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Martínez-Nova A, Gascó-López de Lacalle J, Morán-Cortés JF, Pedrera-Zamorano JD, Sánchez-Rodríguez R. Plantar pressures values related with appearance of mechanical hyperkeratosis before and after surgery of mild hallux valgus. Front Med (Lausanne) 2023; 10:1141091. [PMID: 37122332 PMCID: PMC10130441 DOI: 10.3389/fmed.2023.1141091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 03/14/2023] [Indexed: 05/02/2023] Open
Abstract
Background Hyperkeratoses are thickenings of the stratum corneum, provoked by deviation of the ray and excessive plantar pressures. They are very common under the first metatarsal head (MTH) and on the big toe when there exists hallux valgus. The objective of this study was to assess plantar pressures pre- and post-surgery to try to define the threshold values that could determine the appearance of keratopathies. Materials and methods Seventy-nine patients (100 feet) who had undergone percutaneous distal soft-tissue release and the Akin procedure were evaluated prospectively. The BioFoot/IBV® in-shoe system was used for objective baropodometric functional evaluations of the heel, midfoot, first through fifth MTHs, hallux, and lesser toes. The presence or absence of a hyperkeratosis (HK) or plantar callus under the first MTH or hallux was recorded. The average follow-up time at which the measurements were repeated was 28.1 months. Results Pre-surgery, 62 feet presented a painful HK on the big toe, while post-surgery, only 9 of the feet presented the same lesion. Patients who presented a prior HK at the first metatarsophalangeal (MTP) joint had a mean pressure of 417.2 ± 254.5 kPa as against a value of 359.6 ± 185.1 kPa for the rest. Post-surgery, these values dropped to 409.8 and 346.3 kPa, respectively. Conclusion Patients with HK presented an 11% greater mean pressure than those without. The values obtained with the BioFoot/IBV® system in the present study can therefore be considered predictive of the appearance of HK under the first MTH and on the side of the big toe.
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Affiliation(s)
| | - Jaime Gascó-López de Lacalle
- School of Health Sciences, Catholic University of Valencia San Vicente Mártir, Valencia, Spain
- *Correspondence: Jaime Gascó-López de Lacalle,
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Symptomatic Bunionette Treated with Sliding Oblique Metatarsal Osteotomy-Case Series. J Clin Med 2022; 11:jcm11143962. [PMID: 35887727 PMCID: PMC9318869 DOI: 10.3390/jcm11143962] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 07/03/2022] [Accepted: 07/04/2022] [Indexed: 01/27/2023] Open
Abstract
Background: The purpose of this study is to investigate the clinical and radiological results of a sliding oblique metatarsal osteotomy (SOMO) to correct bunionette deformity. Methods: We retrospectively reviewed 44 patients (51 feet, left/right: 29/22) from December 2010 to December 2018 who underwent SOMO and compared radiographic measurements and clinical outcome scores preoperatively and postoperatively. Radiographic measurements included 4th and 5th intermetatarsal angle (IMA), metatarsophalangeal angle (MTPA), and lateral deviation angle (LDA). Clinical outcome measurements included The American Orthopedic Foot and Ankle Society (AOFAS) score for lesser metatarsophalangeal procedures and visual analog scale (VAS) pain score. The mean follow-up period was 26.6 months (minimum 18 months). Based on Coughlin and Fallat classification, all cases were separated into four subtypes: 6 type I, 10 type II, 12 type III, 23 type IV cases included.) Results: All radiographic parameters significantly improved after SOMO procedure (IMA/MTPA/LDA, p value < 0.001). Clinical scores also showed a significant improvement in AOFAS and VAS scores (p value < 0.001). In terms of subgroup based on each type, both radiographic measurements and clinical scores revealed significant improvements in each subgroup (p value < 0.05), except LDA of type I subgroup (p value = 0.09). Three cases reported pin-tract infection but recovered with good healing after removal of the K-wire and a prescription of oral antibiotic. Conclusion: The SOMO procedure may be considered as a reliable and simple treatment for most types of bunionette deformity with satisfactory outcomes and no severe complications. Level of Evidence: Level IV, case series.
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Tan MWP, Chen JY, Yeo EMN. Clinical Outcomes of Scarf-Akin Osteotomy for Hallux Valgus With Simultaneous Bunionette Correction: A Propensity Score-Matched Cohort Analysis. J Foot Ankle Surg 2022; 61:520-527. [PMID: 34799274 DOI: 10.1053/j.jfas.2021.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 07/01/2021] [Accepted: 10/03/2021] [Indexed: 02/03/2023]
Abstract
Hallux valgus and bunionette (Tailor's bunion) deformities are debilitating forefoot deformities that may occur together. Successful outcomes of surgery for either pathology have been well-described; however, the literature is sparce on outcomes of patients undergoing simultaneous surgery for both deformities. Between 2007 and 2018, 429 patients underwent a scarf-Akin osteotomy, and 20 patients underwent simultaneous bunionette surgery. Propensity score matching was used to match the scarf + bunionette group in a 1:2 ratio to a corresponding scarf only group using logistic regression. Their hallux and fifth metatarsal visual analogue scale (VAS), American Orthopaedic Foot & Ankle Society (AOFAS) Hallux Metatarsophalangeal-Interphalangeal Scale, Short Form-36 (SF-36), expectations and satisfaction scores were recorded at preoperative, 6-month and 2-year intervals. There were no differences in baseline characteristics between groups after matching (p > .05). At 6 months, the scarf + bunionette group had a significantly worse fifth metatarsal AOFAS (80.7 vs 92.9, p = .002) and VAS (1.5 vs 0.1, p = .008). However, at 2 years, greater improvements in the scarf + bunionette group resulted in no significant differences for fifth metatarsal AOFAS and VAS. The scarf + bunionette group had better SF-36 scores in the domains of physical functioning, bodily pain, general health and mental health (p < .05). Scarf + bunionette patients trended toward higher satisfaction (100.0% vs 85.0%, p = .165) and expectation fulfilment (95.0% vs 80.0%, p = .249) at 2 years, although not significant with the available numbers. In patients with similar baseline hallux and fifth metatarsal pain and function, simultaneous surgery and a scarf osteotomy alone result in similar improvements to pain and function at 2 years. However, patients who undergo both procedures have higher quality of life scores.
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Affiliation(s)
- Marcus Wei Ping Tan
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore.
| | - Jerry Yongqiang Chen
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
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Benavente Valdivia JC, Thull DM. Minimally Invasive Distal Chevron Osteotomy for Symptomatic Bunionette: Clinical and Radiologic Results of a 31-Case Retrospective Study. FOOT & ANKLE ORTHOPAEDICS 2022; 7:24730114221099022. [PMID: 35615075 PMCID: PMC9125066 DOI: 10.1177/24730114221099022] [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] [Indexed: 11/17/2022] Open
Abstract
Background Bunionette is a common forefoot deformity that usually leads to significant discomfort. Multiple surgical techniques have been described for correcting bunionette. The purpose of this study is to analyze the clinical and radiologic outcomes of a new surgical technique via minimally invasive distal Chevron osteotomy of the fifth metatarsal without fixation, trying to find an effective technique with fewer complications. Methods We retrospectively analyzed the data of 28 patients (31 feet) who presented with symptomatic bunionette that was resistant to conservative treatment and who underwent surgery at our center from February 2018 to February 2020. A minimum follow-up of 20 months was obtained (mean follow-up 26 months, range 20-37). Clinical results were evaluated using the visual analog scale (VAS) and the American Orthopaedic Foot & Ankle Society (AOFAS) score; 5 different radiologic parameters were analyzed. Results After surgery, the mean AOFAS score increased by 29 points (P < .001) and the mean VAS scores decreased by 6 points (P < .001). An adequate radiologic correction was observed with a decrease in the M4-M5 intermetatarsal angle from 10.3 to 4.8 degrees (P < .001), metatarsophalangeal angle by a mean of 16.05 degrees (P < .001), and lateral deviation angle of the fifth metatarsal from 8.5 to 0.97 degrees (P < .001). Moreover, the length of the fifth metatarsal and the forefoot width was reduced (P < .001). The only complication was an asymptomatic delay in bone healing, but a complete bone consolidation was achieved after therapy. Conclusion The proposed surgical technique shows a good correction capacity with excellent clinical and radiologic results and low complication rates.Level of Evidence: Level IV, retrospective case series.
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Affiliation(s)
| | - Daniel M. Thull
- Cologne Foot and Ankle Surgery Center, Fußzentrum Köln, Cologne, Germany
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Mazoteras-Pardo V, Becerro-de-Bengoa-Vallejo R, Losa-Iglesias M, Palomo-López P, López-López D, Calvo-Lobo C, Romero-Morales C, Casado-Hernández I. Degree of Impact of Tailor's Bunion on Quality of Life: A Case-Control Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18020736. [PMID: 33467061 PMCID: PMC7830808 DOI: 10.3390/ijerph18020736] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 01/09/2021] [Accepted: 01/13/2021] [Indexed: 12/24/2022]
Abstract
Tailor’s bunion (TB) disease should be considered one of the foot injuries that causes disability in feet as well as general health. This case–control descriptive study investigated and contrasted the effects of different TB types in a sociodemographic population using the Foot Health Status Questionnaire (FHSQ). A sample of 100 subjects with a mean age of 51.70 ± 17.78 years was recruited and requested to reply to a foot health survey. Results were self-reported. Subjects were scored. Participants with TB type III (TB3) registered lower scores for foot pain, foot function, footwear, and foot health. Physical activity and social capacity had higher scores, and vigor and general health were lower. A Kruskal–Wallis test was used for systematic differences between the FHSQ and different TB types. In all analyses, statistical significance was considered a p-value <0.05 with a 95% confidence interval. Statistically significant differences were found between all domains of the FHSQ and TB, except for the social capacity domain and vigor. The FHSQ is an important measurement tool in TB subjects, showing that factors such as sex, age, and footwear used throughout an individual’s life are significantly associated with the development of TB3 and its influence on foot pain and foot health.
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Affiliation(s)
- Victoria Mazoteras-Pardo
- Grupo de Investigación ENDOCU, Departamento Enfermería, Fisioterapia y Terapia Ocupacional, Facultad de Fisioterapia y Enfermería de Toledo, Universidad de Castilla-La Mancha, 45071 Toledo, Spain;
| | - Ricardo Becerro-de-Bengoa-Vallejo
- Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, 28040 Madrid, Spain; (R.B.-d.-B.-V.); (C.C.-L.); (I.C.-H.)
| | - Marta Losa-Iglesias
- Faculty of Health Sciences, Universidad Rey Juan Carlos, 28922 Alcorcón, Spain;
| | - Patricia Palomo-López
- Department of Nursing, University Center of Plasencia, Universidad de Extremadura, 10600 Plasencia, Spain
- Correspondence: ; Tel.: +34-927-25-70-00 (ext. 52181)
| | - Daniel López-López
- Research, Health and Podiatry Group, Department of Health Sciences, Faculty of Nursing and Podiatry, Universidade da Coruña, 15403 Ferrol, Spain;
| | - César Calvo-Lobo
- Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, 28040 Madrid, Spain; (R.B.-d.-B.-V.); (C.C.-L.); (I.C.-H.)
| | - Carlos Romero-Morales
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain;
| | - Israel Casado-Hernández
- Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, 28040 Madrid, Spain; (R.B.-d.-B.-V.); (C.C.-L.); (I.C.-H.)
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Paterson R, Saragas NP, Ferrao PNF. Comparison of 2 Oblique Fifth Metatarsal Osteotomies for the Management of a Bunionette. FOOT & ANKLE ORTHOPAEDICS 2021; 6:2473011421993793. [PMID: 35097433 PMCID: PMC8702927 DOI: 10.1177/2473011421993793] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: A bunionette is a painful prominence of the fifth metatarsal head. This study aimed to compare the clinical outcome of 2 corrective osteotomies, namely, the Mau-type and Ludloff-type osteotomies. We report results with regard to correction, healing, complications, and patient-reported outcomes. Methods: Thirty-two patients who underwent bunionette corrective surgery from March 2011 to May 2017 were included in the study. All patients had pre- and postoperative radiographs. The pre- and postoperative fourth-fifth intermetatarsal angles (IMAs) and postoperative fifth metatarsal bowing angle were measured. Radiographic union was assessed at 12 weeks. All patients completed the Self-Reported Foot and Ankle Score (SEFAS) questionnaire to assess clinical outcome. Thirty-two patients (43 feet) were available for follow-up and completed the SEFAS score. Twenty-two Mau-type and 21 Ludloff-type osteotomies were performed. Results: The mean pre- and postoperative IMA for Mau was 10.5 and 4.3 degrees, respectively, and for the Ludloff was 10.2 and 4 degrees, respectively, with no statistically significant difference between the 2 groups. The Mau caused more bowing with a mean of 9.8 degrees as compared to a mean of 3.5 degrees with the Ludloff. No patients in the Mau group reported clinical problems related to the increased bowing. All osteotomies united. The Mau cohort had a mean SEFAS score of 45 and the Ludloff cohort a mean of 46. No feet had fair or poor outcome scores. Conclusion: Patient satisfaction after bunionette correction with an oblique shaft rotational osteotomy was good. Orientation of the osteotomy did not affect outcomes. Postoperative bowing of the fifth metatarsal was greater with the Mau-type osteotomy. Postoperative fifth metatarsal bowing had no negative clinical effects. The trend in our unit has been a preference toward the Mau-type osteotomy as it is perceived to be more stable. Level of Evidence: Level III, retrospective comparative series.
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Affiliation(s)
- Richard Paterson
- Orthopaedic Department, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | | | - Paulo Norberto Faria Ferrao
- Orthopaedic Department, University of the Witwatersrand, Johannesburg, Gauteng, South Africa.,Orthopaedic Foot and Ankle Unit, Netcare Linksfield Hospital, Johannesburg, Gauteng, South Africa
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Ferreira GF, Dos Santos TF, Oksman D, Pereira Filho MV. Percutaneous Oblique Distal Osteotomy of the Fifth Metatarsal for Bunionette Correction. Foot Ankle Int 2020; 41:811-817. [PMID: 32436745 DOI: 10.1177/1071100720917906] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Bunionette is a common foot disorder, and several types of corrective surgery have been described. With the popularization of minimally invasive surgeries, the forefoot region has become a suitable area for this type of technique. The aim of this study was to evaluate the results of oblique distal osteotomy of the fifth metatarsal adapted for a percutaneous approach. METHODS We prospectively evaluated 31 consecutive tailor's bunion patients who underwent operative correction on a total of 42 feet between 2017 and 2019 after failure of conservative treatment. Clinical outcomes such as pain (visual analog scale [VAS]), function (American Orthopaedic Foot & Ankle Society [AOFAS] Lesser Toe Metatarsophalangeal-Interphalangeal Scale scoring system), personal satisfaction, and complications were evaluated. Radiographic aspects were also examined. Shapiro and Mann-Whitney statistical tests were conducted. The average age of the patients was 69.5 years, and the average follow-up was 13.1 months. RESULTS After the operative procedure, there was a decrease of 6.6 points on the VAS for pain (P < .001) and an increase of 34.9 in the AOFAS score (P < .001). Radiographic correction was achieved for both the fifth metatarsophalangeal angle (P < .001) and the intermetatarsal angle (P < .001), which showed decreased values. There was 1 case of superficial infection and 2 cases of nonunion (asymptomatic). A large majority of patients regarded the procedure outcome as satisfactory. CONCLUSION This percutaneous oblique distal osteotomy of the fifth metatarsal for bunionette deformity produced improvements in pain and function and a high rate of satisfaction, with a low incidence of complications and a high capacity for correcting the deformity. LEVEL OF EVIDENCE Level II, prospective cohort study.
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Affiliation(s)
- Gabriel Ferraz Ferreira
- Foot and Ankle Surgery Group, Orthopaedics and Traumatology Unit, Prevent Senior, São Paulo, SP, Brazil
| | | | - Daniel Oksman
- Head of Orthopedics and Traumatology, Prevent Senior, São Paulo, SP, Brazil
| | - Miguel Viana Pereira Filho
- Head of Foot and Ankle Surgery Group, Orthopaedics and Traumatology Unit, Prevent Senior, São Paulo, SP, Brazil
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