/10, respectively. In group A, stiffness had a percentage equal to 60.9%, and a floating toe was noticed in 16 osteotomies. In group B, superficial infection represented the commonest complication, with an incidence of 25.6%. Conclusion: Both Weil and triple Weil osteotomies are effective procedures in the surgical treatment of patients who suffer from third-rocker metatarsalgia. In both cases, correct preoperative planning is of paramount importance for the outcome. However, in terms of the appearance of the floating toe, it seems that in cases where a ray’s shortening of more than 3 mm is required, the triple osteotomy is superior to the Weil osteotomy.
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Neunteufel E, Krenn S, Chraim M, Amann P, Greiner F, Kranzl A, Bock P. Minimally Invasive Distal Metatarsal Metaphyseal Osteotomy of the Lesser Toes: Clinical, Radiologic, and Pedobarographic Outcomes. Foot Ankle Int 2022; 43:153-163. [PMID: 34404241 DOI: 10.1177/10711007211034849] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The minimally invasive distal metatarsal metaphyseal osteotomy (DMMO) is a percutaneous operative technique with the aim to relieve the symptoms of metatarsalgia. To our knowledge, no previous research has analyzed both pre- and postoperative pedobarographic data including the changes in plantar pressure. METHODS Thirty patients (31 feet) were operated on with a DMMO and included in a prospective study. Clinical, radiologic, and pedobarographic outcomes were evaluated in comparison with the preoperative parameters. The American Orthopaedic Foot & Ankle Society (AOFAS) forefoot score, the Foot Function Index (FFI), the Foot and Ankle Outcome Score (FAOS), and a visual analog scale (VAS) for pain were used in order to assess clinical parameters. Radiographs were taken to compare metatarsal lengths. The pedobarographic analysis served to determine plantar peak pressure (PPP) beneath the metatarsophalangeal (MTP) joints. RESULTS All scores indicated a significant mean pre- to postoperative improvement (AOFAS = 31.9 points, FAOS = 16.3%, FFI = 24.3%, VAS pain = 4.1 points, VAS general limitation = 3.3 points) (P < .05). PPP was substantially reduced in the relevant area (M6 [plantar area beneath the second and third MTP joint] had a mean pre to post PPP = 14.15 N/cm2) and concurrently higher in the lateral and medial MTP joint areas (M5 mean pre to post = +14.37, M7 pre to post = +7.11). Our mean metatarsal shortening was 6.6 mm. However, our findings do not demonstrate a significant correlation between metatarsal length relationships and the prevalence of metatarsalgia. CONCLUSION Our results demonstrate a significant improvement in clinical scores and PPP. A statistically significant relation between metatarsal length and the prevalence of metatarsalgia was not found in this prospective case series. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
| | - Sabine Krenn
- Orthopaedic Hospital Speising Vienna, Vienna, Austria
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Flexor tenodesis procedure in the treatment of lesser toe deformities. Arch Orthop Trauma Surg 2022; 142:3125-3137. [PMID: 33974142 PMCID: PMC9522816 DOI: 10.1007/s00402-021-03942-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 05/03/2021] [Indexed: 11/16/2022]
Abstract
In this technical report study, we describe the use of a flexor tenodesis procedure in the treatment of lesser toe deformities (LTD). Using a specific implant, both the flexor digitorum longus and brevis tendons are attached to the plantar aspect of the proximal phalanx, allowing dynamic correction of flexible deformities of metatarsophalangeal and interphalangeal joints. Good clinical results and absence of complications were observed in a series of 3 patients, with considerable correction of the LTD, and absence of substantial residual floating toe or metatarsophalangeal joint stiffness. LEVEL OF EVIDENCE: V - Technical Report/Case Report/Expert Opinion.
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12
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Chopra V, Savage T, Kruse D, Stone P. Sagittal Chevron Shortening Osteotomy With Lateral Wedge for Treatment of Lesser Metatarsal Overload: A Case Report. J Foot Ankle Surg 2021; 60:374-377. [PMID: 33422444 DOI: 10.1053/j.jfas.2018.11.008] [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: 10/13/2016] [Indexed: 02/03/2023]
Abstract
Metatarsalgia is a common problem that refers to the tenderness and pain beneath the forefoot. Many metatarsal shortening osteotomies have been described to alleviate metatarsal overload; however, these osteotomies have been associated with a high complication rate of floating toe deformity. We present a case study that describes an innovative technique for the treatment of lesser metatarsalgia that allows for the repositioning of the metatarsal head, using a stable screw fixation designed to minimize the common complication of the floating toe.
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Affiliation(s)
- Varun Chopra
- Resident, Highlands-Presbyterian/St. Luke's Podiatric Medicine and Surgery Residency Program, Colorado Health Foundation, Denver, CO
| | - Thomas Savage
- Attending, Highlands-Presbyterian/St. Luke's Podiatric Medicine and Surgery Residency Program, Colorado Health Foundation, Denver, CO
| | - Dustin Kruse
- Director of Research, Highlands-Presbyterian/St. Luke's Podiatric Medicine and Surgery Residency Program, Colorado Health Foundation, Denver, CO
| | - Paul Stone
- Program Director, Highlands-Presbyterian/St. Luke's Podiatric Medicine and Surgery Residency Program, Colorado Health Foundation, Denver, CO.
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13
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Giunta JC, Mouton T, Fessy MH, Besse JL. Rheumatoid Forefoot Reconstruction in Nonrheumatic Patients: Lesser Metatarsal Head Resection versus Osteotomy. J Foot Ankle Surg 2021; 60:252-257. [PMID: 33423887 DOI: 10.1053/j.jfas.2020.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 03/09/2020] [Indexed: 02/03/2023]
Abstract
In the literature, first metatarsophalangeal joint arthrodesis with lesser metatarsal head resection seems to be a reliable procedure in rheumatoid foot deformity. Maybe this procedure could be proposed in nonrheumatoid severe forefoot deformity (hallux valgus angle >40° and lesser metatarsophalangeal dislocation). The aim of this study was to compare radiological and clinical outcomes between lesser metatarsal head resection and lesser metatarsal head osteotomy in nonrheumatoid patients. Thirty-nine patients (56 feet) suffering from well-defined nonrheumatoid severe forefoot deformity were retrospectively enrolled in our institution between 2009 and 2015. Metatarsal head resection and metatarsal head osteotomy represented 13 patients (20 feet) and 26 patients (36 feet), respectively. In this observational study, a rheumatoid population (21 patients) was included as the control. The clinical outcome measures consisted of American Orthopaedic Foot and Ankle Society score, Foot and Ankle Ability Measurement, and Short Form-36. The radiological outcomes were: intermetatarsal angle, hallux valgus angle, and metatarsophalangeal alignment. Mean follow-up was 24 months. Satisfaction rate was, respectively, 92% for resection, 91% for osteotomy procedure, and 80% for surgery in rheumatoid patients. Short Form-36 global score was, respectively, 80.7 (52.5-96.4), 76 (57.7-93), and 68.3 (22.6-86). No functional outcome difference was found between resection and osteotomy procedures, except that the metatarsal head resection group had poorer results in sports activities than the osteotomy group. Complications were similar between osteotomy and resection (p > .05). The radiological outcomes were improved significantly from preoperative to postoperative. First metatarsophalangeal joint arthrodesis with lesser metatarsal head resection in nonrheumatoid severe forefoot deformity might be a good therapeutic option.
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Affiliation(s)
- Jean-Charles Giunta
- Orthopaedic Surgeon, Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Service de Chirurgie Orthopédique et Traumatologique, Pierre-Bénite Cedex, France.
| | - Tanguy Mouton
- Orthopaedic Surgeon, Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Service de Chirurgie Orthopédique et Traumatologique, Pierre-Bénite Cedex, France
| | - Michel-Henri Fessy
- Orthopaedic Surgeon, Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Service de Chirurgie Orthopédique et Traumatologique, Pierre-Bénite Cedex, France; Orthopaedic Surgeon, Université Lyon 1, IFSTTAR, LBMC UMR-T 9406 - Laboratoire de Biomécanique et Mécanique des Chocs, Bron Cedex, France
| | - Jean-Luc Besse
- Orthopaedic Surgeon, Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Service de Chirurgie Orthopédique et Traumatologique, Pierre-Bénite Cedex, France; Orthopaedic Surgeon, Université Lyon 1, IFSTTAR, LBMC UMR-T 9406 - Laboratoire de Biomécanique et Mécanique des Chocs, Bron Cedex, France; Orthopaedic Surgeon, Hospices Civils de Lyon, Service de Biostatistique et Bioinformatique, Lyon, France; Orthopaedic Surgeon, Université de Lyon, Lyon, France; Orthopaedic Surgeon, Université Lyon 1, Villeurbanne, France; Orthopaedic Surgeon, CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne, France
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14
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Fujimaki T, Wako M, Koyama K, Furuya N, Shinohara R, Otawa S, Kobayashi A, Horiuchi S, Kushima M, Yamagata Z, Haro H. Prevalence of floating toe and its relationship with static postural stability in children: The Yamanashi adjunct study of the Japan Environment and Children's Study (JECS-Y). PLoS One 2021; 16:e0246010. [PMID: 33760833 PMCID: PMC7990192 DOI: 10.1371/journal.pone.0246010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 03/12/2021] [Indexed: 11/19/2022] Open
Abstract
Floating toe (FT) is a frequently seen condition in which a toe is inadequately in contact with the ground. Although toes play an important role in stabilizing standing posture and walking, many aspects of the effects of FT on the body remain unclear. To our knowledge, there have been no reports about the relationship between FT and postural stability, especially in children. This study aimed to clarify the prevalence of FT and its relationship with static postural stability in children. Of the 400 children aged 8 years who participated in our cohort study, 396, who were examined for static postural stability, were included in this study. Postural stability and FT were assessed using a foot pressure plate. The sway path length of the center of pressure and the area of the ellipse defined as the size of the area marked by the center of pressure, were measured as an evaluation of static postural stability. We calculated the "floating toe score (FT score: small FT score indicates insufficient ground contact of the toes)" using the image of the plantar footprint obtained at the postural stability measurement. The rate of FT was elevated at more than 90%, and the FT score in the eyes-closed condition was significantly higher than that in the eyes-open condition in both sexes. The FT score significantly correlated with the center of pressure path and area. Our results suggest that ground contact of the toes is not directly related to static postural stability in children, but it may function to stabilize the body when the condition becomes unstable, such as when the eyes are closed.
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Affiliation(s)
- Taro Fujimaki
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Yamanashi, Chuo-shi, Yamanashi, Japan
| | - Masanori Wako
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Yamanashi, Chuo-shi, Yamanashi, Japan
- * E-mail:
| | - Kensuke Koyama
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Yamanashi, Chuo-shi, Yamanashi, Japan
| | - Naoto Furuya
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Yamanashi, Chuo-shi, Yamanashi, Japan
| | - Ryoji Shinohara
- Center for Birth Cohort Studies, Interdisciplinary Graduate School of Medicine, University of Yamanashi, Chuo-shi, Yamanashi, Japan
| | - Sanae Otawa
- Center for Birth Cohort Studies, Interdisciplinary Graduate School of Medicine, University of Yamanashi, Chuo-shi, Yamanashi, Japan
| | - Anna Kobayashi
- Center for Birth Cohort Studies, Interdisciplinary Graduate School of Medicine, University of Yamanashi, Chuo-shi, Yamanashi, Japan
| | - Sayaka Horiuchi
- Center for Birth Cohort Studies, Interdisciplinary Graduate School of Medicine, University of Yamanashi, Chuo-shi, Yamanashi, Japan
| | - Megumi Kushima
- Center for Birth Cohort Studies, Interdisciplinary Graduate School of Medicine, University of Yamanashi, Chuo-shi, Yamanashi, Japan
| | - Zentaro Yamagata
- Center for Birth Cohort Studies, Interdisciplinary Graduate School of Medicine, University of Yamanashi, Chuo-shi, Yamanashi, Japan
| | - Hirotaka Haro
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Yamanashi, Chuo-shi, Yamanashi, Japan
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Park YH, Kim W, Kim JY, Choi GW, Kim HJ. Impact of crossover second toe on the postoperative outcome of distal chevron osteotomy for moderate to severe hallux valgus. Foot Ankle Surg 2020; 26:845-850. [PMID: 31839479 DOI: 10.1016/j.fas.2019.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 10/28/2019] [Accepted: 10/29/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Crossover second toe is often presented in moderate to severe hallux valgus. However, its clinical impact on the postoperative outcome of hallux valgus is still unknown. METHODS Thirty-five patients who had moderate to severe hallux valgus with crossover second toe were matched with 35 controls who did not have crossover second toe, according to preoperative hallux valgus angle and first-second intermetatarsal angle. Radiological parameters, Foot Function Index (FFI), and Visual Analog Scale (VAS) were assessed as postoperative outcomes at 3, 6, and 12 months after surgery. RESULTS At 3 months, the FFI in the crossover second toe group was lower than in the control group (p=0.001), while other outcomes were similar. On the other hand, there were no significant differences between the groups at 6 and 12 months, in terms of radiological parameters, FFI, and VAS. CONCLUSIONS Patients who had moderate to severe hallux valgus with crossover second toe were at risk for slow functional recovery after surgical treatment in the short term, but, in the long-term, there was no difference in overall postoperative outcomes in patients with and without crossover second toe. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Young Hwan Park
- Department of Orthopaedic Surgery, Korea University Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul, 08308, South Korea.
| | - Woon Kim
- Department of Orthopaedic Surgery, Korea University Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul, 08308, South Korea.
| | - Jae Young Kim
- Department of Orthopaedic Surgery, Korea University Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul, 08308, South Korea.
| | - Gi Won Choi
- Department of Orthopaedic Surgery, Korea University Ansan Hospital, 123 Jeokgeum-ro, Danwon-gu, Ansan, 15355, South Korea.
| | - Hak Jun Kim
- Department of Orthopaedic Surgery, Korea University Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul, 08308, South Korea.
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16
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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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Wagner E, O’Connell LA, Radkievich R, Caicedo N, Mococain P, Wagner P. Incidence of and Functional Significance of Floating Toe After Weil Osteotomy. FOOT & ANKLE ORTHOPAEDICS 2019; 4:2473011419891956. [PMID: 35097355 PMCID: PMC8697231 DOI: 10.1177/2473011419891956] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Background: The most frequent complication after Weil osteotomies is a floating toe deformity, but there are no reports about its effect on the patient. In this study, we analyzed the consequences of floating toe deformities after the performance of a modified Weil osteotomy (MWO) or a modified Weil osteotomy with interphalangeal fixation (MWOIF). Methods: We performed a retrospective review with a prospective follow-up of 50 patients (98% women, 120 rays) who underwent MWO (65 rays) or MWOIF (55 rays), with a mean age of 54 ± 12 years and a minimum follow-up of 4 years (mean of 6 years). We analyzed the presence of floating toe deformity in MWO and MWOIF and the outcomes measured by the subjective satisfaction, Lower Extremity Functional Scale (LEFS), American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score, and quality of prehension force between patients with or without floating toe deformity. Results: The mean floating toe incidence was of 57%, with no significant difference between operative techniques (48% MWO, 67% MWOIF; P = .053). Our analysis did not show differences in satisfaction, LEFS and AOFAS scores, or grip strength between the group of patients with or without floating toes. Conclusion: The presence of a floating toe deformity was more frequent than generally believed but did not have a meaningful impact on the patient’s satisfaction or functional outcomes measured by the AOFAS and LEFS scales. There was no clear correlation between operative technique, floating toe, and quality of prehension force. Level of Evidence: Level III, retrospective comparative series.
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Affiliation(s)
- Emilio Wagner
- Department of Orthopaedic Surgery, Clínica Alemana de Santiago-Universidad del Desarrollo, Santiago, Chile
| | - Luis A. O’Connell
- Department of Orthopaedic Surgery, Clínica Alemana de Santiago-Universidad del Desarrollo, Santiago, Chile
| | - Ruben Radkievich
- Department of Orthopaedic Surgery, Clínica Alemana de Santiago-Universidad del Desarrollo, Santiago, Chile
| | - Nathaly Caicedo
- Department of Orthopaedic Surgery, Clínica Alemana de Santiago-Universidad del Desarrollo, Santiago, Chile
| | - Pablo Mococain
- Department of Orthopaedic Surgery, Clínica Alemana de Santiago-Universidad del Desarrollo, Santiago, Chile
| | - Pablo Wagner
- Department of Orthopaedic Surgery, Clínica Alemana de Santiago-Universidad del Desarrollo, Santiago, Chile
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18
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Abstract
Weil osteotomy (WO) is the most common technique worldwide for the treatment of mechanical metatarsalgia. The main indication for WO is propulsive/third rocker metatarsalgia that is in relation with an abnormal length of a certain metatarsal with respect to the neighboring metatarsals in the frontal plane. Most clinical studies have showed good to excellent results after WO. However, complications such as floating toes led to evolution of WO and the development of the triple-cut WO that allows for shortening coaxial to the shaft without plantar translation of metatarsal head. Other variations of WO may treat other forefoot disorders.
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Affiliation(s)
- Manuel Monteagudo
- Orthopaedic Foot and Ankle Unit, Orthopaedic and Trauma Department, Hospital Universitario Quirónsalud Madrid, Faculty Medicine UEM Madrid, Madrid, Spain.
| | - Ernesto Maceira
- Orthopaedica Foot and Ankle Unit, Complejo Hospitalario La Mancha Centro, Av de la Constitución 3, 13600, Alcázar de San Juan, Ciudad Real, Spain
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19
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Rivero-Santana A, Perestelo-Pérez L, Garcés G, Álvarez-Pérez Y, Escobar A, Serrano-Aguilar P. Clinical effectiveness and safety of Weil's osteotomy and distal metatarsal mini-invasive osteotomy (DMMO) in the treatment of metatarsalgia: A systematic review. Foot Ankle Surg 2019; 25:565-570. [PMID: 30321939 DOI: 10.1016/j.fas.2018.06.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 06/25/2018] [Accepted: 06/27/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND Weil's osteotomy (WO) is the most applied surgical treatment for metatarsalgia, a persistent pain in the lesser metatarsals' heads. We aim to review its effectiveness and safety compared to the percutaneous technique known as distal metatarsal mini-invasive osteotomy (DMMO). METHODS Systematic review in Medline, Pubmed, Embase, Cinahl and Cochrane Library. We included studies that directly compared WO and DMMO for the treatment of primary metatarsalgia. Data on pain, function, complications and patients' satisfaction were extracted and narratively synthesized. RESULTS Four retrospective studies were identified. There were no significant differences in clinical effectiveness or patients' satisfaction. Time to bone healing was significantly longer for DMMO, whereas WO showed more wound problems and metatarsophalangeal stiffness. Other complications were infrequent in the two procedures. CONCLUSION Evidence on the direct comparison of WO and DMMO is scarce and of low quality. Randomized studies are needed in order to control for potential confounders.
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Affiliation(s)
- Amado Rivero-Santana
- Canary Islands Foundation of Health Research, Bco. de la Ballena, s/n, 35019 Las Palmas de GC, Spain; Health Services Research on Chronic Patients Network, Camino Candelaria, 44, El Rosario, 38109 Tenerife, Spain; Center for Biomedical Research of the Canary Islands, Campus Ciencias de La Salud, s/n, 38071 San Cristobal de La Laguna, Spain.
| | - Lilisbeth Perestelo-Pérez
- Health Services Research on Chronic Patients Network, Camino Candelaria, 44, El Rosario, 38109 Tenerife, Spain; Center for Biomedical Research of the Canary Islands, Campus Ciencias de La Salud, s/n, 38071 San Cristobal de La Laguna, Spain; Evaluation Unit of the Canary Islands Health Service, Camino Candelaria, 44, El Rosario, 38109 Tenerife, Spain.
| | - Gerardo Garcés
- Department of Orthopedics, Hospital Perpetuo Socorro, C/León y Castillo, 407, 35007 Las Palmas de Gran Canaria, Spain; School of Medicine, University of Las Palmas de Gran Canaria, Paseo Blas Cabrera Felipe, s/n, 35016 Las Palmas de Gran Canaria, Spain.
| | - Yolanda Álvarez-Pérez
- Canary Islands Foundation of Health Research, Bco. de la Ballena, s/n, 35019 Las Palmas de GC, Spain; Health Services Research on Chronic Patients Network, Camino Candelaria, 44, El Rosario, 38109 Tenerife, Spain; Center for Biomedical Research of the Canary Islands, Campus Ciencias de La Salud, s/n, 38071 San Cristobal de La Laguna, Spain.
| | - Antonio Escobar
- Health Services Research on Chronic Patients Network, Camino Candelaria, 44, El Rosario, 38109 Tenerife, Spain; Research Unit, Hospital Basurto, Montevideo Etorb., 18, 48013 Bilbao, Spain.
| | - Pedro Serrano-Aguilar
- Health Services Research on Chronic Patients Network, Camino Candelaria, 44, El Rosario, 38109 Tenerife, Spain; Center for Biomedical Research of the Canary Islands, Campus Ciencias de La Salud, s/n, 38071 San Cristobal de La Laguna, Spain; Evaluation Unit of the Canary Islands Health Service, Camino Candelaria, 44, El Rosario, 38109 Tenerife, Spain.
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20
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Evaluation of results after distal metatarsal osteotomy by minimal invasive surgery for the treatment of metatarsalgia: patient and anatomical pieces study. J Orthop Surg Res 2019; 14:121. [PMID: 31068197 PMCID: PMC6505219 DOI: 10.1186/s13018-019-1159-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 04/17/2019] [Indexed: 12/05/2022] Open
Abstract
Background Metatarsalgia of the lesser toes is a common cause of consultation in the podiatric clinic. However, there continues to be a controversy with respect to which is the best surgical technique, and there is few information in the literature regarding objectively comparable results in percutaneous surgery. Methods The second metatarsal bones of 30 feet belonging to patients who had attended the podiatric clinic were studied before and after distal metatarsal pecutaneous osteotomy. The degree of shortening of the second metatarsal (RX) and the degree of functional recovery and perception of the well-being of the patient (AOFAS) were evaluated retrospectively. The same bones of 10 cadaveric feet were also studied. The surgical procedure was identical to that used on patients, and electronic callipers were employed to take measurements of the second metatarsal. The integrity of the plantar plate was checked visually. Results The mean shortening of the second metatarsal bone, as determined by the radiological study, was 2.76 mm. After an average follow-up period of 1.5 years, the final mean score on the AOFAS scale was 95.26 points. In none of the cases was the mobility of the metatarsophalangeal (MTP) joint affected. The mean shortening in the cadaveric feet was 2.10 mm, and in all cases, the plantar plate and flexor apparatus were perfectly preserved. Conclusions Percutaneous osteotomy achieved, in our study, a lower degree of shortening than Weil’s surgery, according to the data published in the literature. However, it shows good clinical results without causing problems of consolidation or rigidity in the MTP joint. Neither, with the caution that should be taken due to the use of experimental cadaver models, damage of the flexor apparatus of the foot is observed. These results suggest that this could be a safe and effective surgical procedure to be considered for metatarsalgias of the lesser rays.
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21
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Park CH, Chang MC. Forefoot disorders and conservative treatment. Yeungnam Univ J Med 2019; 36:92-98. [PMID: 31620619 PMCID: PMC6784640 DOI: 10.12701/yujm.2019.00185] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 04/05/2019] [Accepted: 05/10/2019] [Indexed: 02/05/2023] Open
Abstract
Forefoot disorders are often seen in clinical practice. Forefoot deformity and pain can deteriorate gait function and decrease quality of life. This review presents common forefoot disorders and conservative treatment using an insole or orthosis. Metatarsalgia is a painful foot condition affecting the metatarsal (MT) region of the foot. A MT pad, MT bar, or forefoot cushion can be used to alleviate MT pain. Hallux valgus is a deformity characterized by medial deviation of the first MT and lateral deviation of the hallux. A toe spreader, valgus splint, and bunion shield are commonly applied to patients with hallux valgus. Hallux limitus and hallux rigidus refer to painful limitations of dorsiflexion of the first metatarsophalangeal joint. A kinetic wedge foot orthosis or rocker sole can help relieve symptoms from hallux limitus or rigidus. Hammer, claw, and mallet toes are sagittal plane deformities of the lesser toes. Toe sleeve or padding can be applied over high-pressure areas in the proximal or distal interphalangeal joints or under the MT heads. An MT off-loading insole can also be used to alleviate symptoms following lesser toe deformities. Morton's neuroma is a benign neuroma of an intermetatarsal plantar nerve that leads to a painful condition affecting the MT area. The MT bar, the plantar pad, or a more cushioned insole would be useful. In addition, patients with any of the above various forefoot disorders should avoid tight-fitting or high-heeled shoes. Applying an insole or orthosis and wearing proper shoes can be beneficial for managing forefoot disorders.
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Affiliation(s)
- Chul Hyun Park
- Department of Orthopedic Surgery, Yeungnam University College of Medicine, Daegu, Korea
| | - Min Cheol Chang
- Department of Physical Medicine and Rehabilitation, Yeungnam University College of Medicine, Daegu, Korea
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22
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Hollawell SM, Kane BJ, Paternina JP, Santamaria GJ, Heisey CM. Lesser Metatarsophalangeal Joint Pathology Addressed With Arthrodesis: A Case Series. J Foot Ankle Surg 2019; 58:387-391. [PMID: 30658960 DOI: 10.1053/j.jfas.2018.08.039] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Indexed: 02/03/2023]
Abstract
Lesser metatarsophalangeal joint pathology is a common condition facing the foot and ankle surgeon, often beginning as a mild subluxation of the toe and progressing to a full dislocation of the metatarsophalangeal joint. In severe or recalcitrant deformities, traditional conservative and surgical methods can fail to resolve the issue. We report on 4 patients with 5 severely dislocated lesser metatarsophalangeal joints with varied etiologies and comorbidities who underwent arthrodesis of these joints using screw and plate fixation. All patients achieved radiographic and clinical signs of union at an average of 16.4 weeks.
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Affiliation(s)
- Shane M Hollawell
- Associate Clinical Professor, Rutgers New Jersey Medical School, Newark, NJ.
| | - Brendan J Kane
- Resident Physician, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, NJ
| | - Juliana P Paternina
- Resident Physician, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, NJ
| | - Gregory J Santamaria
- Resident Physician, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, NJ
| | - Christopher M Heisey
- Resident Physician, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, NJ
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23
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Charen DA, Markowitz JS, Cheung ZB, Matijakovich DJ, Chan JJ, Vulcano E. Overview of Metatarsalgia. Orthopedics 2019; 42:e138-e143. [PMID: 30540873 DOI: 10.3928/01477447-20181206-06] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 05/23/2018] [Indexed: 02/03/2023]
Abstract
Metatarsalgia can be viewed as more of a symptom rather than a distinct diagnosis. Timing of forefoot pain during the gait cycle and evaluation of whether the pain is from anatomic abnormalities, indirect overloading, or iatrogenic causes can suggest a specific metatarsalgia etiology. A thorough physical examination of the lower extremity, especially evaluation of the plantar foot, and weight-bearing radiographs are critical for diagnosis and treatment. Nonoperative treatment consists of physical therapy, orthotics, shoe wear modification, and injections. If conservative treatment fails, surgical options may be considered. [Orthopedics. 2019; 42(1):e138-e143.].
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Suh JW, Lee JW, Park JY, Choi WJ, Han SH. Posterior Fibular Groove Deepening Procedure With Low-Profile Screw Fixation of Fibrocartilaginous Flap for Chronic Peroneal Tendon Dislocation. J Foot Ankle Surg 2018; 57:478-483. [PMID: 29269024 DOI: 10.1053/j.jfas.2017.10.033] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Indexed: 02/03/2023]
Abstract
Chronic peroneal tendon dislocation is an uncommon disorder that frequently presents with concomitant pathology. Posterior fibular groove deepening and retinaculum repair have been increasing in popularity for treatment of peroneal tendon dislocations. The purpose of the present study was to introduce a posterior fibular groove deepening procedure using low-profile snap-off screws to securely and simply fix the fibrocartilaginous flap to facilitate faster rehabilitation and to assess the clinical outcomes of patients with chronic peroneal tendon dislocation and associated pathologic features. In the present retrospective case series, 34 ankles in 34 patients underwent the fibular groove deepening procedure using low-profile screws with superior peroneal retinaculum repair. The clinical outcomes were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale and patient subjective satisfaction rate. The time of return to recreational and sports activities was also assessed. Weightbearing ankle radiographs were evaluated to assess the stability of the flap by checking the screws. The mean follow-up period was 47.96 (range 12 to 142) months. The mean AOFAS scale score for all patients improved from 69.96 ± 13.14 to 87.72 ± 10.13 at the last follow-up examination (p < .001). Overall, 85.3% of patients subjectively rated their operative outcomes as excellent or good. The 18 (52.9%) patients with an isolated peroneal tendon dislocation had a faster return to recreational or sports activities than the 16 (47.1%) patients with concomitant pathologic features (2.95 ± 0.19 versus 4.14 ± 1.34 months; p = .002). No patient experienced residual dislocation, screw loosening, or irritation from the screws. The fibular groove deepening procedure using low-profile screws is be a simple procedure that offers rigid fixation. This leads to relatively fast rehabilitation and resumption of recreational or sports activities.
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Affiliation(s)
- Jae Wan Suh
- Assistant Professor, Department of Orthopaedic Surgery, Dankook University Hospital, Cheonan, Republic of Korea; Graduate Student, Department of Orthopaedic Surgery, Graduate School of Medicine, Yonsei University, Seoul, Republic of Korea
| | - Jin Woo Lee
- Professor, Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jun Young Park
- Resident, Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Woo Jin Choi
- Associate Professor, Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seung Hwan Han
- Associate Professor, Department of Orthopaedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Cook JJ, Johnson LJ, Cook EA. Anatomic Reconstruction Versus Traditional Rebalancing in Lesser Metatarsophalangeal Joint Reconstruction. J Foot Ankle Surg 2018; 57:509-513. [PMID: 29685561 DOI: 10.1053/j.jfas.2017.11.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Indexed: 02/03/2023]
Abstract
Traditional rebalancing techniques, such as capsulotomies and capsulorrhaphies, are commonly performed during complex hammertoe and lesser metatarsal osteotomy procedures involving metatarsophalangeal joint (MTPJ) contractures; however, floating toes, digital instability, and malalignment are concerns. We critically analyzed the outcomes after anatomic reconstruction of the plantar plate and collateral ligaments compared with those after traditional rebalancing techniques. A case-control study was conducted of 54 patients who had undergone surgical correction of lesser MTPJ imbalances due to complex hammertoe deformities (power 80%, type I error = 0.05). Cases were defined as consecutive patients treated with anatomic plantar plate and collateral ligament reconstruction. Controls had undergone traditional lesser MTPJ rebalancing and were matched to cases by age, gender, follow-up duration (minimum 12 months), and concomitant procedures of the same lesser ray. Multivariate logistic regression demonstrated that patients treated with anatomic reconstruction had greater digital stability (negative dorsal drawer and negative paper pull-out test findings) at final follow-up examination compared with the controls. American College of Foot and Ankle Surgeons (ACFAS) forefoot module scores were greater in the anatomic group in all domains (p ≤ .05). Controls had greater postoperative radiographic MTPJ angles than the cases, with no differences detected between the 2 groups in visual analog scale scores or proximal interphalangeal joint angles. The importance of restoration of the plantar plate and collateral ligament integrity as a digital stabilizer is generally accepted but has not been well studied. We found that anatomic reconstruction yielded greater digital stability, greater ACFAS Forefoot module scores, and better radiographic MTPJ alignment than controls. Additional studies are warranted to assess the long-term viability of anatomic lesser MTPJ reconstruction.
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Affiliation(s)
- Jeremy J Cook
- Clinical Instructor in Surgery, Harvard Medical School, Boston, MA; Director of Research and Quality Assurance, Division of Podiatric Surgery, Department of Surgery, Mount Auburn Hospital, Cambridge, MA
| | - Lindsay J Johnson
- Clinical Instructor in Surgery, Harvard Medical School, Boston, MA; Chief, Division of Podiatric Surgery, Department of Surgery, Harvard Vanguard Medical Associates, an Affiliate of Atrius Health, Braintree, MA; Assistant Director of Resident Training, Division of Podiatric Surgery, Department of Surgery, Mount Auburn Hospital, Cambridge, MA
| | - Emily A Cook
- Clinical Instructor in Surgery, Harvard Medical School, Boston, MA; Director of Resident Training, Division of Podiatric Surgery, Department of Surgery, Mount Auburn Hospital, Cambridge, MA.
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Li X, Guo M, Zhu Y, Xu X. The excessive length of first ray as a risk factor for hallux valgus recurrence. PLoS One 2018; 13:e0205560. [PMID: 30304018 PMCID: PMC6179288 DOI: 10.1371/journal.pone.0205560] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 09/25/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND It is still unknown whether the excessive length of the first ray is a risk factor for hallux valgus recurrence. The purpose of this study is to clarify the relationship between the excessive length of the first ray and the recurrence of hallux valgus. METHODS Between 2008 and 2011, a total of 186 feet (left 105, right 81) who underwent chevron osteotomy combined with distal soft tissue procedure in our foot and ankle center were retrospectively reviewed. A postoperative hallux valgus angle(HVA) ≥20° was defined as recurrence. Patients were divided into two groups: recurrence and non-recurrence group. Weight-bearing radiographs were evaluated preoperatively and at the time of last follow-up for both groups. Radiographic parameters including the length of the great toe(P1), the length of the second toe(P2), the length distance between the first and second metatarsal(D), the hallux valgus angle(HVA) were obtained. The excessive length of the first ray(EL) was calculated using the equation of EL = P1-P2-D. RESULTS A total of 45 patients (24.2%) had hallux valgus recurrence at the time of last follow-up with a mean follow-up of 83.7 ±12.1 months (range, 66-110). The mean postoperative P1 was 5.06±0.39cm for recurrence group and 4.84±0.34cm for no recurrence group(p<0.001). The mean post operative EL was 5.71±5.01mm for recurrence group and 1.61±4.09mm for no recurrence group(p<0.001). The predictive cutoff value of postoperative P1 and postoperative EL for hallux valgus recurrence was 4.9cm [odds ratio (OR) = 8.67, p = 0.03] and 0.4cm (OR = 6.79, p = 0.001) respectively. CONCLUSIONS Significant relationships between postoperative P1, postoperative EL and hallux valgus recurrence were identified according to our radiographic results. A postoperative P1>4.9cm and postoperative EL>0.4cm can be risk factors for hallux valgus recurrence. The appreciation of the excessive length of the first ray prior to surgery may help to improve the surgical outcome.
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Affiliation(s)
- Xingchen Li
- Orthopaedic Department, Ruijin Hospital North, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Min Guo
- Orthopaedic Department, Anqing Hospital, Anhui University School of Medicine, Anhui, China
| | - Yuan Zhu
- Foot and Ankle Center, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xiangyang Xu
- Orthopaedic Department, Ruijin Hospital North, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Foot and Ankle Center, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- * E-mail:
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Krenn S, Albers S, Bock P, Mansfield C, Chraim M, Trnka HJ. Minimally Invasive Distal Metatarsal Metaphyseal Osteotomy of the Lesser Toes: Learning Curve. Foot Ankle Spec 2018; 11:263-268. [PMID: 29298501 DOI: 10.1177/1938640017750251] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Minimally invasive surgery has a shorter surgical time, and in this study we focus on minimally invasive distal metatarsal metaphyseal osteotomy (DMMO). The operation seems to be less complex but requires a high learning curve. We report on our first patients to underline the need for extensive training and great awareness for the risks in the early learning stages. METHODS We evaluated 27 patients (mean age = 60.9 years) with a mean follow-up time of 7.2 months. Indication was metatarsalgia, intractable plantar keratosis, and the (sub-)luxation of the metatarsophalangeal joint. Clinical results were evaluated with the 12-item Short Form (SF-12), Foot Function Index (FFI), Foot and Ankle Ability Measure (FAAM), and the American Orthopaedic Foot and Ankle Score (AOFAS). Radiographs and pedobarographic analysis were obtained. RESULTS Scores ranged closely to standard value (AOFAS 88.07 points; FFI 93%; FAAM 36.4 points; SF-12 31.27 points). Pedobarography showed significant differences in several forefoot areas. We encountered nonunion/malunion and necrosis of the metatarsal head. CONCLUSIONS The aim of this study was to demonstrate the need for intensive training before practicing DMMO. Results show that minimally invasive DMMO requires a high learning curve. Correct handling of the burr is associated with a lot of training. Wrong handling can lead to nonunion/malunion or necrosis. LEVELS OF EVIDENCE Therapeutic, Level IV: Case series.
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Affiliation(s)
- Sabine Krenn
- Orthopaedic Hospital Speising Vienna, Vienna, Austria (SK, PB, CM, MC, HJT).,Fußzentrum Vienna, Vienna, Austria (SA, HJT)
| | - Sascha Albers
- Orthopaedic Hospital Speising Vienna, Vienna, Austria (SK, PB, CM, MC, HJT).,Fußzentrum Vienna, Vienna, Austria (SA, HJT)
| | - Peter Bock
- Orthopaedic Hospital Speising Vienna, Vienna, Austria (SK, PB, CM, MC, HJT).,Fußzentrum Vienna, Vienna, Austria (SA, HJT)
| | - Clemens Mansfield
- Orthopaedic Hospital Speising Vienna, Vienna, Austria (SK, PB, CM, MC, HJT).,Fußzentrum Vienna, Vienna, Austria (SA, HJT)
| | - Michel Chraim
- Orthopaedic Hospital Speising Vienna, Vienna, Austria (SK, PB, CM, MC, HJT).,Fußzentrum Vienna, Vienna, Austria (SA, HJT)
| | - Hans-Joerg Trnka
- Orthopaedic Hospital Speising Vienna, Vienna, Austria (SK, PB, CM, MC, HJT).,Fußzentrum Vienna, Vienna, Austria (SA, HJT)
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Abstract
Complex digital deformities and metatarsophalangeal joint instability encompass a wide range of pathology, and we must identify the different degrees of ligamentous disruption. It is important to address a combination of procedures to treat gross deformities of the lesser toes. Surgical treatment should be individualized and requires a sequential process for adequate reduction and deformity correction. There is no gold standard procedure for every deformity. Although residual stiffness can result from tendon transfer, overall patient satisfaction levels remain high when it is performed under the proper indications and concomitantly with other procedures to gain full correction of these challenging deformities.
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Affiliation(s)
- Caio Nery
- UNIFESP - Federal University of São Paulo, R. Sena Madureira, 1500 - Vila Clementino, São Paulo - SP, 04021-001, Brazil.
| | - Daniel Baumfeld
- UFMG - Federal University of Minas Gerais, Belo Horizonte, Av. Pres. Antônio Carlos, 6627 - Pampulha, Belo Horizonte - MG, 31270-901, Brazil
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Abstract
Metatarsal osteotomies can be divided into proximal and distal. The proximal osteotomies, such as the oblique, segmental, set cut, and Barouk-Rippstein-Toullec (BRT) osteotomy, all provide the ability to significantly change the position of the metatarsal head without violating the joint. These osteotomies, however, have a high rate of nonunion when done without internal fixation and can lead to transfer metatarsalgia when done without regard to the parabola of metatarsal head position. Distal osteotomies such as the Weil and Helal offer superior healing but have an increased incidence of recurrent metatarsalgia, joint stiffness, and floating toe.
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Affiliation(s)
- Veerabhadra Babu Reddy
- Department of Surgery, Texas A&M Health Science Center College of Medicine, Bryan, TX, USA; Foot and Ankle Surgery Fellowship Program, Baylor University Medical Center, Dallas, 3900 Junius Street, Suite 500, Dallas, TX 75246, USA.
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Abstract
Many different distal metatarsal osteotomies have been described in the surgical treatment of metatarsalgia. The surgeon should use such osteotomies judiciously, and indeed, in the author's experience, they are infrequently required and are certainly not a first port of call. In cases where nonoperative treatments have failed, a thorough understanding of the causes of metatarsalgia and a detailed clinical assessment of the patient are essential if good surgical outcomes are to be achieved. If using distal metatarsal osteotomies as part of the surgical plan, then the author favors extra-articular percutaneous osteotomies to minimize postoperative stiffness.
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Matthews AH, Jagodzinski NA, Westwood M, Metcalfe JE, Trimble KT. Effectiveness of the Cobb-Stainsby excision arthroplasty. Foot Ankle Surg 2018; 24:49-53. [PMID: 29413774 DOI: 10.1016/j.fas.2016.11.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 10/21/2016] [Accepted: 11/13/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND Dislocated metatarsophalangeal joints from clawed or hammer toes can be a disabling consequence of several conditions. The Cobb-Stainsby forefoot arthroplasty combines partial phalangectomy (Stainsby) with extensor tendon transfer to the metatarsal head (Cobb). We present a retrospective, three surgeon case series of 215 toes in 126 patients. METHODS Early results and complications were gathered from the medical charts of 126 patients who met the inclusion criteria. Seventy-five patients were contactable by phone with a follow up range of 12-82 months (median follow up 45 months). Primary outcome measures were improvement of pain and function, reduction in plantar callosities and cosmetic improvement of the deformity. RESULTS Pre-operatively all patients presented with pain and shoe wear problems. Post-operatively seventy-two patients (96%) were satisfied, 72 (96%) reported pain relief, 55 (73%) were happy with toe control, 61 (81%) were pleased with cosmesis and 56 (75%) reported unlimited daily activities. Superficial wound infections were observed in 13 of the 126 patients (10%) and two in 75 patients (2%) developed recurrent clawing. CONCLUSION Our case series demonstrates improved outcomes over alternatives such as the Weil's osteotomy.
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Affiliation(s)
- A H Matthews
- Derriford Hospital, Derriford Road, Crownhill, Plymouth, Devon PL6 8DH, United Kingdom.
| | - N A Jagodzinski
- Derriford Hospital, Derriford Road, Crownhill, Plymouth, Devon PL6 8DH, United Kingdom
| | - M Westwood
- Derriford Hospital, Derriford Road, Crownhill, Plymouth, Devon PL6 8DH, United Kingdom
| | - J E Metcalfe
- Derriford Hospital, Derriford Road, Crownhill, Plymouth, Devon PL6 8DH, United Kingdom
| | - K T Trimble
- Derriford Hospital, Derriford Road, Crownhill, Plymouth, Devon PL6 8DH, United Kingdom
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Biz C, Gastaldo S, Dalmau-Pastor M, Corradin M, Volpin A, Ruggieri P. Minimally Invasive Distal Metatarsal Diaphyseal Osteotomy (DMDO) for Chronic Plantar Diabetic Foot Ulcers. Foot Ankle Int 2018; 39:83-92. [PMID: 29110516 DOI: 10.1177/1071100717735640] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The aims of this prospective study were first to evaluate the safety and effectiveness of minimally invasive distal metatarsal diaphyseal osteotomies (DMDOs) for treating a consecutive series of diabetic patients with chronic plantar diabetic foot ulcers (CPDFUs) and second to assess their clinical-functional and radiographic outcomes. METHODS A consecutive series of patients affected by diabetes mellitus with CPDFUs, not responsive to previous nonoperative management, underwent DMDO. The CPDFUs were evaluated using the University of Texas Diabetic Wound Classification System (UTDWC). Demographic parameters, Foot & Ankle Society (AOFAS) scores, visual analog scale (VAS) scores, healing times, and complications were recorded. Maestro et al criteria and bone callus formation were analyzed radiologically. Statistical analysis was carried out ( P < .05). Thirty consecutive enrolled patients with a mean age of 66.7 (range, 53-75) years presented 35 CPDFUs with a mean diameter of 16.3 mm and a mean duration of 10.3 months. The most frequent grade of the UTDWC was IIIB (42.9%). RESULTS All ulcers recovered with a mean healing time of 7.9 ± 4.0 (range, 4-17) weeks. AOFAS scores improved significantly from 55.3 to 81.4 points ( P < .001). At a mean follow-up of 25.3 months (range, 18-71), no cases of ulcer recurrence were recorded, while a major complication or a wound infection required longer healing time. CONCLUSION Minimally invasive DMDO was a safe and effective method in promoting CPDFU healing, regardless of the grade of severity, by the reduction of the high plantar pressure under the metatarsal heads. This technique improved functional and radiographic outcomes with few complications. LEVEL OF EVIDENCE IV, case series.
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Affiliation(s)
- Carlo Biz
- 1 Orthopaedic Clinic, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padua, Padova, Italy
| | - Stefano Gastaldo
- 1 Orthopaedic Clinic, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padua, Padova, Italy
| | - Miki Dalmau-Pastor
- 2 Human Anatomy and Embryology Unit, Experimental Pathology and Therapeutics Department, University of Barcelona, Barcelona, Spain.,3 Faculty of Health Sciences at Manresa, University of Vic Central, University of Catalonia, Manresa, Spain.,4 Groupe de Recherche et d'Etude en Chirurgie Mini-Invasive du Pied, Merignac, France
| | - Marco Corradin
- 1 Orthopaedic Clinic, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padua, Padova, Italy
| | - Andrea Volpin
- 1 Orthopaedic Clinic, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padua, Padova, Italy.,5 Department of Trauma and Orthopaedics, University College London Hospital, London, UK
| | - Pietro Ruggieri
- 1 Orthopaedic Clinic, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padua, Padova, Italy
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Fraser EJ, Sullivan M, Panti JP, Rositano P, Walton J, Fung S. Computed tomography measurements of the lesser metatarsal heads: Anatomic considerations for surgeons performing distal metatarsal osteotomies. Foot Ankle Surg 2017; 23:230-235. [PMID: 29202980 DOI: 10.1016/j.fas.2016.05.321] [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] [Received: 11/27/2015] [Revised: 04/24/2016] [Accepted: 05/25/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND The purpose of the current study was to provide a standardized, anatomical description of the lesser metatarsals to assist surgeons when planning distal metatarsal surgery and fixation. METHODS Eighty CT scans were included for assessment, based on a priori power analysis. Patient age was a mean 52.7±16.6 years (24-83). Metatarsals two through five were assessed in all patients. Three independent observers completed measurements for all metatarsals. Three measurements were made on all metatarsals, including a vertical height and metatarsal head and neck measurements. Statistical analysis was performed (alpha value 0.05). Inter-observer reliability was assessed for all measurements and intra-class correlation (ICC) reported. RESULTS A sequential decrease in metatarsal measurements was noted from the second to the fifth metatarsal. A mean vertical height measurement of 16.1±1.4mm (range, 13.4-19.4) was recorded for the second metatarsal, decreasing 13.0±1.1mm (range, 10.3-16.1) for fifth. There were no significant differences in metatarsal measurements based on gender in our study. Similar patient and metatarsal variability was seen head and neck measurements. Intraclass correlation coefficients (ICC) for metatarsal measurements were greater than 0.9 [95% CI; 0.936-0.991] correlation, denoting an 'excellent' interobserver reliability. CONCLUSION This study provides a baseline anatomical description of the distal metatarsals. These findings, including the variation found between patients and between metatarsal two through five, are relevant to surgeons planning and performing distal metatarsal osteotomies.
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Affiliation(s)
| | | | | | | | - Judie Walton
- University of New South Wales, Faculty of Medicine, Sydney, Australia
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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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Phisitkul P, Hosuru Siddappa V, Sittapairoj T, Goetz JE, Den Hartog BD, Femino JE. Cadaveric Evaluation of Dorsal Intermetatarsal Approach for Plantar Plate and Lateral Collateral Ligament Repair of the Lesser Metatarsophalangeal Joints. Foot Ankle Int 2017; 38:791-796. [PMID: 28399657 DOI: 10.1177/1071100717702460] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Access to the plantar plate has been described using either a plantar approach or an extensive dorsal approach that required complete joint destabilization and often a metatarsal osteotomy. Clinical scenarios related to plantar plate tear vary and the pathologies in early stages are frequently limited to unilateral soft tissue structures; a less invasive operative approach may be possible. A novel approach requiring a release of only the lateral collateral ligament and the lateral half of the plantar plate is presented in this cadaver model; the extent of joint exposure possible is described. The ability to place a secure suture through the lateral collateral ligament and the plantar plate was analyzed. METHODS Nine fresh-frozen cadaveric specimens were dissected in a randomized fashion across the second to fourth metatarsophalangeal joints through the intermetatarsal space dorsally. Under distraction, soft tissue was sequentially released, including dorsal capsule, lateral collateral ligament, and the lateral half of the plantar plate. Integrity of the extensor tendons, deep transverse intermetatarsal ligament, proximal attachment of the plantar plate, and osseous structures was carefully preserved. The joint exposure was quantified after each step with sizing rods. Using a suture passer, 2-0 nonabsorbable braided sutures were passed into the lateral collateral ligament and the plantar plate, and the construct strength was measured using a tensiometer. RESULTS Progressive increase in mean joint exposure was noted after each step of soft tissue release with the final exposure of 6 mm after release of the lateral half of the plantar plate. Joint exposures after a capsulotomy and a lateral collateral release were 3 mm and 4 mm, respectively. Under distraction, the unilateral release of soft tissue created a lateral opening of the joint while the proximal phalangeal base adducted and medially deviated. Successful suture passage was noted in all specimens that could sustain a minimum tension of 25 N without a catastrophic failure. There was no statistically significant correlation with age, sex, foot length, and rays of the specimens when joint exposure was considered. CONCLUSION The dorsal intermetatarsal approach appeared to be feasible for access to the lateral collateral ligament and the lateral half of the plantar plate. The average joint exposure of 6 mm allowed a quality suture passage by a suture passer in both structures in all specimens without the need of a metatarsal osteotomy. CLINICAL RELEVANCE This operative approach may be appropriate for early stages plantar plate tear when only lateral soft tissue repair is needed. This technique should not preclude conversion to a more extensile operative approach or an additional metatarsal osteotomy if needed. Applicability of this operative approach in cases with more advanced pathologies or involving only medial soft tissue structures requires further studies.
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Affiliation(s)
- Phinit Phisitkul
- 1 Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, IA, USA
| | - Vinay Hosuru Siddappa
- 2 Musculo-skeletal Research Institute, People Tree Hospitals, Bengaluru, Karnataka, India
| | - Tinnart Sittapairoj
- 1 Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, IA, USA
| | - Jessica E Goetz
- 1 Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, IA, USA
| | - Bryan D Den Hartog
- 1 Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, IA, USA
| | - John E Femino
- 1 Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, IA, USA
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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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Nixon DC, McKean RM, Klein SE, Johnson JE, McCormick JJ. Rheumatoid Forefoot Reconstruction in the Nonrheumatoid Patient. Foot Ankle Int 2017; 38:605-611. [PMID: 28335610 DOI: 10.1177/1071100717696253] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Recurrent pain and deformity following forefoot surgery can cause significant patient disability. In patients with rheumatoid arthritis, first metatarsophalangeal (MTP) joint arthrodesis with lesser metatarsal head resections-termed the rheumatoid forefoot reconstruction-has been shown to be a reliable operation for pain relief and deformity correction. Limited data, however, have been published on outcomes of the same forefoot reconstruction operation in the nonrheumatoid patient. Here, we describe our experience with this procedure in patients without rheumatoid disease, hypothesizing improved clinical and radiographic outcomes following surgery. METHODS Following chart review and reviewing billing codes, we retrospectively identified patients without a diagnosis of rheumatoid arthritis who underwent first MTP arthrodesis with lesser metatarsal head resections. Phone surveys were conducted to assess clinical outcomes including pain and patient satisfaction. Preoperative and postoperative radiographs were reviewed for 1, 2 intermetatarsal angle (IMA), hallux valgus angle (HVA), second MTP angle (MTP-2), and lesser MTP alignment (in both sagittal and axial planes). Postoperative radiographs were assessed for radiographic union. We identified 14 nonrheumatoid patients (16 feet) who underwent forefoot reconstruction. Of those, 13 patients (15 feet) were successfully contacted via follow-up phone survey at an average of 44.3 months postoperatively (range: 20-76 months). RESULTS Mean postoperative satisfaction scores were 9.0 (out of 10). No patients required reoperation at final phone follow-up. Pain scores significantly decreased from 6.2 preoperatively to 1.9 postoperatively ( P <.001). Radiographic parameters (1,2 IMA, HVA, MTP-2, and lesser MTP alignment in the sagittal plane) improved with surgery ( P <.05), and all 16 feet achieved union of the first MTP arthrodesis. CONCLUSION With decreased pain, high satisfaction rates, and improved radiographic parameters, first MTP arthrodesis coupled with lesser metatarsal head resection was a viable option for nonrheumatoid patients who failed prior attempts at forefoot reconstruction or have chronic forefoot pain with deformity. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Uritani D, Sakamoto C, Fukumoto T. Effect of floating toes on knee and trunk acceleration during walking: a preliminary study. J Phys Ther Sci 2017; 29:361-364. [PMID: 28265174 PMCID: PMC5333005 DOI: 10.1589/jpts.29.361] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 11/16/2016] [Indexed: 12/02/2022] Open
Abstract
[Purpose] This study investigated the effect of floating toes on knee and trunk
acceleration during walking in experimental setting. [Subjects and Methods] Twelve healthy
volunteers walked barefoot at a preferred speed along a linear pathway under 2 conditions:
normal gait (control) condition and floating toes (FT) condition. In the latter, weight
bearing by the toes was avoided using kinesiology tape applied along the toe extensors.
Accelerations of the knee (Kn) and lumbar spine (Lx) were assessed using triaxial
accelerometers mounted on the right fibular head and the spinous process of L3.
Acceleration vectors were oriented such that the anterior, right, and cranial deviations
were positive along the anteroposterior, lateral, and vertical axes, respectively. The
root mean squares (RMSs; anteroposterior, RMSap; lateral, RMSl; vertical, RMSv) were
calculated, and the mean values of 3 trials in each condition were determined. Differences
between the conditions were assessed using the Wilcoxon signed-rank test. [Results]
LxRMSap and LxRMSv were larger in the FT condition than in the control condition. KnRMSv
tended to be higher in the FT condition than in the control condition. [Conclusion]
Floating toes increase acceleration and might create mechanical stress on the lower back
and knee during walking.
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Affiliation(s)
- Daisuke Uritani
- Department of Physical Therapy, Faculty of Health Science, Kio University, Japan
| | | | - Takahiko Fukumoto
- Department of Physical Therapy, Faculty of Health Science, Kio University, Japan
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Chowdhary A, Drittenbass L, Stern R, Assal M. Technique tip: Simultaneous first metatarsal lengthening and metatarsophalangeal joint fusion for failed hallux valgus surgery with transfer metatarsalgia. Foot Ankle Surg 2017; 23:e8-e11. [PMID: 28159053 DOI: 10.1016/j.fas.2015.12.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 11/20/2015] [Accepted: 12/16/2015] [Indexed: 02/04/2023]
Abstract
BACKGROUND Failed hallux valgus surgery may result in residual or recurrent hallux valgus, and as well transfer metatarsalgia. The present technical tip concerns the combination of fusion of the first metatarsophalangeal (MTP) joint and lengthening of the first metatarsal (MT) through a scarf osteotomy. MATERIALS AND METHODS Six patients underwent the presented technique, all for the indication of failed hallux valgus surgery with shortening of the first MT and degenerative changes in the 1st MTP joint. RESULTS Follow-up at six months revealed all patients had complete healing of the osteotomy and arthrodesis sites. They were all asymptomatic and fully active, completely satisfied with the outcome. CONCLUSIONS Combined fusion of the first MTP joint and lengthening of the first MT through a scarf osteotomy results in an excellent outcome in patients with failed hallux valgus surgery with shortening of the first MT and degenerative changes in the 1st MTP joint.
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Affiliation(s)
- Ashwin Chowdhary
- Center for Surgery of the Foot & Ankle, Clinique La Colline, Av. de Beau-Séjour 6, Geneva 1206, Switzerland.
| | - Lisca Drittenbass
- Center for Surgery of the Foot & Ankle, Clinique La Colline, Av. de Beau-Séjour 6, Geneva 1206, Switzerland
| | - Richard Stern
- Center for Surgery of the Foot & Ankle, Clinique La Colline, Av. de Beau-Séjour 6, Geneva 1206, Switzerland
| | - Mathieu Assal
- Center for Surgery of the Foot & Ankle, Clinique La Colline, Av. de Beau-Séjour 6, Geneva 1206, Switzerland; Faculté de Médecine, University of Geneva Medical Center, Rue Gabrielle-Perret-Gentil 4, Geneva 1205, Switzerland
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Choi JY, Suh YM, Yeom JW, Suh JS. Comparison of Postoperative Height Changes of the Second Metatarsal Among 3 Osteotomy Methods for Hallux Valgus Deformity Correction. Foot Ankle Int 2017; 38:20-26. [PMID: 27660292 DOI: 10.1177/1071100716666566] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND We aimed to compare the postoperative height of the second metatarsal head relative to the first metatarsal head using axial radiographs among 3 different commonly used osteotomy techniques: proximal chevron metatarsal osteotomy (PCMO), scarf osteotomy, and distal chevron metatarsal osteotomy (DCMO). METHODS We retrospectively reviewed the radiographs and clinical findings of the patients with painful callosities under the second metatarsal head, complicated by hallux valgus, who underwent isolated PCMO, scarf osteotomy, or DCMO from February 2005 to January 2015. Each osteotomy was performed with 20 degrees of plantar ward obliquity. Along with lateral translation and rotation of the distal fragment to correct the deformity, lowering of the first metatarsal head was made by virtue of the oblique metatarsal osteotomy. RESULTS Significant postoperative change in the second metatarsal height was observed on axial radiographs in all groups; this value was greatest in the PCMO group (vs scarf: P = .013; vs DCMO: P = .008) but did not significantly differ between the scarf and DCMO groups ( P = .785). The power for second metatarsal height correction was significantly greater in the PCMO group (vs scarf: P = .0005; vs DCMO: P = .0005) but did not significantly differ between the scarf and DCMO groups ( P = .832). CONCLUSIONS Among the 3 osteotomy techniques commonly used to correct hallux valgus deformity, we observed that PCMO yielded the most effective height change of the second metatarsal head. LEVEL OF EVIDENCE Level III, retrospective comparative series.
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Affiliation(s)
- Jun Young Choi
- 1 W institute for foot and ankle disease and trauma, W Hospital, Daegu, South Korea
| | - Yu Min Suh
- 2 New York University School of Medicine, New York, NY, USA
| | - Ji Woong Yeom
- 3 Department of Orthopedic Surgery, Inje University, Ilsan Paik Hospital, Goyang-si, Gyeonggi-do, South Korea
| | - Jin Soo Suh
- 3 Department of Orthopedic Surgery, Inje University, Ilsan Paik Hospital, Goyang-si, Gyeonggi-do, South Korea
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Abstract
Deformities of the lesser toes are common and can be associated with significant morbidity. These deformities are often multiple, and numerous treatment strategies have been described in the literature.The goal of surgical treatment is to improve symptoms by restoring alignment and function, and avoiding recurrence. In order to achieve this, it is essential for the treating surgeon to understand the normal anatomy and pathology of the various deformities.There is a paucity of prospective studies and randomised-controlled trials assessing the efficacy of specific interventions.We describe the normal anatomy and biomechanics of the lesser toes, and the pathology of commonly adult deformities. The rationale behind various treatment strategies is discussed and the results of published literature presented. Algorithms for the management of lesser toe deformities based on current literature are proposed. Cite this article: Malhotra K, Davda K, Singh D. The pathology and management of lesser toe deformities. EFORT Open Rev 2016;1:409-419. DOI: 10.1302/2058-5241.1.160017.
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Affiliation(s)
- Karan Malhotra
- Foot & Ankle Unit, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, UK
| | - Kinner Davda
- Foot & Ankle Unit, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, UK
| | - Dishan Singh
- Foot & Ankle Unit, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, UK
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Abstract
The traditional open surgical options for the treatment of metatarsalgia and lesser toe deformities are limited and often result in unintentional stiffness. The use of percutaneous techniques for the treatment of metatarsalgia and lesser toe deformities allows a more versatile and tailor-made approach to the individual deformities. As with all percutaneous techniques, it is vital the surgeon engage in cadaveric training from surgeons experienced in these techniques before introducing them into his/her clinical practice.
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Özkul E, Gem M, Alemdar C, Arslan H, Boğatekin F, Kişin B. Results of two different surgical techniques in the treatment of advanced-stage Freiberg's disease. Indian J Orthop 2016; 50:70-3. [PMID: 26955180 PMCID: PMC4759878 DOI: 10.4103/0019-5413.173514] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Freiberg's disease is an osteochondrosis most commonly seen in adolescent women and characterized by pain, swelling and motion restriction in the second metatarsal. The early stages of this disease can be managed with semirigid orthoses, metatarsal bars and short leg walking cast. Number of operative methods are suggested which can be used depending on the pathophysiology of the disease, including abnormal biomechanics, joint congruence and degenerative process. We evaluated the outcomes of the patients with Freiberg's disease who were treated with dorsal closing-wedge osteotomy and resection of the metatarsal head. PATIENTS AND METHODS 16 patients (11 female, 5 male) with a mean age of 24.5 (range 13-49 years) years who underwent dorsal closing wedge osteotomy or resection of the metatarsal head were included in this retrospective study. Second metatarsal was affected in 13 and third metatarsal in three patients. According to the Smillie's classification system, ten patients had type IV osteonecrosis and six patients had type V. The results of the patients were evaluated using the lesser metatarsophalangeal-interphalangeal (LMPI) scale. RESULTS According to the LMPI scale, the postoperative scores for the osteotomy and excision groups were 86 (range 64-100) and 72.6 (range 60-85), respectively. In the osteotomy group, mean passive flexion restriction was 18° (range 0°-35°) and mean passive extension restriction was 12° (range 0°-25°). Mean metatarsal shortening was 2.2 mm (range 2-4 mm) in the osteotomy group as opposed to 9.8 mm (range 7-14 mm) in the excision group. Significant pain relief was obtained in both groups following the surgery. CONCLUSIONS The decision of performing osteotomy or resection arthroplasty in the patients with advanced-stage Freiberg's disease should be based on the joint injury and the patients should be informed about the cosmetic problems like shortening which may arise from resection.
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Affiliation(s)
- Emin Özkul
- Department of Orthopaedics and Traumatology, Medical Faculty, Dicle University, Diyarbakir, Turkey,Address for correspondence: Dr. Emin Özkul, Department of Orthopaedics and Traumatology, Medical Faculty, Dicle University, Diyarbakir, Turkey. E-mail:
| | - Mehmet Gem
- Department of Orthopaedics and Traumatology, Medical Faculty, Dicle University, Diyarbakir, Turkey
| | - Celil Alemdar
- Department of Orthopaedics and Traumatology, Medical Faculty, Dicle University, Diyarbakir, Turkey
| | - Hüseyin Arslan
- Department of Orthopaedics and Traumatology, Medical Faculty, Dicle University, Diyarbakir, Turkey
| | - Ferit Boğatekin
- Department of Diyarbakir Training and Educational Hospital, Diyarbakir, Turkey
| | - Bülent Kişin
- Department of Diyarbakir Training and Educational Hospital, Diyarbakir, Turkey
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Haque S, Kakwani R, Chadwick C, Davies MB, Blundell CM. Outcome of Minimally Invasive Distal Metatarsal Metaphyseal Osteotomy (DMMO) for Lesser Toe Metatarsalgia. Foot Ankle Int 2016; 37:58-63. [PMID: 26314303 DOI: 10.1177/1071100715598601] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND As in all fields of surgery, advances in orthopaedic surgery develop toward less invasive surgical techniques. The advantages of smaller incisions include minimal soft tissue dissection allowing procedures to be performed as outpatient surgery. There is the assumption that this leads to a quicker recovery time permitting an earlier return to work. As with any new surgical technique, there is an associated learning curve. This study looked into the outcome of minimally invasive distal metatarsal metaphyseal osteotomy (DMMO) performed at a University Hospital. METHODS Thirty patients underwent minimally invasive surgery for DMMO. There were 13 males and 17 females with an average age of 60 years. More than one metatarsal osteotomy was done in all cases to facilitate the moulding of the metatarsal head to the correct alignment with full weight bearing. The outcome was measured with the Manchester-Oxford Foot Questionnaire (MOXFQ), patient-reported outcome (PRO), and visual analog scale (VAS) pain score. Minimum follow up was 1 year. RESULTS At the final review, the average MOXFQ score was an excellent 31. Average improvement in VAS score was 3.5, which ranged from 10 to -7. The VAS was affected by 2 patients whose pain worsened after the operation. There were 4 complications, one each of nonunion, malunion, transfer metatarsalgia, and soft tissue ossification. CONCLUSION The 3 most common complications of foot and ankle surgery are infection, wound dehiscence, and skin ulcer or blister. Intra-articular metatarsal osteotomies are commonly associated with stiffness due to scarring and consequently hammertoes. By reducing the soft tissue injury in minimally invasive surgery, these risks can be potentially minimized. Minimally invasive DMMO produced good patient satisfaction, functional improvement, and low complication rates in most cases. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Syed Haque
- Sheffield Teaching Hospitals, NHS Trust, Sheffield, United Kingdom
| | - Rajesh Kakwani
- Sheffield Teaching Hospitals, NHS Trust, Sheffield, United Kingdom
| | | | | | - Chris M Blundell
- Sheffield Teaching Hospitals, NHS Trust, Sheffield, United Kingdom
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Complicaciones de la osteotomía de Weil: análisis retrospectivo de 25 pies intervenidos en 21 pacientes. REVISTA ESPAÑOLA DE PODOLOGÍA 2016. [DOI: 10.1016/j.repod.2016.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Aydogan U, Moore B, Andrews SH, Roush EP, Kunselman AR, Lewis GS. Comparison of Proximal and Distal Oblique Second Metatarsal Osteotomies with Varying Achilles Tendon Tension: Biomechanical Study in a Cadaver Model. J Bone Joint Surg Am 2015; 97:1945-51. [PMID: 26631995 PMCID: PMC4657221 DOI: 10.2106/jbjs.o.00216] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The optimal surgery for reducing pressure under the second metatarsal head to treat metatarsalgia is unknown. We tested our hypothesis that a proximal oblique dorsiflexion osteotomy of the second metatarsal would decrease second-metatarsal plantar pressures in a cadaver model with varying Achilles tendon tension. We also tested the plantar pressure effects of two popular techniques of distal oblique osteotomy. METHODS Twelve fresh-frozen feet from six cadavers were randomly assigned to either the distal osteotomy group (a classic distal oblique osteotomy followed by a modified distal oblique osteotomy) or proximal metatarsal osteotomy group. Each specimen was tested intact and then after the osteotomy or osteotomies. The feet were loaded with 0, 300, and 600 N of Achilles tendon tension and a 400-N ground reaction force. Plantar pressures were measured by a pressure sensitive mat and analyzed in sections located under each metatarsal. RESULTS The proximal metatarsal osteotomy significantly reduced average pressures beneath the second metatarsal head during both 300 and 600 N of Achilles tendon loading by an average of 19.4 and 29.7 kPa, respectively (p < 0.05). The modified distal oblique osteotomy significantly decreased these pressures during 600 N of Achilles tendon loading, by a mean of 20.2 kPa, which was to a lesser extent than the proximal metatarsal osteotomy. Interestingly, the classic distal oblique osteotomy was not found to have significant effects on pressures beneath the second metatarsal head. CONCLUSIONS The proximal oblique dorsiflexion metatarsal osteotomy may be the most effective procedure for decreasing plantar pressures under the second metatarsal. The modified distal oblique osteotomy may be the second most effective. CLINICAL RELEVANCE The findings of this biomechanical study help shed light on which of the common second metatarsal osteotomies are best for decreasing plantar pressures.
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Affiliation(s)
- Umur Aydogan
- Penn State Hershey Bone and Joint Institute, 30 Hope Drive, Hershey, PA 17033. E-mail address for U. Aydogan:
| | - Blake Moore
- Penn State Hershey Bone and Joint Institute, 30 Hope Drive, Hershey, PA 17033. E-mail address for U. Aydogan:
| | - Seth H. Andrews
- Department of Orthopaedics and Rehabilitation (S.H.A., E.P.R., and G.S.L.) and Department of Public Health Sciences (A.R.K.), Penn State Hershey College of Medicine, 500 University Drive, Hersey, PA 17033. E-mail address for G.S. Lewis:
| | - Evan P. Roush
- Department of Orthopaedics and Rehabilitation (S.H.A., E.P.R., and G.S.L.) and Department of Public Health Sciences (A.R.K.), Penn State Hershey College of Medicine, 500 University Drive, Hersey, PA 17033. E-mail address for G.S. Lewis:
| | - Allen R. Kunselman
- Department of Orthopaedics and Rehabilitation (S.H.A., E.P.R., and G.S.L.) and Department of Public Health Sciences (A.R.K.), Penn State Hershey College of Medicine, 500 University Drive, Hersey, PA 17033. E-mail address for G.S. Lewis:
| | - Gregory S. Lewis
- Department of Orthopaedics and Rehabilitation (S.H.A., E.P.R., and G.S.L.) and Department of Public Health Sciences (A.R.K.), Penn State Hershey College of Medicine, 500 University Drive, Hersey, PA 17033. E-mail address for G.S. Lewis:
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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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Araki T, Masuda T, Jinno T, Morita S. Incidence of floating toe and its association with the physique and foot morphology of Japanese children. J Phys Ther Sci 2015; 27:3159-62. [PMID: 26644665 PMCID: PMC4668156 DOI: 10.1589/jpts.27.3159] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 07/10/2015] [Indexed: 11/24/2022] Open
Abstract
[Purpose] Physical development, foot morphology, and toe contact of children aged 3 to 5 years were assessed in order to investigate the relationships between body and foot morphology and the incidence of the condition known as "floating toe". [Subjects] A total of 198 children, aged 3 to 5 years old, participated in this study. [Methods] Height and weight were measured for body morphology, and foot length and width were measured for foot morphology. Footprint images were taken to calculate the number of floating toes. Information about the children's height and weight at birth, and the time of starting to walk was obtained from their guardians. [Results] At least one floating toe was observed in 87.7-98.7% of the children depending on their ages. The fifth toe was most commonly affected, occurring in 74.2% of the study population. Among the body and foot morphology parameters, only weight at birth showed a significant but very weak correlation with the number of floating toes. [Conclusion] There was a high incidence of floating toe among the children, with the fifth toe most commonly affected. Floating toe weakly but significantly correlated with weight at birth, but did not correlated with other measures of physique at birth, physical development, or the time of starting to walk.
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Affiliation(s)
- Tomoko Araki
- Faculty of Rehabilitation, Kobe International University: 9-1-6 Koyocho-naka, Higashinada, Kobe, Hyogo 658-0032, Japan ; Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan
| | - Tadashi Masuda
- Faculty of Symbiotic Systems Science, Fukushima University, Japan
| | - Tetsuya Jinno
- Department of Joint Surgery and Sports Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan
| | - Sadao Morita
- Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan
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Abstract
This article describes some of the common techniques used in percutaneous surgery of the forefoot. Techniques such as minimally invasive chevron Akin osteotomy for correction of hallux valgus, first metatarsophalangeal joint cheilectomy, distal minimally invasive metatarsal osteotomies, bunionette correction, and hammertoe correction are described. This article is an introduction to this rapidly developing area of foot and ankle surgery. Less invasive techniques are continually being developed across the whole spectrum of surgical specialties. The surgical ethos of minimizing soft-tissue disruption in the process of achieving surgical objectives remains at the center of this evolution.
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Affiliation(s)
- David Redfern
- London Foot and Ankle Centre, Hospital of St John and St Elizabeth, 60 Grove End Road, London NW8 9NH, UK.
| | - Joel Vernois
- Sussex Orthopaedic Treatment Centre, West Sussex, UK
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