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Couvercelle C, Bilger G, Simon E. [Case report: Great toe dorsal defect reconstruction by cross-toe flap]. ANN CHIR PLAST ESTH 2024; 69:228-232. [PMID: 37932174 DOI: 10.1016/j.anplas.2023.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 09/25/2023] [Accepted: 09/28/2023] [Indexed: 11/08/2023]
Abstract
Reconstruction of hallux soft-tissue defects is essential for the locomotor function. Some regional flaps are available and have to be preferred in case of small defect. Here, we present the case of a patient treated by a cross-toe flap in order to cover an exposed hallux proximal interphalangeal joint, after an open fracture. The functional outcome of this reliable and easy flap was very satisfying, with quick wound healing and resumption walk.
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Affiliation(s)
- C Couvercelle
- Service de chirurgie plastique, reconstructrice et esthétique, CHRU de Nancy, 29, avenue du Maréchal-de-Lattre-de-Tassigny, 54035 Nancy, France; Service de chirurgie orthopédique traumatologique et arthroscopique, CHRU de Nancy, 29, avenue du Maréchal-de-Lattre-de-Tassigny, 54035 Nancy, France.
| | - G Bilger
- Service de chirurgie plastique, reconstructrice et esthétique, CHRU de Nancy, 29, avenue du Maréchal-de-Lattre-de-Tassigny, 54035 Nancy, France; Service de chirurgie orthopédique traumatologique et arthroscopique, CHRU de Nancy, 29, avenue du Maréchal-de-Lattre-de-Tassigny, 54035 Nancy, France
| | - E Simon
- Service de chirurgie plastique, reconstructrice et esthétique, CHRU de Nancy, 29, avenue du Maréchal-de-Lattre-de-Tassigny, 54035 Nancy, France; Service de chirurgie orthopédique traumatologique et arthroscopique, CHRU de Nancy, 29, avenue du Maréchal-de-Lattre-de-Tassigny, 54035 Nancy, France
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Pomares G, Ledoux A, Duysens C, Jager T, Fouasson-Chailloux A. Proximal toe wrap-around: a coverage technique for circumferential skin defects of the fingers. Hand Surg Rehabil 2024; 43:101673. [PMID: 38432517 DOI: 10.1016/j.hansur.2024.101673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 02/16/2024] [Accepted: 02/18/2024] [Indexed: 03/05/2024]
Abstract
Circumferential skin defects of the fingers are a technical challenge. Although rare, their management should respect tissue organization and functional abilities. We report two cases of circumferential skin defect. Management used individually tailored "wrap-around" flaps taken from the hallux. The sample concerned the proximal cutaneous sheath of the first toe and the neurovascular pedicle of the first inter-metatarsal space. Nail and toe pad were spared. Both cases had complex circumferential skin defect of the finger, involving the neuro-vascular pedicle. Postoperative results were favorable, without functional limitation. The wrap-around technique provided skin coverage and also neurovascular pedicle reconstruction. Donor site damage was limited, with no functional consequences. This technique is a valuable option for management of circumferential skin defect of the finger.
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Affiliation(s)
- Germain Pomares
- Institut Européen de la Main, Luxembourg, L-2540, Luxembourg; Medical Training Center, Hôpital Kirchberg, Luxembourg L-2540, Luxembourg
| | - Amandine Ledoux
- Institut Européen de la Main, Luxembourg, L-2540, Luxembourg
| | | | - Thomas Jager
- Institut Européen de la Main, Luxembourg, L-2540, Luxembourg; Medical Training Center, Hôpital Kirchberg, Luxembourg L-2540, Luxembourg
| | - Alban Fouasson-Chailloux
- Institut Européen de la Main, Luxembourg, L-2540, Luxembourg; Medical Training Center, Hôpital Kirchberg, Luxembourg L-2540, Luxembourg; Service de MPR Locomotrice et Respiratoire, Nantes Université, CHU Nantes, 44093 Nantes, France; Institut Régional de Médecine du Sport (IRMS), Hôpital St Jacques, 44093 Nantes, France.
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Westberry DE, Shull ER, Layton B. Great Toe Interphalangeal Fusion for Hallux Valgus Interphalangeus Deformity in Young Patients. J Pediatr Orthop 2024; 44:179-183. [PMID: 37997383 DOI: 10.1097/bpo.0000000000002580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2023]
Abstract
OBJECTIVES The purposes of this study were to examine indications, radiographic outcomes, and clinical complications for primary arthrodesis of the great toe interphalangeal (IP) joint in young patients. BACKGROUND Hallux valgus interphalangeus deformity of the great toe is uncommon in the pediatric population and often requires fusion of the IP joint. METHODS A retrospective review of patients, ages 8 to 19 years, who underwent operative fusion of the great toe IP joint, and had >1 year radiographic follow-up was performed. Medical records and radiographs were reviewed to determine indications for surgery, concomitant procedures, success of fusion, complications, and need for revision procedures or elective hardware removal. Differences between pre and postradiographic outcomes for the hallux valgus angle, IP angle, and intermetatarsal angle were analyzed. RESULTS Twenty-seven patients (31 feet) were included in the analyses. The average age at fusion surgery was 14.9 years (SD ± 2.3) with a mean follow-up visit of 35.2 months. The most common indications for fusion of the great toe IP joint were pain and deformity. Kirschner wire fixation was utilized in 7 cases, with the remaining 24 cases fixed with a single retrograde cannulated screw. Fifty-five concomitant toe and foot procedures were performed in 21 feet (68%) to address additional foot and toe deformity. Successful fusion occurred in 30 of 31 toes after the primary fusion. Patient satisfaction with the toe position and diminished pain were high (94.1%). Significant improvement was noted in the measure of the IP angle ( P < 0.001), with minimal clinical change in the hallux valgus angle ( P = 0.24) or the intermetatarsal angle ( P = 0.03). CONCLUSIONS Hallux valgus interphalangeus of the great toe was successfully managed with the fusion of the IP joint. Single screw fixation or the use of Kirschner wires led to similar outcomes. Hardware-related issues with the use of screws were the most common adverse outcome. Patients should be made aware of the possible need for hardware removal after fusion utilizing screw fixation. LEVEL OF EVIDENCE Level IV-a retrospective case series.
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Affiliation(s)
| | | | - Branum Layton
- University of South Carolina Greenville School of Medicine, Greenville, SC
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Soares S, Mota Gomes T, Garibaldi R, Martin Oliva X. Hallux Valgus: The Influence of Intersesamoid Crista's Osteoarthritis on Frontal Plane Pronation. J Foot Ankle Surg 2024; 63:151-155. [PMID: 37806483 DOI: 10.1053/j.jfas.2023.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 09/26/2023] [Accepted: 09/30/2023] [Indexed: 10/10/2023]
Abstract
A frontal plane metatarsal rotational (pronation) has been documented in a high percentage of hallux valgus patients. Pathoanatomical concepts leading to pronation are still debated. Nevertheless, there is no consensus on how to measure this component of the deformity. The aim of the present study was to find potential associations between sesamoid's crista osteoarthritis and the frontal plane deformity in HV cases. Our study showed a moderate correlation between the crista's OA and the intermetatarsal angle (IMA), the hallux valgus angle (HVA) and the alpha angle. In severe hallux vulgus deformed specimens, with an eroded intersesamoid crista, frontal plane pronation was not as prevalent nor severe as in those without osteoarthritic degeneration. Severe hallux valgus cases with a completely eroded crista, showed lower pronation, and higher IMA, when compared to specimens with a preserved anatomy. This brings to light the intersesamoid crista's unique function in retaining the IMA. Understanding the role the frontal plane plays in hallux valgus' biomechanics and in its radiographic appearance is vital to change the current paradigm.
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Affiliation(s)
- Sérgio Soares
- Department of Orthopaedic Surgery and Traumatology, HFR - Hôpital Fribourgeois, Villars-sur-Glâne, Switzerland; Foot and Ankle Unit, Department of Anatomy and Human Embryology, Faculty of Medicine, University of Barcelona, Barcelona, Spain.
| | - Tiago Mota Gomes
- Foot and Ankle Unit, Department of Anatomy and Human Embryology, Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Riccardo Garibaldi
- Department of Orthopaedic Surgery and Traumatology, HFR - Hôpital Fribourgeois, Villars-sur-Glâne, Switzerland
| | - Xavier Martin Oliva
- Foot and Ankle Unit, Department of Anatomy and Human Embryology, Faculty of Medicine, University of Barcelona, Barcelona, Spain; Department of Orthopaedics, Clinica del Remei, Barcelona, Spain
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Mansur H, Lucas PPA, Maranho DA. Treatment of Dynamic Claw Toe Deformity Through Lengthening of the Flexor Tendons of the Hallux and Toes at the Midfoot Level. Foot Ankle Spec 2024; 17:6S-12S. [PMID: 38124260 DOI: 10.1177/19386400231218338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
The claw toe deformity is characterized by the flexion of interphalangeal joints (IPJs) with hyperextension of the metatarsophalangeal (MTP) joint. It can be flexible and reducible or rigid and irreducible, or dynamic. The most common cause of dynamic claw toes is a neurological disorder, like sequelae of an ischemic contracture of the muscle belly after a compartment syndrome. Most of the surgical techniques require multiple procedures and may be associated with complications such as toe stiffness, persisting metatarsalgia, and toe malalignment. The aim of this study is to present an option for the surgical treatment of the dynamic claw toe deformity, by simultaneous tenodesis and lengthening of the flexor hallucis longus (FHL) and flexor digitorum longus (FDL) tendons at Henry's knot through a single midfoot incision.Levels of Evidence: V; Therapeutic Study; Expert Opinion.
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Affiliation(s)
- Henrique Mansur
- Department of Orthopaedics Surgery, Hospital Santa Helena and Hospital Regional do Gama, Distrito Federal, Brazil; Instituto Montenegro, Distrito Federal, Brazil
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Tang L, Zhou X, Huang S, Zou Y. Combined Great Toe Dorsal Nail-Skin Flap and Medial Plantar Flap for Reconstruction of Degloved Finger Loss. Plast Reconstr Surg 2024; 153:143-152. [PMID: 37039517 DOI: 10.1097/prs.0000000000010517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
BACKGROUND Historically, the degloved finger with the total loss of nails and skin has been resurfaced in two stages. Furthermore, proximal finger amputation requires an additional bone-tendon graft and an expanded great toe wraparound flap transfer for better outcomes. This article recommends a novel strategy to address these problems in a single stage using a dorsal nail-skin flap and medial plantar artery perforator flap. METHODS From March of 2015 to June of 2018, nine procedures were performed to resurface with skin loss to the metacarpophalangeal joint level, and three amputated fingers were reconstructed with an extra bone-joint-tendon graft simultaneously. The dorsal great toe donor was covered with a thin groin flap, and the medial plantar site was covered with a full-thickness skin graft. A standardized assessment of outcome in terms of sensory, functional, and aesthetic performance was completed. RESULTS All flaps survived. The contour and length of the reconstructed digits were comparable with the contralateral finger. The mean static two-point discrimination was 11.0 mm (range, 9.0 to 14.0 mm). The average score of the Disabilities of the Arm, Shoulder, and Hand questionnaire and Michigan Hand Outcomes Questionnaire were 2.5 (range, 0 to 5) and 90.1 (range, 82 to 96), respectively. The mean Foot and Ankle Disability Index score was 95.6 (range, 93 to 99). At the last follow-up, the functional and aesthetic outcomes, and the restored sensation, were satisfactory for all fingers. CONCLUSION This strategy may provide an alternative for selected patients seeking cosmetic resurfacing and functional reconstruction, preserving a weight-bearing plantar area with less morbidity. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Affiliation(s)
- Lin Tang
- From the Department of Orthopedic, Jiangbei Campus, The First Affiliated Hospital of Army Medical University
| | - Xin Zhou
- Department of Plastic and Cosmetic Surgery, Xinqiao Hospital, Army Medical University
| | - Shuqing Huang
- Department of Plastic and Cosmetic Surgery, Xinqiao Hospital, Army Medical University
| | - Yonggen Zou
- Depstableartment of Orthopedics, Guizhou Provincial People's Hospital
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Simón-Pérez E, Jiménez-Martín R, Cicchinelli LD, Yagüe JF, Simón-Pérez C, Paez-Moguer J, Cortés-Rodríguez A, Castillo-Domínguez A. A 28-Year-Old Woman with Down Syndrome, Congenital Heart Disease, and a History of Knee Surgery and Plantar Fasciitis, with Hallux Abducto Valgus (Bunion) and Lapiplasty Three-Dimensional Correction Surgery. Am J Case Rep 2023; 24:e940879. [PMID: 38091276 PMCID: PMC10728881 DOI: 10.12659/ajcr.940879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 11/06/2023] [Accepted: 10/27/2023] [Indexed: 12/18/2023]
Abstract
BACKGROUND Tarsometatarsal joint (TMJ) arthrodesis is common method used for correcting hallux abductus valgus (HAV). Its popularity has grown due to studies revealing HAV's triplanar deformity with frontal plane rotation. This case report presents a 28-year-old woman with Down syndrome, congenital heart disease, and a history of knee surgery and plantar fasciitis, with severe HAV deformity and flexible valgus flatfoot associated with ligamentous hyperlaxity. CASE REPORT Examination revealed severe foot deformities, and radiographic studies confirmed the condition. A surgical intervention was planned, and the patient's cardiologist confirmed she was fit for the procedure. The modified Lapidus technique with frontal plane rotational correction included realigning the metatarsal joint, resecting spurs, osteosynthesis material, and arthrosis in the sinus tarsi. After surgery, the patient underwent a recovery period without support for 8 weeks and received appropriate medical care. Radiographs showed successful alignment, and the patient gradually resumed her daily activities. The patient had an uneventful recovery, and postoperative radiographs showed good alignment in all planes. CONCLUSIONS The hyperlaxity associated with Down syndrome makes the incidence of HAV more frequent, and TMJ fusion is preferable to correction by osteotomy. The modified Lapidus technique with frontal plane rotational correction could be a good technique to achieve satisfactory correction in patients with severe HAV deformity and flexible valgus flatfoot associated with ligamentous hyperlaxity. TMJ fusion is indicated when severe or recurrent rotational component is observed in X-rays.
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Affiliation(s)
| | | | | | | | - Clarisa Simón-Pérez
- Department of Podiatry, Hospital Recoletas Felipe II, Valladolid, Spain
- Professor, Discipline of Orthopaedics, University of Valladolid, Valladolid, Spain
| | - Joaquin Paez-Moguer
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Málaga, Málaga, Spain
| | - Antonio Cortés-Rodríguez
- Research, Health and Podiatry Group, Department of Health Sciences, Faculty of Nursing and Podiatry, Industrial Campus of Ferrol, Universidade da Coruña, Ferrol, Spain
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Braswell MJ, Hysong AA, Macknet DM, Jones CP, Ford SE, Ellington JK. Outcomes After Hallux Interphalangeal Joint Arthrodesis. Foot Ankle Int 2023; 44:1213-1218. [PMID: 37772914 DOI: 10.1177/10711007231200021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
BACKGROUND Hallux interphalangeal joint arthrodesis (HIPJA) is indicated for a variety of pathologies. Despite high nonunion rates, techniques remain unchanged. The aim of this study is to examine nonunion and complication rates and describe risk factors for treatment failure. METHODS A query of an institutional database was performed to identify all patients undergoing HIPJA procedure over a 10-year period. Records were reviewed to the procedure, evaluate patient factors, indications, and radiographic/clinical arthrodesis. Radiographic union was defined as 2 cortical continuations or bridging at the arthrodesis site, absence of hardware failure, and the absence of lytic gapping of the arthrodesis. Clinical fibrous union was defined as radiographic nonunion with painless toe range of motion and physical examination consistent with fusion across the interphalangeal joint. RESULTS Two hundred twenty-seven primary HIPJA procedures were identified. Our cohort demonstrated a 25.5% nonunion rate (58/227) and 21.1% reoperation rate (48/227). Patients with diabetes were at higher risk for nonunion (P = .014), but no significant differences were identified based on smoking status or diagnosis of inflammatory arthritis. No difference was seen between implant groups: single screw, multiple screws, screw plus other fixation, nonscrew fixation. Patients with prior hallux metatarsophalangeal joint arthrodesis did not have a significantly higher nonunion rate than patients without prior first metatarsophalangeal joint arthrodesis. Patients diagnosed with radiographic nonunion were at higher risk for reoperation (P < .0001). CONCLUSION Our cohort represents the largest single-center series of HIPJA procedures published to date. We found relatively high nonunion and reoperation rates with standard current techniques. LEVEL OF EVIDENCE Level III, retrospective case series.
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Affiliation(s)
- Matthew J Braswell
- Department of Orthopaedic Surgery, Atrium Health-Carolinas Medical Center, Charlotte, NC, USA
| | - Alexander A Hysong
- Department of Orthopaedic Surgery, Atrium Health-Carolinas Medical Center, Charlotte, NC, USA
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Elattar O, Andrews NA, Halstrom J, Harrelson WM, Nair P, Shah A. A Novel Plating System for First Metatarsophalangeal Joint Arthrodesis: A Retrospective Comparison of Hybrid and Traditional Locking Plate Constructs. Foot Ankle Spec 2023; 16:537-546. [PMID: 35048726 DOI: 10.1177/19386400211067860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Dorsal plate fixation is commonly used for first metatarsophalangeal joint (1st MTPJ) arthrodesis and plate design continues to evolve. A new staple compression plate (SCP) design attempts to utilize the continuous compression of a nitinol staple across the fusion site while simultaneously providing the stability of a dorsal locked plate. Herein, we compare the radiographic, clinical, and patient-reported outcomes of 1st MTPJ joint arthrodesis using 2 dorsal locking plate constructs including a novel SCP construct. METHODS Forty-four patients who underwent 1st MTPJ arthrodesis between 2016 and 2020 were retrospectively evaluated. There were 2 group cohorts. Group 1 cohort included 23 patients who received a CrossRoads Extremity SCP, and Group 2 cohort included 21 patients who received a Stryker dorsal locking precontoured titanium plate (LPP). All patients were evaluated with radiographs, Patient-Reported Outcomes Measures Information System (PROMIS) outcome scores, and Foot Function Index (FFI). RESULTS The complication and union rates did not vary between groups with a fusion rate of 95.7% in the SCP group and 90.5 % in the LPP group. Similarly, we found no significant differences in PROMIS or FFI scores between the SCP and LPP plates. CONCLUSION Use of either dorsal locking plate construct for 1st MTPJ arthrodesis was associated with high union rates and comparable functional outcomes. As locked plate technology continues to evolve for 1st MTPJ arthrodesis, it is important that clinical outcomes are reported. LEVELS OF EVIDENCE Level IV.
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Affiliation(s)
- Osama Elattar
- Department of Orthopaedic Surgery, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Nicholas A Andrews
- The University of Toledo, Toledo, and Ohio and Department of Orthopaedic Surgery, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Jared Halstrom
- The University of Toledo, Toledo, and Ohio and Department of Orthopaedic Surgery, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Whitt M Harrelson
- The University of Toledo, Toledo, and Ohio and Department of Orthopaedic Surgery, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Pallavi Nair
- The University of Toledo, Toledo, and Ohio and Department of Orthopaedic Surgery, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Ashish Shah
- The University of Toledo, Toledo, and Ohio and Department of Orthopaedic Surgery, The University of Alabama at Birmingham, Birmingham, Alabama
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Kawalec JS, Chambers SP, Ali R, Osher LS. Multiple factors contributing to the metatarsal head eversion in hallux valgus deformity. A prospective study using weight-bearing CT. Foot (Edinb) 2023; 57:101965. [PMID: 37865069 DOI: 10.1016/j.foot.2023.101965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 01/29/2023] [Indexed: 02/05/2023]
Abstract
PURPOSE Recently first tarsometatarsal arthrodesis for hallux abducto valgus (HAV) has been advocated as the sole procedure to correct the multiplanar components of the deformity. However, recent debate suggests other factors such as rearfoot pronation and metatarsal torsion affect frontal plane metatarsal eversion and sesamoid positioning. Using weight-bearing CT, 12 feet (12 subjects) with HAV deformities were placed in positions of maximum rearfoot pronation and supination in order to study the effects on metatarsal eversion, sesamoid rotation/displacement, and secondarily the influence of first metatarsal torsion. Sesamoid displacement was quantified by the novel use of the sesamoid displacement angle. PRINCIPLE RESULTS Although first metatarsal eversion was nearly double in the pronated versus supinated foot, the difference was not statistically significant. Therefore, the bulk of first metatarsal eversion was not secondary to rearfoot eversion. Conversely, a significant positive correlation was found between metatarsal torsion and metatarsal head eversion angles in both supinated and pronated foot positions, with the strongest correlation with rearfoot pronation. Finally, significant increases in sesamoid displacement angles were noted with pronation. MAJOR CONCLUSIONS The findings of the present study support the contention that multiple factors are associated with frontal plane first metatarsal eversion and sesamoid displacement. Weight-bearing CT scanning can be used to effectively evaluate the frontal plane components in HAV deformities. The sesamoid displacement angle appears to be a useful adjunct to evaluating the hallucal sesamoids. For surgical correction of the deformity, consideration should be given to pre-operative weight-bearing CT evaluation of the foot. This can illuminate the effects of rearfoot/medial column pronation and the potential influence of metatarsal torsion on the frontal plane components of this triplane deformity. In this way the potential for post-operative HAV recurrence can be minimized.
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Affiliation(s)
- Jill S Kawalec
- Kent State University College of Podiatric Medicine, 6000 Rockside Woods Blvd, Independence, OH 44131, USA
| | - Steven P Chambers
- Kent State University College of Podiatric Medicine, 6000 Rockside Woods Blvd, Independence, OH 44131, USA
| | - Riasat Ali
- Kent State University College of Podiatric Medicine, 6000 Rockside Woods Blvd, Independence, OH 44131, USA
| | - Lawrence S Osher
- Kent State University College of Podiatric Medicine, 6000 Rockside Woods Blvd, Independence, OH 44131, USA.
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Riediger M, Sheridan GA, Gul R. Outcomes of First Metatarsophalangeal Joint Fusion Using a Precontoured Plate. Foot Ankle Spec 2023; 16:522-526. [PMID: 33754869 DOI: 10.1177/19386400211000594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The purpose of this study was to determine the results of an arthrodesis technique of the first metatarsophalangeal joint (MTPJ) using a precontoured dorsal plate to correct the hallux valgus deformity. METHODS This was a retrospective analysis of outcomes for first MTPJ arthrodesis performed using 2 precontoured dorsal plates. Radiographic outcomes (intermetatarsal angle [IMA] and hallux valgus angle [HVA]) and patient-reported functional outcome measures (Short-Form 12 and Foot and Ankle Outcome Score) were recorded and compared. RESULTS Fifty-five patients underwent 77 first MTPJ arthrodeses for severe hallux valgus deformity with associated degenerative changes at the first MTPJ. The mean reduction of the IMA was 5.67° (P < .05) and the mean reduction of the HVA was 33° (P < .05). The Short-Form 12 assessment of global health demonstrated a significant improvement in both the physical and mental health composite scores by 16.4 points and 10.4 points (P < .05), respectively. The Foot and Ankle Outcome Score demonstrated a cumulative decrease of 35% (59.28; P < .05) in all domains. CONCLUSIONS First MTPJ arthrodesis using a precontoured dorsal plate is a successful procedure with a high union rate, low complication rate, and a high level of patient-reported satisfaction. LEVELS OF EVIDENCE Level III.
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Affiliation(s)
| | | | - Rehan Gul
- Cork University Hospital, Cork, Ireland
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12
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Hussain F, Kotwal S, Utpat N, Utpat S, Phadtare P, Lenz R. Clinical outcomes of selective plantar fascia release for hallux interphalangeal joint ulcers. Wounds 2023; 35:E394-E398. [PMID: 38048617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
Abstract
BACKGROUND Plantar hallux IPJ ulcers are common and challenging to manage, with many available treatments. One newer technique called SPFR has been used in the management of plantar forefoot ulcers. OBJECTIVE This case series reports the clinical results of SPFR for treatment of strictly plantar hallux IPJ ulcers. MATERIALS AND METHODS A retrospective chart review was conducted on patients that underwent SPFR procedure by a single foot and ankle surgeon from 2018 to 2023. The primary study outcome was to identify the rate and time of healing associated with SPFR for hallux IPJ ulcers. Only the initial surgery was evaluated for time of healing for the ulcer, healing rate, and complications. Subsequent surgeries were reviewed as well. Patient charts were further reviewed to determine the presence or absence of a postoperative complication. RESULTS A total of 17 feet from 17 patients were studied. The hallux IPJ ulcers healed in an average of 3.0 months. The average follow-up time was 26.9 months. Fifteen patients (88.2%) healed after the SPFR procedure. Five patients (29.4%) developed transfer lesions, and 7 patients (41.2%) developed postoperative complications. CONCLUSIONS The authors believe that SPFR can be utilized in the treatment of hallux IPJ ulcers if both surgeons and patients are aware of the potential complications and limitations of this procedure. Further research is warranted to evaluate the efficacy and reproducibility of these results.
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Affiliation(s)
- Fahad Hussain
- Community Medical Center-RWJ Barnabas Health, Toms River, NJ
| | | | - Nishka Utpat
- Community Medical Center-RWJ Barnabas Health, Toms River, NJ
| | - Sandeepa Utpat
- Community Medical Center-RWJ Barnabas Health, Toms River, NJ
| | - Pranav Phadtare
- Community Medical Center-RWJ Barnabas Health, Toms River, NJ
| | - Robin Lenz
- Community Medical Center-RWJ Barnabas Health, Toms River, NJ; Ocean County Foot and Ankle Surgical Associates, Toms River, NJ
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Wang J, Xue M, Lu H, Tao X, Qiang L, Zhou X. Functional and aesthetic recovery of the second toe defect using a wrap-around pedicled flap from the great toe. J Hand Surg Eur Vol 2023; 48:926-929. [PMID: 37334718 DOI: 10.1177/17531934231181329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
We report the results of using a fibula-sided digital artery pedicled flap from the great toe to cover the second toe free flap donor site, which avoids delayed wound healing, and prevents pain and skin ulceration. This study included 15 patients who had second toe wrap-around free flaps to reconstruct thumb and finger defects. All 15 pedicled flaps used to cover the defect healed uneventfully. All patients were able to stand and walk and were satisfied with the postoperative aesthetic outcome at the 6-month follow-up. We conclude that this an effective procedure for preventing donor site defects after second toe wrap-around free flap transfer.Level of evidence: IV.
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Affiliation(s)
- Jin Wang
- Department of Hand surgery, Wuxi NO. 9 People's Hospital affiliated to Soochow University, Wuxi Hand Surgery Hospital, China
| | - Mingyu Xue
- Department of Hand surgery, Wuxi NO. 9 People's Hospital affiliated to Soochow University, Wuxi Hand Surgery Hospital, China
| | - Hao Lu
- Department of Hand surgery, Wuxi NO. 9 People's Hospital affiliated to Soochow University, Wuxi Hand Surgery Hospital, China
| | - Xianyao Tao
- Department of Hand surgery, Wuxi NO. 9 People's Hospital affiliated to Soochow University, Wuxi Hand Surgery Hospital, China
| | - Li Qiang
- Department of Hand surgery, Wuxi NO. 9 People's Hospital affiliated to Soochow University, Wuxi Hand Surgery Hospital, China
| | - Xiao Zhou
- Department of Hand surgery, Wuxi NO. 9 People's Hospital affiliated to Soochow University, Wuxi Hand Surgery Hospital, China
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Veigas TA, Pinto E, Godinho M, Caixeiro L, Zenha H, Atilano P, Teixeira J. Severe Soft Tissue Loss on Dorsum of the Foot with Irreparable Hallucis Extensors: An Orthoplastic Reconstruction Case Report. JBJS Case Connect 2023; 13:01709767-202312000-00052. [PMID: 38134289 DOI: 10.2106/jbjs.cc.23.00333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2023]
Abstract
CASE A motorcycle accident resulted in severe soft tissue loss on the foot's dorsum with irreparable hallucis extensors, with exposure of the first metatarsal and hallux. An arthrodesis of the hallux interphalangeal joint, a transfer of the second toe's extensor digitorum longus, and an anterolateral thigh free flap were performed simultaneously. The patient obtained a fair result and could wear regular shoes. DISCUSSION This is the first report describing this orthoplastic reconstructive option in these complex injuries. It replenished both hallux extensor tendons and soft tissue coverage losses without severely compromising the foot's contour, recreating anatomy and function.
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Affiliation(s)
| | - Eduardo Pinto
- Centro Hospitalar de Entre o Douro e Vouga, Santa Maria Da Feira, Portugal
| | - Manuel Godinho
- Centro Hospitalar de Entre o Douro e Vouga, Santa Maria Da Feira, Portugal
| | - Leonor Caixeiro
- Centro Hospitalar Vila Nova de Gaia e Espinho, Vila Nova De Gaia, Portugal
| | - Horácio Zenha
- Centro Hospitalar Vila Nova de Gaia e Espinho, Vila Nova De Gaia, Portugal
| | - Pedro Atilano
- Centro Hospitalar de Entre o Douro e Vouga, Santa Maria Da Feira, Portugal
| | - João Teixeira
- Centro Hospitalar de Entre o Douro e Vouga, Santa Maria Da Feira, Portugal
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15
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Dayton M, Dayton P, Togher CJ, Thompson JM. What Do Patients Report Regarding Their Real-World Function Following Triplane Metatarsophalangeal Joint Arthrodesis for Hallux Valgus? J Foot Ankle Surg 2023; 62:905-911. [PMID: 37209902 DOI: 10.1053/j.jfas.2023.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 04/29/2023] [Indexed: 05/22/2023]
Abstract
First metatarsal phalangeal (MTP) joint arthrodesis has been employed for decades for pain related to arthritis and other associated abnormalities. Despite the commonality of the procedure there continues to be questions regarding functional expectations following the procedure especially when employed for correction of hallux valgus deformity. We surveyed 60 patients who had a tri plane MTP joint arthrodesis at mean 28.4 months (median 27.8) regarding their activities of daily living and sports activity through a direct conversation. Secondary endpoints assessed were return to activity, deformity correction and arthrodesis healing rate based on chart review and weightbearing radiographs. The primary outcomes showed robust return to all activities of daily living with 96.7% able to walk without restrictions and or pain, 98.3% were able to walk at a normal pace and 95% responded that loss of motion of their big toe did not affect their daily function. Regarding return to sports all patients that participated in sports before surgery resumed participation after with a trend toward increased sports activity. Early return to walking in a fracture boot was noted in this cohort at mean 4.1 days, return to athletic shoe at mean 6.3 weeks and full unrestricted activity at mean 13.3 weeks with no non-unions identified on radiographic or clinical exam. Deformity correction of the typical components of hallux valgus deformity was similar to previously published studies. This data set supports the hypothesis that patients undergoing first MTP joint arthrodesis can expect rapid and full return to activities of daily living and sports with a low complication rate.
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16
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Chen Z, Li M, Huang S, Wu G, Zhang Z. The role of great toe terminal branch artery split-thickness nail bed flaps in fingertip reconstruction surgery. J Plast Reconstr Aesthet Surg 2023; 84:642-649. [PMID: 37085343 DOI: 10.1016/j.bjps.2022.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 10/24/2022] [Accepted: 12/09/2022] [Indexed: 04/23/2023]
Abstract
BACKGROUND The common treatments used to repair fingertip defects remain controversial. We have previously conducted research on split-thickness nail bed flaps, but this method still damages the proper plantar digital arteries and nerves. The great toe terminal branch arteries (TBAs) have not been described in detail. METHODS Twenty cadaveric feet were used to dissect the terminal branches of the plantar arteries. The locations and diameters of the terminal branches were analyzed. Five patients underwent operations with a TBA split-thickness nail bed flap. We recorded the recovery of both the donor and recipient sites and evaluated the results. RESULTS The diameter of the TBAs was between 0.4 and 0.8 mm. The TBA split-thickness nail bed flaps of five patients survived. No complications were found in any of the patients. The nail outcomes were excellent (A) in four patients and very good (B) in one patient. All patients were satisfied with the appearance of the recipient and donor sites. The mean static two-point discrimination was 6.0 mm (range, 4-9). The mean Semmes-Weinstein monofilament test score was 3.03 g (range, 1.65-3.84). Patients neither experienced severe pain in the reconstructed finger or at the donor site, nor did they experience severe cold intolerance. This microsurgical technique avoids the destruction of the proper plantar digital arteries and nerves. CONCLUSIONS A TBA split-thickness nail bed flap from the great toe is clinically feasible and can achieve satisfactory results in fingertip repair. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, V.
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Affiliation(s)
- Zhiying Chen
- Department of Hand Surgery, Longgang Orthopedics Hospital of Shenzhen, No. 36, Nantong Avenue, Tongle Community, Baolong Sub-district, Longgang District, Shenzhen 518116, Guangdong Province, PR China
| | - Muwei Li
- Department of Hand Surgery, Longgang Orthopedics Hospital of Shenzhen, No. 36, Nantong Avenue, Tongle Community, Baolong Sub-district, Longgang District, Shenzhen 518116, Guangdong Province, PR China.
| | - Shaogeng Huang
- Department of Hand Surgery, Longgang Orthopedics Hospital of Shenzhen, No. 36, Nantong Avenue, Tongle Community, Baolong Sub-district, Longgang District, Shenzhen 518116, Guangdong Province, PR China
| | - Gong Wu
- Department of Hand Surgery, Longgang Orthopedics Hospital of Shenzhen, No. 36, Nantong Avenue, Tongle Community, Baolong Sub-district, Longgang District, Shenzhen 518116, Guangdong Province, PR China
| | - Zhe Zhang
- Department of Hand Surgery, Longgang Orthopedics Hospital of Shenzhen, No. 36, Nantong Avenue, Tongle Community, Baolong Sub-district, Longgang District, Shenzhen 518116, Guangdong Province, PR China
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17
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Godoy-Santos AL, Pires EA, Fonseca FC, de Cesar-Netto C, Auch EC, Rammelt S. Staged reconstruction of the hallux for infected non-union using bulk autograft and a customized implant: Case report. Foot (Edinb) 2023; 56:102031. [PMID: 37075520 DOI: 10.1016/j.foot.2023.102031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 07/05/2021] [Accepted: 03/27/2023] [Indexed: 04/21/2023]
Abstract
This case report illustrates the outcome of a deep infection following internal fixation of a fracture of the big toe. Hallux amputation could be avoided through staged salvage procedure. This paper can assist readers on how to effectively and safely recognize and treat this type of injury.
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Affiliation(s)
- Alexandre Leme Godoy-Santos
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil; Lab Prof Manlio Mario Marco Napoli, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, SP, Brazil
| | - Eduardo Araujo Pires
- Lab Prof Manlio Mario Marco Napoli, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, SP, Brazil.
| | | | | | | | - Stefan Rammelt
- UniversitätsCentrum für Orthopädie und Unfallchirurgie, Universitätsklinikum Carl Gustav Carus, Dresden, Germany
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18
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Kaur K, Meyr AJ. Correlation Analysis Between Clinical Hypermobility Measurement and Radiographic Parameters of the Hallux Valgus Deformity. J Foot Ankle Surg 2023; 62:764-767. [PMID: 36872102 DOI: 10.1053/j.jfas.2023.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 01/21/2023] [Indexed: 03/07/2023]
Abstract
The finding of "hypermobility" has conventionally been considered as a dichotomous categorical variable in both clinical practice and in the literature. In other words, it is defined as being either "present" or "absent" in patients with hallux valgus. Yet it might be far more likely that this represents a continuous variable described by a bell-shaped distribution. Therefore the objective of this investigation was to consider hypermobility as a continuous variable, and to compare the sagittal plane first ray motion to radiographic parameters commonly used in the evaluation of the hallux valgus deformity by means of correlation analyses. The radiographs and measurements of 86 feet were included and measurement of sagittal plane first ray motion was performed with the validated Klaue device. No statistically significant correlation was observed between the total first ray motion with the first intermetatarsal angle (Pearson correlation coefficient 0.106; p = .333), hallux valgus angle (Pearson correlation coefficient -0.106; p = .330), nor sesamoid position (Pearson correlation coefficient 0.155; p = .157). The results of this investigation uniquely consider measurement of hypermobility as a continuous variable, and find no correlation between first ray sagittal plane motion and radiographic parameters associated with the hallux valgus deformity. These results might indicate that although the concept of hypermobility has traditionally been coupled with presentation of the hallux valgus deformity, this might simply represent the result of a historical confirmation bias.
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Affiliation(s)
- Kushkaran Kaur
- Resident, Temple University Hospital Podiatric Surgical Residency Program, Philadelphia, PA
| | - Andrew J Meyr
- Professor, Department of Podiatric Surgery, Temple University School of Podiatric Medicine, Philadelphia, PA.
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19
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Fan X, Zhou Y, Zhou J, Dai S, Liu J, Lao K. The reconstruction of fingertip injury by mini hallux toenail flap pedicled with the hallux transverse artery and toe pulp vein transplantation technique based on the equivalent design theory. BMC Surg 2023; 23:231. [PMID: 37568142 PMCID: PMC10422757 DOI: 10.1186/s12893-023-02097-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 07/04/2023] [Indexed: 08/13/2023] Open
Abstract
INTRODUCTION How to reconstruct the damaged fingertip is a clinical problem. Our team propose the theory of equivalent design and use the mini toenail flap pedicled with the hallux transverse artery and toe pulp vein transplantation technique to reconstruct Allen's type II fingertip injury. Thus, we perform the retrospective study to evaluate the effects of this technique on fingertip injury. MATERIALS AND METHODS A retrospective analysis was performed on 56 patients admitted to our hospital from January 2015 to January 2020 who used equivalently designed miniature hallux toenail flaps for the plastic repair of fingertip damage. We recorded the size of the miniature hallux toenail flap, operation time, intraoperative blood loss, and complications and calculated the survival rate of the transplanted miniature hallux toenail flap. During routine follow-up after surgery, we recorded nail growth time and observed finger appearance. At the last time of follow-up, we recorded Semmes-Weinstein evaluating tactile sensation and Two-point discrimination testing (TPD). The efficacy was evaluated by Zook score evaluation. RESULTS The size of the mini hallux toenail flap was 0.71 cm × 1.22 cm to 0.88 cm × 1.71 cm. The operation time was (3.54 ± 0.58) hours, the intraoperative blood loss was (20.66 ± 4.87) ml, and the survival rate of mini hallux toenail flaps was 100%. The postoperative follow-up time was (30.82 ± 11.21) months, and the total nail growth time was (9.68 ± 2.11) months. The average tactile sensation evaluated by the Semmes-Weinstein test was (0.32 ± 0.14) g, and the average TPD was (7.33 ± 1.02) mm. According to Zook score, the curative effect of fifty-six cases were all excellent or good with 100% excellent and good rate, and all patients had beautiful appearances and good function of damaged fingertips. CONCLUSIONS Based on the equivalent design theory, the mini hallux toenail flap pedicled with the hallux transverse artery and toe pulp vein transplantation technique is an effective method to reconstruct Allen's type II fingertip injury with a beautiful appearance and good function. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Xiao Fan
- Qingdao Hospital, University of Health and Rehabilitation Science (Qingdao Municipal Hospital), Qingdao, 266011, Shandong, China
| | - Yimin Zhou
- Changchun University of Traditional Chinese Medicine, Changchun, Jilin, 130117, China
| | - Jian Zhou
- Qingdao Hospital, University of Health and Rehabilitation Science (Qingdao Municipal Hospital), Qingdao, 266011, Shandong, China
| | - Shiyou Dai
- Qingdao Hospital, University of Health and Rehabilitation Science (Qingdao Municipal Hospital), Qingdao, 266011, Shandong, China
| | - Jinhai Liu
- Qingdao Hospital, University of Health and Rehabilitation Science (Qingdao Municipal Hospital), Qingdao, 266011, Shandong, China.
| | - Kecheng Lao
- Qingdao Hospital, University of Health and Rehabilitation Science (Qingdao Municipal Hospital), Qingdao, 266011, Shandong, China.
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20
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Khan Y, Arora S, Sabat D, Kashyap A, Maini L, Dhal A. Acquired Hallux Varus Deformity Correction: Pivotless Distraction Technique. J Am Podiatr Med Assoc 2023; 113:21-197. [PMID: 37715973 DOI: 10.7547/21-197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/18/2023]
Abstract
Acquired hallux varus deformity secondary to postburn contracture is a rare condition. It causes cosmetic disfigurement, pain, and inability to wear a shoe. Soft-tissue procedures and tendon transfers have been described for correction; however, these may require multiple operations and the outcome may be poor. We report a 6-year-old neglected case of hallux varus deformity secondary to burn contracture successfully managed by contracture release with pivotless distraction technique using a biplanar distractor and skin grafting with Z-plasty in the same procedure. The deformity was corrected to a lesser extent and with good functional outcomes. The scar was excised and Z-plasty was performed. The medial joint capsule was released. We used gradual differential distraction with monitoring on sequential radiographs. Pain-free flexion of 45° and extension of 40° were achieved and the patient was able to wear shoes after 4 weeks postoperatively. Hallux varus is a multidimensional deformity. A severe and rigid deformity might not respond well to tendon transfers in a single stage. Our described technique can be used to correct rigid hallux varus deformity with preservation of joint function.
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Affiliation(s)
- Yasim Khan
- *Maulana Azad Medical College, New Delhi, India
| | - Sumit Arora
- †Department of Orthopaedic Surgery, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
| | - Dhananjaya Sabat
- ‡Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
| | - Abhishek Kashyap
- ‡Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
| | - Lalit Maini
- ‡Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
| | - Anil Dhal
- ‡Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
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21
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Quist M, Yim J, Mirkin G, Hao X. A Subungual Nevoid Melanoma of the Right Hallux from a 65-Year-Old Man: A Case Report. J Am Podiatr Med Assoc 2023; 113:21-108. [PMID: 37715977 DOI: 10.7547/21-108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/18/2023]
Abstract
Nevoid melanoma (NeM) is a rare variant of malignant melanoma characterized by slight cellular atypia, polymorphism, and incomplete maturation. It most frequently occurs on the trunk and arms but rarely on the foot. Here, we report a subungual NeM of the right hallux. A 65-year-old man presented with severe pain of 6 months' duration to his right great toe following self-treatment for an ingrown nail. He was evaluated and treated with debridement of the toenail at an urgent medical center 3 months prior. However, this had not relieved his pain. The patient also noticed discoloration of his distal great toe over the past 3 months. Removal of part of the ingrown nail revealed a pigmented mass extending distally from the matrix. Surgical excision of the mass was performed because of the concern for malignancy. The diagnosis of NeM was based on histologic analysis along with enhanced diagnostic modalities. The patient was further treated with surgical amputation of the great toe and anti-programmed cell death-1 therapy. The patient had no relapse at 1-year follow-up. Nevoid melanoma is a rare variant of malignant melanoma on the toes, which needs to be differentiated from a nevus with atypia, with a variety of modalities including cellular and molecular profiling. The optimal treatment is amputation.
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Affiliation(s)
- Mark Quist
- *Foot and Ankle Specialists of the Mid-Atlantic, LLC, Huntersville, NC
| | - Joon Yim
- †Foot and Ankle Specialists of the Mid-Atlantic, LLC, Rockville, MD
| | - Gene Mirkin
- ‡Foot and Ankle Specialists of the Mid-Atlantic, LLC, Annapolis, MD
| | - Xingpei Hao
- †Foot and Ankle Specialists of the Mid-Atlantic, LLC, Rockville, MD
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22
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Peters J, Köhler HC, Müller-Meinhard D, Gutcke A, Rüttermann M. [Atraumatic rupture of the extensor hallucis longus tendon]. HANDCHIR MIKROCHIR P 2022; 54:525-528. [PMID: 35785805 DOI: 10.1055/a-1780-8846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
An atraumatic rupture of the extensor hallucis longus tendon is a rare injury. Chronic overload due to contact sports, bony anomalies, previous operations, and drug injections close to the tendon have been reported as a cause. We report the case of a young patient who presented with an acute loss of function in his extensor hallucis longus tendon for no apparent reason.
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Affiliation(s)
- Jan Peters
- Bundeswehrkrankenhaus Westerstede Klinik für Orthopädie und Unfallchirurgie, Plastische, Rekonstruktive und Handchirurgie
| | - Hans-Christian Köhler
- Bundeswehrkrankenhaus Westerstede Klinik für Orthopädie und Unfallchirurgie, Plastische, Rekonstruktive und Handchirurgie
| | - Doris Müller-Meinhard
- Bundeswehrkrankenhaus Westerstede Klinik für Orthopädie und Unfallchirurgie, Plastische, Rekonstruktive und Handchirurgie
| | - Andre Gutcke
- Bundeswehrkrankenhaus Westerstede Klinik für Orthopädie und Unfallchirurgie, Plastische, Rekonstruktive und Handchirurgie
| | - Mike Rüttermann
- Bundeswehrkrankenhaus Westerstede Klinik für Orthopädie und Unfallchirurgie, Plastische, Rekonstruktive und Handchirurgie
- Department of Plastic Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- HPC-Oldenburg, Institut für Hand- und Plastische Chirurgie, Oldenburg
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23
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Zhang T, Liu ZJ, Liu SZ, Cheng JN, Yang L, Zhou R, Guo LP, Yang L, Xiong S, Ju JH. [Clinical effects of free superficial peroneal artery perforator flaps in repairing skin and soft tissue defects of the hallux]. Zhonghua Shao Shang Yu Chuang Mian Xiu Fu Za Zhi 2022; 38:753-758. [PMID: 36058698 DOI: 10.3760/cma.j.cn501120-20210604-00211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Objective: To explore the clinical effects of free superficial peroneal artery perforator flaps in repairing skin and soft tissue defects of the hallux. Methods: A retrospective observational study was conducted. From January 2020 to January 2021, 13 patients with skin and soft tissue defects of the hallux who met the inclusion criteria were admitted to Department of Foot and Ankle Surgery of Ruihua Affiliated Hospital of Soochow University, including 12 males and 1 female, aged 26 to 53 years. Before operation, the perforating point of the superficial peroneal artery perforator was located by color Doppler ultrasound on the calf on the same side of the affected hallux and marked on the body surface. The operation was performed under spinal anesthesia combined with continuous epidural anesthesia. The area of skin and soft tissue defect after debridement was 4.5 cm×2.5 cm to 12.0 cm×3.0 cm. According to the size and shape of the wound, the superficial peroneal artery perforator flap was designed with the line between the fibular head and the lateral malleolus tip parallel shifting 2 cm to the tibial side as the flap axis line, and the perforating point of the perforator near the midpoint of the axis line as the center. The cut area of the flap was 5.0 cm×3.0 cm to 13.0 cm×4.0 cm, and part of the deep fascia was cut when the pedicle was freed. The donor site wound was sutured directly. During the operation, the number and type of the perforator and the cutting time of the flap were recorded, and the length of the perforator pedicle and diameter of the perforator were measured. The survival of the flap, the healing time and the healing condition of the donor and recipient areas were recorded after operation. The color, texture, elasticity of the flap, standing and walking functions of patients, the recovery of the donor area, and the patients' satisfaction with the recovery of the donor and recipient areas were recorded during the follow-up. At the last follow-up, the sensation of the flap was evaluated by the British Medical Association sensory function evaluation standard, the function of the affected limb was evaluated by the American Society of Foot and Ankle Surgery scoring system, and the excellent and good rate of the function of the affected limb was calculated. Results: A total of 13 perforators of the superficial peroneal artery were detected during the operation, all of which were septocutaneous perforators, and the perforator diameter was 0.3 to 0.5 mm. The vascular pedicle length was 2 to 5 cm. Flap cutting time was 11 to 26 minutes. The flaps of 13 patients all survived completely. The wounds at the donor and recipient sites healed well 9 to 18 days after operation. During follow-up of 6 to 14 months, the flaps had good color, texture, and elasticity; 11 patients had no obvious bloated appearance, and the other 2 patients underwent flap thinning and plastic surgery in the second stage because of their bloated appearance; all the patients returned to normal walking and standing functions. There was only one linear scar left in the donor site, with no obvious scar hyperplasia or hyperpigmentation. All the patients were satisfied with the recovery of the donor and recipient areas. At the last follow-up, the sensation of the flap was evaluated as grade S3 in 2 cases, grade S2 in 9 cases, and grade S1 in 2 cases; the function of the affected limb was evaluated as excellent in 7 cases and good in 6 cases, with an excellent and good rate of 100%. Conclusions: The free superficial peroneal artery perforator flap has relatively constant vascular anatomy, which is thin and wear-resistant, with less damage to the donor site after flap excision, and can preserve the shape and function of the hallux to the greatest extent. It is an effective method for repairing skin and soft tissue defect of the hallux.
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Affiliation(s)
- T Zhang
- Department of Hand Surgery, Ruihua Affiliated Hospital of Soochow University, Suzhou 215104, China
| | - Z J Liu
- Department of Hand Surgery, Ruihua Affiliated Hospital of Soochow University, Suzhou 215104, China
| | - S Z Liu
- Department of Hand Surgery, Ruihua Affiliated Hospital of Soochow University, Suzhou 215104, China
| | - J N Cheng
- Department of Hand Surgery, Ruihua Affiliated Hospital of Soochow University, Suzhou 215104, China
| | - L Yang
- Department of Hand Surgery, Ruihua Affiliated Hospital of Soochow University, Suzhou 215104, China
| | - R Zhou
- Department of Foot and Ankle Surgery, Ruihua Affiliated Hospital of Soochow University, Suzhou 215104, China
| | - L P Guo
- Department of Foot and Ankle Surgery, Ruihua Affiliated Hospital of Soochow University, Suzhou 215104, China
| | - L Yang
- Department of Foot and Ankle Surgery, Ruihua Affiliated Hospital of Soochow University, Suzhou 215104, China
| | - S Xiong
- Department of Pediatric Orthopedics, Ruihua Affiliated Hospital of Soochow University, Suzhou 215104, China
| | - J H Ju
- Department of Hand Surgery, Ruihua Affiliated Hospital of Soochow University, Suzhou 215104, China
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24
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Xing PP, Mu XL, Xia CD, Shi JJ, Xue JD, Yang GY, Zhang J, Di HP. [Clinical effects of free hallux-nail flap combined with the second toe composite tissue flap in the reconstruction of damaged thumb after electrical burns]. Zhonghua Shao Shang Yu Chuang Mian Xiu Fu Za Zhi 2022; 38:677-682. [PMID: 35899335 DOI: 10.3760/cma.j.cn501120-20210621-00222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Objective: To explore the clinical effects of free hallux-nail flap combined with the second toe composite tissue flap in the reconstruction of damaged thumb after electrical burns. Methods: A retrospective observational study was conducted. From May 2018 to April 2021, 12 male patients with thumb destructive defects caused by electrical burns who met the inclusion criteria were admitted to Zhengzhou First People's Hospital, aged 27 to 58 years, including 10 cases with degree Ⅲ thumb defect and 2 cases with degree Ⅳ thumb defect after thorough debridement. The thumb was reconstructed with free hallux-nail flap combined with composite tissue flap of the second phalangeal bone, joint, and tendon with skin island. The donor site of hallux-nail flap was covered with artificial dermis in the first stage and performed with continuous vacuum sealing drainage, and covered with medium-thickness skin graft from the groin site in the second stage. The donor site in the second toe was filled and fixed with iliac bone strips. The survival of reconstructed thumb was observed 1 week after the reconstruction surgery, the survival of skin graft in the donor site of hallux-nail flap was observed 2 weeks after skin grafting, and the callus formation of the reconstructed thumb phalanx and the second toe of the donor foot was observed by X-ray 6 weeks after the reconstruction surgery. During the follow-up, the shape of reconstructed thumb was observed and the sensory function was evaluated; the function of reconstructed thumb was evaluated with trial standard for the evaluation of the functions of the upper limbs of the Hand Surgery Society of the Chinese Medical Association; whether the interphalangeal joints of the hallux and the second toe were stiff, the scar hyperplasia of the foot donor site, and whether the walking and standing functions of the donor feet were limited were observed. Results: One week after the reconstruction surgery, all the reconstructed thumbs of the patients survived. Two weeks after skin grafting, the skin grafts in the donor site of hallux-nail flap of 11 patients survived, while the skin graft in the donor site of hallux-nail flap of 1 patient was partially necrotic, which was healed completely after 10 days' dressing change. Six weeks after the reconstruction surgery, callus formation was observed in the reconstructed thumb and the second toe of the donor foot of 10 patients, the Kirschner wires were removed; while callus formation of the reconstructed thumb was poor in 2 patients, and the Kirschner wires were removed after 2 weeks of delay. During the follow-up of 6 to 24 months, the shape of reconstructed thumb was similar to that of the healthy thumb, the discrimination distance between the two points of the reconstructed thumb was 7 to 11 mm, and the functional evaluation results were excellent in 4 cases, good in 6 cases, and fair in 2 cases. The interphalangeal joints of the hallux and the second toe of the donor foot were stiff, mild scar hyperplasia was left in the donor site of foot, and the standing and walking functions of the donor foot were not significantly limited. Conclusions: The application of free hallux-nail flap combined with the second toe composite tissue flap in the reconstruction of damaged thumb after electrical burns adopts the concept of reconstruction instead of repair to close the wound. It can restore the shape and function of the damaged thumb without causing great damage to the donor foot.
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Affiliation(s)
- P P Xing
- Department of Burns, Zhengzhou First People's Hospital, Zhengzhou 450004, China
| | - X L Mu
- Department of Burns, Zhengzhou First People's Hospital, Zhengzhou 450004, China
| | - C D Xia
- Department of Burns, Zhengzhou First People's Hospital, Zhengzhou 450004, China
| | - J J Shi
- Department of Burns, Zhengzhou First People's Hospital, Zhengzhou 450004, China
| | - J D Xue
- Department of Burns, Zhengzhou First People's Hospital, Zhengzhou 450004, China
| | - G Y Yang
- Department of Burns, Zhengzhou First People's Hospital, Zhengzhou 450004, China
| | - J Zhang
- Department of Burns, Zhengzhou First People's Hospital, Zhengzhou 450004, China
| | - H P Di
- Department of Burns, Zhengzhou First People's Hospital, Zhengzhou 450004, China
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Gorica Z, McFarland K, Lewis JS, Schweitzer KM, Vap AR. Surgical Repair of Posttraumatic Hallux Valgus Deformity in a Collegiate Football Player: A Case Report. JBJS Case Connect 2022; 12:01709767-202206000-00012. [PMID: 36099514 DOI: 10.2106/jbjs.cc.22.00023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
CASE We report a rare case of posttraumatic hallux valgus in a collegiate football player after an acute medial collateral ligament tear of the first metatarsophalangeal joint. The patient was treated with a modification of the modified McBride technique, using an all-suture anchor for the medial ligamentous complex repair. There was return to sport at 5 months and a Foot and Ankle Outcome Score of 95% at 10 months. CONCLUSION A modified McBride procedure further modified with the utilization of an all-suture anchor for the medial ligamentous complex repair can result in correction of deformity, pain-free movement and return to sport.
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Affiliation(s)
- Zylyftar Gorica
- Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, Virginia
| | | | - John S Lewis
- Louisville Orthopedic Clinic, Louisville, Kentucky
| | - Karl M Schweitzer
- Department of Orthopaedic Surgery, Duke University, Raleigh, North Carolina
| | - Alexander R Vap
- Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, Virginia
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Tytgat HE, Wuite S, Matricali GA. Arthrodesis of the first metatarsophalangeal joint using an intraosseous fixation device. Acta Orthop Belg 2022; 88:135-142. [PMID: 35512164 DOI: 10.52628/88.1.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The complication rate for an arthrodesis of the first metatarsophalangeal joint remains high. To improve results, we used a complete intraosseous fixation device (IOFIX) with proposed biomechanical advantages. Our hypothesis is that this technique has at least an equal union rate and less hardware irritation compared to other techniques. Seventy procedures were performed in 55 patients. Average follow-up was 24.5 months. All patients returned to follow-up after 6 weeks and were evaluated for union. Fifty-nine feet (84%) completed full follow- up. Union occurred in 62 of 70 feet (88.5%). Eight feet had nonunion at 1 year follow-up. Average time to fusion was 51 days. Three of 59 feet had malunion. No hardware removal was necessary. In conclusion, an MTP1 arthrodesis using IOFIX provides consistent and good functional outcomes. Due to the low-profile design, no hardware removal was necessary. However, union rates seem slightly lower compared to other techniques.
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Tritto M, Mirkin G, Hao X. Subungual Exostosis on the Right Hallux. J Am Podiatr Med Assoc 2021; 111. [PMID: 35294159 DOI: 10.7547/20-209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Subungual exostosis (SE) is a benign, relatively uncommon bony growth underneath the nails of the distal phalanx of toes or fingers, with a majority on the toes. Clinically, it has two subvariants-protruded and nonprotruded growths from nail plates-which are treated differently. In this article, we report a case of protruded SE in a teenager with illustrative surgical excision. A 15-year-old boy presented with a painful growth on his right great toe of 6 months' duration. Physical examination revealed a 1-cm-diameter, solid, erythematous, rough, irregular growth penetrating through the skin along the dorsolateral nail bed of the right hallux with deformity of the lateral nail plate. Radiographs showed an elevated mass over the distal phalanx of the right lateral hallux. The mass was surgically excised and histopathologic examination confirmed the diagnosis of SE. The patient had no relapse or recurrence at follow-ups of 6 and 18 months. Subungual exostosis is a relatively uncommon bony growth in the toes. Radiography is favored for the diagnosis. Complete surgical excision is the optimal treatment, with rare recurrence. It needs to be differentiated from other bony lesions, including bizarre parosteal osteochondromatous proliferation, myositis ossificans, fibro-osseous pseudotumor, osteochondroma, and enchondroma.
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Michelson JD, Bernknopf JW, Charlson MD, Merena SJ, Stone LM. What Is the Efficacy of a Nonoperative Program Including a Specific Stretching Protocol for Flexor Hallucis Longus Tendonitis? Clin Orthop Relat Res 2021; 479:2667-2676. [PMID: 34170867 PMCID: PMC8726539 DOI: 10.1097/corr.0000000000001867] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 05/28/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Diagnosis and treatment of tendonitis/entrapment of the flexor hallucis longus (FHL) has been sporadically described in the evidence, primarily in the context of dancers and other athletes. Although various nonspecific nonoperative treatments have been described, it is not clear how often they achieve a satisfactory amount of symptom improvement. QUESTIONS/PURPOSES The present study was designed to address the following questions regarding the nonoperative treatment of FHL tendonitis: (1) In a population of patients where the default management option for FHL tendonitis is a comprehensive nonsurgical approach, what proportion of patients thus treated opted not to have surgery? (2) What factors were associated with a patient's decision to undergo surgery after a period of nonsurgical management? METHODS The 656 patients included were all those diagnosed with FHL tendonitis who were initially treated nonoperatively in the foot and ankle division between January 2009 and December 2018. Demographics, comorbidities, examination findings, imaging results, pain scores, treatment instituted, and final outcome were obtained from the electronic medical record. The primary outcome was the decision to have surgery due to unsatisfactory symptom improvement. We compared patients who opted for surgery with those who did not after nonoperative treatment with univariable and multivariable statistics using demographics, comorbidities, and clinical findings as potential risk factors, with p < 0.05. RESULTS Forty-four percent (180 of 409) of patients decided to forgo surgery after the institution of a specific FHL stretching program. Surgery was more likely in patients with clinical hallux rigidus (OR 2.4 [95% CI 1.16 to 4.97]; p = 0.02) or posteromedial ankle pain (OR 1.78 [95% CI 1.12 to 2.83]; p = 0.01) and less likely in those who completed an FHL stretching program (OR 0.15 [95% CI 0.08 to 0.27]; p < 0.001). CONCLUSION FHL tendonitis is more common than the previous evidence suggests and frequently occurs in nonathletes. Once it was diagnosed by detection of tenderness anywhere along the tendon, most frequently at the fibroosseous tunnel, nonoperative treatment focused on specific FHL stretching and immobilization in more severe cases reduced the symptoms to the extent that 44% of patients decided that surgery was unnecessary. The key to its diagnosis is awareness that this injury is possible because most patients treated in this study had been previously seen by orthopaedic providers who had not appreciated the presence of the condition, leading to a delay in diagnosis and treatment of more than a year in many patients. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- James D. Michelson
- Department of Orthopaedics and Rehabilitation, Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - Jacob W. Bernknopf
- Department of Orthopaedics and Rehabilitation, Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - Mark D. Charlson
- Department of Orthopaedics and Rehabilitation, Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - Stephen J. Merena
- Department of Orthopaedics and Rehabilitation, Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - Lara M. Stone
- Department of Orthopaedics and Rehabilitation, Larner College of Medicine, University of Vermont, Burlington, VT, USA
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Meershoek AJA, Roks DJGH, Somford MP. [A boy with an abnormal hallux]. Ned Tijdschr Geneeskd 2021; 165:D6452. [PMID: 35138764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
An eleven-year-old boy was seen by the general practioner due to a painfull hallux. The diagnosis unguis incarnatus was made. Therefore, a partial nail extraction was performed. Unfortunately, the patient still had complaints of a painful hallux and was forwarded to the surgical outpatient clinic. We saw a round, hard and benign tumor on the lateral side of the nail (picture 1). We performed a partial nail extraction as well. Due to persistence complaints and the abnormal course and X-ray was performed. On the X-ray an exostosis was seen (picture 2). This confirmed the diagnosis: subungual exostosis. It is a rare clinical manifestation and has a long delay up until diagnosis. It is a benign bone tumor and often seen on the hallux. A radical excision must be performed.
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Gibson TW, Westberry DE, Carpenter AM, Colucciello N, Carson L. Terminal Syme Amputation of the Great Toe in the Pediatric Population. J Pediatr Orthop 2021; 41:e823-e827. [PMID: 34411052 DOI: 10.1097/bpo.0000000000001952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND In the pediatric population, chronic ingrown toenails (onychocryptosis) can cause infection (paronychia), debilitating pain, and may be unresponsive to conservative treatments. Following multiple failed interventions, a terminal Syme amputation is one option for definitive treatment of chronic onychocryptosis. This procedure involves amputation of the distal aspect of the distal phalanx of the great toe with complete removal of the nail bed and germinal center, preventing further nail growth and recurrence. METHODS A retrospective review was performed to determine outcomes of a terminal Syme amputation in the pediatric population. Inclusion criteria included treatment of onychocryptosis involving terminal Syme amputation with a minimum follow-up of 1 year. The medical record was reviewed to assess previous failed treatment efforts, perioperative complications, radiographic outcomes, and the need for additional procedures. RESULTS From 1984 to 2017, 11 patients (13 halluces) with onychocryptosis were treated with a terminal Syme amputation. There were no intraoperative complications. One hallux had a postoperative infection requiring antibiotics as well as partial nail regrowth following the terminal Syme procedure that required subsequent removal of the residual nail. Following partial nail ablation, the patient had no further nail growth. An additional patient also developed a postoperative infection requiring oral antibiotic treatment. All patients returned to full weight-bearing physical activities within 6 weeks of surgery. CONCLUSIONS Terminal Syme amputation was successful in treating pediatric patients who have recalcitrant onychocryptosis and paronychia. There was little functional consequence following terminal Syme amputation of the great toe in this patient population, making it an effective salvage procedure. LEVEL OF EVIDENCE Level IV-retrospective comparative study.
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Çatal B, Keskinbora M, Keskinöz EN, Tümentemur G, Azboy İ, Demiralp B. Is denervation surgery possible in the treatment of hallux rigidus? An anatomic study of cadaveric specimens. Acta Orthop Traumatol Turc 2021; 55:327-331. [PMID: 34464308 DOI: 10.5152/j.aott.2021.20329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of this study was to provide anatomic considerations in the first metatarsophalangeal joint (FMPJ) innervation and to evaluate the feasibility of the denervation surgery in the treatment of hallux rigidus. METHODS In this cadaveric study, 14 fresh frozen cadaveric transtibial amputation specimens was used. For nerve dissection, dorsal and plantar longitudinal incision centered over the FMPJ were performed. Deep peroneal and dorsomedial cutaneous nerves were dissected in the dorsal aspect of the joint. Medial plantar nerve branches, medial and lateral hallucal nerves, were dissected in the plantar aspect of the joint. The presence, number, and location of articular branches to the FMPJ capsule were recorded. Dorsal and plantar incision length for proper dissection were also recorded. RESULTS Nerve dissection of the 14 specimens revealed the following number of articular branches from the relevant nerves: 14 from dorsomedial cutaneous nerves, 11 from deep peroneal nerves, 6 from medial hallucal nerve, and 5 from lateral hallucal nerve. Dorsal incision mean length was 60.53 (range, 42.48-85.12) mm, and the plantar incision mean length was 88.08 (range, 77.32-111.21) mm. CONCLUSION Evidence from this study has shown that partial dorsal denervation of the FMPJ may be a technically feasible procedure along with the presence of superficially easily dissected nerves with relatively small incision. LEVEL OF EVIDENCE Level 5.
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Affiliation(s)
- Bilgehan Çatal
- Department of Orthopedic Surgery, Medipol University, School of Medicine, İstanbul, Turkey
| | | | - Elif Nedret Keskinöz
- Department of Anatomy, Acıbadem University, School of Medicine, İstanbul, Turkey
| | - Gamze Tümentemur
- Department of Anatomy, Acıbadem University, School of Medicine, İstanbul, Turkey
| | - İbrahim Azboy
- Department of Orthopedic Surgery, Medipol University, School of Medicine, İstanbul, Turkey
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Walley KC, Muscatelli SR, Singer N, Nicholas M, Holmes JR, Walton DM, Talusan PG. First Metatarsophalangeal Lateral Collateral Ligament Repair in an Athlete: A Case Report. JBJS Case Connect 2021; 11:01709767-202109000-00055. [PMID: 34329201 DOI: 10.2106/jbjs.cc.20.00901] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE Evidence-based surgical strategies to reconstruct the collateral ligament complex of the first metatarsophalangeal (MTP) joint are not available. We report a case of first MTP lateral collateral ligament insufficiency in a young, female gymnast with varus laxity and subsequent satisfactory mid-term and long-term outcomes. CONCLUSION This case report describes an efficient suture anchor technique for restoring stability of the first MTP joint because of chronic varus laxity with acceptable results both clinically and with patient-reported outcome scores at mid-term and long-term follow-ups. We suggest that our strategy is a viable option for addressing chronic varus laxity of the first MTP joint. LEVEL OF EVIDENCE Level IV, case report.
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Affiliation(s)
- Kempland C Walley
- Department of Orthopaedic Surgery, University of Michigan | Michigan Medicine, Ann Arbor, Michigan
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Yoshikawa K, Shima H, Yasuda T, Tsujinaka S, Neo M. Extensor hallucis longus muscle contracture after distal tibial physeal injury: A report of two cases. Foot (Edinb) 2021; 47:101802. [PMID: 33946006 DOI: 10.1016/j.foot.2021.101802] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 02/05/2021] [Accepted: 04/05/2021] [Indexed: 02/04/2023]
Abstract
Few studies have reported about isolated contracture in the extensor hallucis longus (EHL) muscle, but none of the EHL muscle contracture after distal tibial physeal injury. Two such cases in 16- and 14-year-old boys who underwent surgeries for distal physeal injury of the tibia at a previous hospital are presented. Extension contracture of the hallux appeared 1-2 months post-surgery. Physical examinations revealed that the extension contracture of the first metatarsophalangeal joint was aggravated in plantar flexion of the ankle due to a tenodesis effect, and magnetic resonance imaging showed atrophy and signal changes in the anterior compartment muscles. This was diagnosed as EHL muscle contracture due to anterior compartment syndrome (ACS) after distal tibial physeal injury. The EHL tendon transfers were performed in both cases, with favorable short-term results. Therefore, the EHL tendon transfer might be preferable in case of the EHL muscle contracture due to partial ACS.
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Affiliation(s)
- Kei Yoshikawa
- Department of Orthopedic Surgery, Osaka Medical and Phamaceutical University, 2-7, Daigaku-machi, Takatsuki 569-8686, Japan.
| | - Hiroaki Shima
- Department of Orthopedic Surgery, Osaka Medical and Phamaceutical University, 2-7, Daigaku-machi, Takatsuki 569-8686, Japan.
| | - Toshito Yasuda
- Department of Orthopedic Surgery, Osaka Medical and Phamaceutical University, 2-7, Daigaku-machi, Takatsuki 569-8686, Japan.
| | - Seiya Tsujinaka
- Department of Orthopedic Surgery, Osaka Medical and Phamaceutical University, 2-7, Daigaku-machi, Takatsuki 569-8686, Japan.
| | - Masashi Neo
- Department of Orthopedic Surgery, Osaka Medical and Phamaceutical University, 2-7, Daigaku-machi, Takatsuki 569-8686, Japan.
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Kadıoğlu B, Güven M, Akman B, Özkan NK. Longitudinal Epiphyseal Bracket as an Overlooked Etiology of Congenital-Residual Hallux Varus: A Case Report. J Am Podiatr Med Assoc 2021; 111:464167. [PMID: 33872360 DOI: 10.7547/20-021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Longitudinal epiphyseal bracket is a rare ossification disorder of the short tubular bones. The affected bone becomes deformed as a result of the bracket. The normal growth pattern cannot occur, and when it affects the first metatarsal bone, hallux varus may develop with the abnormal growth pattern. We present such a 6-year-old patient who had undergone surgery at 6 months of age for hallux varus and polydactyly. The deformity had worsened gradually after the initial operation because of the overlooked longitudinal epiphyseal bracket. The patient was treated with surgical excision of the epiphyseal bracket, with corrective medial open wedge osteotomy and split transfer of the extensor hallucis longus tendon. The result was excellent at the 20-month follow-up. At an early age, patients who present with hallux varus must be checked for the epiphyseal bracket, which can be invisible on radiographs because of the chondral structure. Untreated or overlooked patients with epiphyseal bracket will need revision operations for recurrent deformities.
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Shimizu S, Sato T, Tateishi T, Nagase T, Nakagawa T, Tsuchiya M. Lateral Collateral Ligament Repair for Hallux Metatarsophalangeal Joint Instability in a Collegiate Sumo Wrestler: A Case Report. J Am Podiatr Med Assoc 2021; 111:462616. [PMID: 33690810 DOI: 10.7547/19-127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Although sprains of the hallux metatarsophalangeal (MTP) joint ligaments occur in barefooted martial arts athletes, few studies discuss the surgical treatments for lateral collateral ligament damage. We report herein a case of lateral collateral ligament repair for chronic hallux MTP joint instability. A 21-year-old male collegiate sumo wrestler injured his left hallux by snagging it on a sumo straw bale at 14 years of age. After entering university (4 years after the injury), he could no longer put weight on his foot at the left hallux; his athletic performance deteriorated, and he was referred to our department by his doctor. He had instability in the MTP joint of the left hallux, and magnetic resonance imaging revealed a tear in the attachment of the lateral collateral ligament to the metatarsal bone. Conservative treatment, such as taping, did not improve the symptoms; thus, surgery was performed, which consisted of passing a strong suture attached to the capsular ligament through a burr hole made in the metatarsal bone and fixing it to the burr-hole wall using an anchor. Postoperatively, the patient's joint instability improved, and he returned to competitive wrestling 4 months after surgery. He was able to put weight on his left hallux, and his athletic performance improved. The follow-up period after surgery was 2 years. In competitive sumo wrestling, hallux weakness and joint instability lead to a significant reduction in performance. Thus, ligament repair is an effective treatment for hallux MTP joint instability that cannot be treated by conservative means.
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Rushing CJ, Amin T, Herrada A, Spinner SM. Hallux Varus Interphalangeus Following Osteochondral Fracture of the Proximal Phalanx: A Case Report. J Am Podiatr Med Assoc 2020; 110:447702. [PMID: 33179059 DOI: 10.7547/19-106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Hallux valgus interphalangeus deformity has been previously reported in the literature following trauma and first metatarsophalangeal joint fusion. However, to the best of our knowledge, hallux varus interphalangeus deformity has not been previously reported. We present the case of a 26-year-old skeletally mature woman who sustained an acute, open hallux varus interphalangeus injury following an osteochondral fracture of the medial head of the proximal phalanx.
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Picouleau A, Orsoni N, Hardy J, Mabit C, Charissoux JL, Marcheix PS. Analysis of the effects of arthrodesis of the hallux metatarsophalangeal joint on gait cycle: results of a GAITRite ® treadmill test. Int Orthop 2020; 44:2167-2176. [PMID: 32683459 DOI: 10.1007/s00264-020-04716-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Accepted: 07/07/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Approximately 80% of patients are satisfied with the outcome of arthrodesis of the hallux metatarsophalangeal (MTP) joint. The hypothesis of this study was that MTP arthrodesis does not influence the walking cycle. The aim of this study was to evaluate the effect of MTP arthrodesis on gait cycle and to measure the functional outcome of MTP arthrodesis after a minimum of two year follow-up. METHOD This was an observational prospective cohort study performed at a single centre that included 26 patients (32 ft) who underwent unilateral or bilateral MTP arthrodesis during the period 2004-2014. An X-ray assessment based on the American Orthopaedic Foot and Ankle Society score was performed pre-operatively and at the last follow-up (average follow-up duration 8.3 years). The walking cycle was analysed at the final follow-up using a GAITRite® treadmill test. RESULTS Twenty unilateral and six bilateral MTP arthrodeses were included in this study. The average age of the patients was 70 years. No significant difference was found in the walking cycle between the operated and non-operated sides for unilaterally MTP arthrodesis. However, we observed a non-significant increase in the percentage of contact time after MTP arthrodesis (65% on the operated side vs. 63% on the non-operated side). We also observed a significant decrease in the average walking rate, and a decrease in walking speed, in cases of bilateral MTP arthrodesis compared with normal walking cycle data from a laboratory study. CONCLUSIONS MTP joint arthrodesis does not appear to have any effect on the walking cycle, but reduced patient pain and increased the walking distance. The patients reported satisfaction with the surgical outcomes and would recommend it to a relative with the same pathology.
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Affiliation(s)
- Alexandre Picouleau
- Department of Orthopedic Surgery, Dupuytren University Hospital, 2, Avenue Martin Luther King, 87042, Limoges cedex, France
| | - Nathlaie Orsoni
- Department of Orthopedic Surgery, Dupuytren University Hospital, 2, Avenue Martin Luther King, 87042, Limoges cedex, France
| | - Jeremy Hardy
- Department of Orthopedic Surgery, Dupuytren University Hospital, 2, Avenue Martin Luther King, 87042, Limoges cedex, France
| | - Christian Mabit
- Department of Orthopedic Surgery, Dupuytren University Hospital, 2, Avenue Martin Luther King, 87042, Limoges cedex, France
| | - Jean-Louis Charissoux
- Department of Orthopedic Surgery, Dupuytren University Hospital, 2, Avenue Martin Luther King, 87042, Limoges cedex, France
| | - Pierre-Sylvain Marcheix
- Department of Orthopedic Surgery, Dupuytren University Hospital, 2, Avenue Martin Luther King, 87042, Limoges cedex, France.
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Park SE, Choi BS, Hwang WH, Jeong JJ. Alternative treatment for varus instability of the hallux interphalangeal joint: A case report. Acta Orthop Traumatol Turc 2020; 54:213-216. [PMID: 32254039 DOI: 10.5152/j.aott.2020.02.463] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Forefoot injuries are commonly caused by sport-related activities and are often around the metatarsophalangeal joints. The hallux interphalangeal (IP) joint is anatomically stable; therefore, injuries to this joint are considered to be rare compared with those to the metatarsophalangeal joint. Instability of the hallux IP joint has rarely been reported in barefoot contact sports, and its treatment has not been sufficiently explored.This study investigated chronic varus instability of the hallux IP joint. We performed a surgical reconstruction owing to conservative treatment failure. A good surgical outcome was achieved by reconstruction of the collateral ligament using the 4th extensor tendon-a promising alternative treatment option for this type of injury. This method indicated no morbidity outside the site of surgery and was more cost-effective than reconstruction using an allograft.
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Affiliation(s)
- Sang Eun Park
- Department of Orthopedic Surgery, Daejeon St. Mary's Hospital, The Catholic University of Korea, College of Medicine, Daejeon, Korea
| | - Bong Seok Choi
- Department of Orthopedic Surgery, Daejeon St. Mary's Hospital, The Catholic University of Korea, College of Medicine, Daejeon, Korea
| | - Won Ha Hwang
- Department of Orthopedic Surgery, Daejeon St. Mary's Hospital, The Catholic University of Korea, College of Medicine, Daejeon, Korea
| | - Jae Jung Jeong
- Department of Orthopedic Surgery, Daejeon St. Mary's Hospital, The Catholic University of Korea, College of Medicine, Daejeon, Korea
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Chun DI, Lee HS, Won SH, Moon SI, Jung KJ, Seo JH, Cho HK, Lee DW, Ryu A, Manggala Y, Kim WJ. Closed atraumatic complete rupture of the flexor halluces longus tendon during forward lunge exercise: A case report. Medicine (Baltimore) 2019; 98:e18409. [PMID: 31852162 PMCID: PMC6922354 DOI: 10.1097/md.0000000000018409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Acute rupture of the flexor halluces longus (FHL) tendon due to trauma or laceration is a well-known phenomenon. Partial rupture of the FHL tendon caused by tendinitis or stenosing tenosynovitis is common in ballet dancers and athletes. However, atraumatic complete rupture of the FHL is rare: as of 2018, only 7 cases of closed atraumatic complete rupture of the FHL tendon have been reported in the literature. Here, we report on a patient who presented with a closed atraumatic complete rupture of the FHL tendon during a forward lunge exercise. PATIENT CONCERNS A 35-year-old female visited the clinic with pain in the plantar medial aspect of the left foot, along with weakness and loss of great toe flexion. The patient had a normal foot structure and no history of trauma or systemic disease. She performed a forward lunge exercise more than 50 times on 1 leg per day, more than once a week to strengthen her leg muscles. She reported that she felt a slight pain in her left, great toe while exercising for 3 weeks prior to her visit. One week prior to presentation, severe pain occurred suddenly when her left hallux dorsiflexed strongly during an anterior lunge exercise motion. DIAGNOSIS Magnetic resonance imaging revealed complete rupture of the FHL tendon near the level of the metatarsal head and neck junction. The lesion was prolonged, with the proximal end displaced to the metatarsal shaft region. INTERVENTIONS Complete rupture of the FHL tendon was treated with a primary suture. OUTCOMES At the 1-year follow-up, active plantar flexion of the interphalangeal joint was possible but joint function had a range of 0° to 25°. Flexion strength was reduced slightly, measuring about 70% when compared to the contralateral side, but flexion strength of the metatarsophalangeal joint was normal. LESSONS We describe an extremely rare case of complete rupture of the FHL tendon at the level of metatarsal head and neck junction. It should be understood that this injury can occur not only in professional athletes but also in the general public, and we recommend educating personal trainers on how to prevent it.
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Affiliation(s)
- Dong Il Chun
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Seoul, Yongsan-gu
| | - Hong Seop Lee
- Department of Foot and Ankle Surgery, Nowon Eulji Medical Center, Eulji University, Hangeulbiseok-ro, Nowon-gu, Seoul
| | - Sung Hun Won
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Seoul, Yongsan-gu
| | - Sang Il Moon
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Cheonan, Dongam-gu, Cheonan
| | - Ki Jin Jung
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Cheonan, Dongam-gu, Cheonan
| | - Jong Hyun Seo
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Seoul, Yongsan-gu
| | - Hyung Ki Cho
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Seoul, Yongsan-gu
| | - Dhong Won Lee
- Department of Orthopaedic Surgery, Konkuk University Medical Center, Neungdong-ro, Gwangjin-gu, Seoul
| | - Aeli Ryu
- Department of Obstetrics and Gynecology, Soonchunhyang University Hospital Cheonan, Suncheonhyang 6-gil, Dongam-gu, Cheonan, Korea
| | - Yudha Manggala
- Department of Orthopaedic and Traumatology Surgery, Medicine Faculty, Soegijapranata Catholic University, Semarang, Indonesia
| | - Woo Jong Kim
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Cheonan, Dongam-gu, Cheonan
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Weber TR, Wrotslavsky P. A Viable Osteochondral Allograft for Articular Cartilage Replacement of the First Metatarsal Head A Case Series. Surg Technol Int 2019; 34:476-482. [PMID: 30574679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Few reports in the literature have described the use of an osteochondral allograft for the treatment of articular cartilage damage of the 1st metatarsal phalangeal joint. We present here the clinical outcomes and detailed surgical technique of four cases in which we used a cryopreserved, viable, osteochondral allograft (CVOCA) for full cartilage replacement of the first metatarsal head to address degenerative articular cartilage damage. At 10-22 months of follow-up, patients reported clinical improvement, with VAS pain-scale scores decreasing from an average of 8.0 to 0 post-operatively, and range-of-motion improvement from an average of 4.3 degrees to 58.3 degrees dorsiflexion. Radiographic improvement was also seen, with an increase in average joint space from 1.1mm, 1.5mm, and 2.2mm from medial to lateral on dorsoplantar views pre-operatively, to 3.1mm, 2.8mm, and 3.1mm 15 months post-operatively, respectively. These results suggest that CVOCA is a desirable treatment option for end-stage degenerative joint disease of the first metatarsal phalangeal joint.
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Affiliation(s)
- Travis R Weber
- Department of Foot and Ankle Surgery, Scripps Mercy San Diego Hospital, San Diego, CA
| | - Phillip Wrotslavsky
- American Board of Foot and Ankle Surgery, Department of Foot and Ankle Surgery Scripps Mercy San Diego Hospital, San Diego, CA
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Montiel V, Alfonso M, Villas C, Valentí A. Medial and lateral exostoses of the distal phalanx of the hallux: A potentially painful bunion-like structure. Part 1: Incidence and clinical application. Foot Ankle Surg 2019; 25:158-164. [PMID: 29409186 DOI: 10.1016/j.fas.2017.10.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 09/20/2017] [Accepted: 10/10/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND Exostoses at the base of the distal phalanx of the great toe are usually asymptomatic. The literature has not generally considered them as the origin of a possible problem resulting from a pressure conflict between hallux and shoe (medial aspect) or second toe (lateral aspect) nor a potential complication of surgical correction of hallux valgus deformity. No studies, to our knowledge, have evaluated its possible correlation with other foot disorders. When one of these neglected exostoses became painful after surgical correction of hallux valgus, we decided to start a study to determine their possible origin, prevalence in daily practice and histo-pathological morphology. METHODS Two hundred and fifty-four feet of patients (average age 41.7y.) were enrolled in the study from January 2007 to June 2009. Dorsoplantar weight-bearing radiographs were used to analyze the presence of exostoses and their correlation with the distal phalanx morphology, metatarsal formula (or transverse plane orientation of the metatarsal heads parabola) and hallux valgus angles. Patients were classified according to their age and main symptom for consultation. Four exostoses removed from cadaver feet were also analyzed microscopically. RESULTS Osseous excrescences arising on the medial or lateral aspect at the proximal part of the terminal phalanx of the hallux were observed in 132 feet (51.9%). Thirty-five feet out of these 132 (13.7%) had exostoses on both sides of the phalanx.A statistically significant positive correlation was found between the presence of a medial exostosis of the phalanx and the severity of HVA. Patients with higher IPH and asymmetry angles have a lower prevalence of medial exostoses (p<0.05). Amongst the different morphologies of the second phalanx, exostoses were most likely found in the standard form. CONCLUSIONS Prevalence of exostoses at the base of the distal phalanx is high (51.9% of the studied feet). Histological findings would suggest that these exostoses could be considered a mechanical reactive process, produced by a chronic irritation by shoes. We encourage surgeons to be aware of its potential clinical implications. Direct resection is very simple and the most appropriate treatment for symptomatic cases.
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Affiliation(s)
- V Montiel
- Dpto de COT, Clínica Univeristaria de Navarra, Avda Pio XII 36, 31008 Pamplona, Spain.
| | - M Alfonso
- Dpto de COT, Clínica Univeristaria de Navarra, Avda Pio XII 36, 31008 Pamplona, Spain
| | - C Villas
- Dpto de COT, Clínica Univeristaria de Navarra, Avda Pio XII 36, 31008 Pamplona, Spain
| | - A Valentí
- Dpto de COT, Clínica Univeristaria de Navarra, Avda Pio XII 36, 31008 Pamplona, Spain
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Beyaz F, Inberg B. [A man with a skin lesion on the big toe]. Ned Tijdschr Geneeskd 2019; 163:D3303. [PMID: 30875165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
We present a 48-year-old man who had developed a skin lesion on his big toe. In 2 years' time, the lesion had evolved from melanonychia striata to an erratic, erosive, granulomatous plaque of approximately 3,0 x 3,0 cm. Histopathological examination of 2 skin biopsies revealed a nodular melanoma. Diagnostic imaging and histopathological examination of 2 sentinel lymph node biopsies showed no signs of metastases. We performed a hallux amputation.
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Affiliation(s)
- Ferhat Beyaz
- Streekziekenhuis Koningin Beatrix, afd. Chirurgie, Winterswijk
- Contact: F. Beyaz
| | - Bas Inberg
- Streekziekenhuis Koningin Beatrix, afd. Chirurgie, Winterswijk
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Moerenhout K, Chopra S, Crevoisier X. Outcome of the modified Lapidus procedure for hallux valgus deformity during the first year following surgery: A prospective clinical and gait analysis study. Clin Biomech (Bristol, Avon) 2019; 61:205-210. [PMID: 30594769 DOI: 10.1016/j.clinbiomech.2018.12.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 12/11/2018] [Accepted: 12/19/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND The modified Lapidus procedure is a surgical option to treat moderate to severe hallux valgus deformity with good radio-clinical outcome. However, comprehensive biomechanical outcome evaluation of this surgery at mid-term follow-up is missing. This study assesses and compares the radio-clinical and gait outcome at 6 and 12 months following modified Lapidus procedure. METHOD Ten consecutive female patients with moderate to severe hallux valgus who underwent modified Lapidus procedure participated in the study. Comprehensive gait assessment was performed preoperatively, at 6 and 12 months postoperatively. Gait parameters including spatiotemporal, kinematics and plantar pressure were analyzed using pressure insoles and 3-dimensional inertial sensors. Outcome was evaluated using two clinical questionnaires, i.e. the American Orthopaedic Foot and Ankle Score and the Foot and Ankle Ability Measure, and X-rays. FINDINGS Three spatiotemporal, two kinematics, and seven plantar pressure parameters significantly improved between 6 months and 12 months postoperatively. Significant improvement in radiological and clinical outcome was reported at 6 and 12 months. The Foot and Ankle Ability Measure showed non-significant improvement at 12 months. INTERPRETATION The outcome of this study is consistent with the previously reported good clinical and radiological results at one year following Lapidus for moderate to severe hallux valgus. Twelve gait parameters demonstrated that outcome improves from 6 months to 12 months postoperative with room for further improvement at long term. The gait outcome in this study confirms the longer rehabilitation period following modified Lapidus procedure. Studies with a larger sample size are required to confirm these findings.
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Affiliation(s)
- K Moerenhout
- Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne (UNIL), Department of Orthopaedic Surgery and Traumatology, Rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - S Chopra
- Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne (UNIL), Department of Orthopaedic Surgery and Traumatology, Rue du Bugnon 46, 1011 Lausanne, Switzerland; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, UK
| | - X Crevoisier
- Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne (UNIL), Department of Orthopaedic Surgery and Traumatology, Rue du Bugnon 46, 1011 Lausanne, Switzerland.
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Abstract
A retrospective survey was carried out to assess the results in the middle aged and elderly of an operation for hallux valgus which combined a basal osteotomy of the first metatarsal with a Keller's procedure. Mean follow up in 34 patients (54 feet) was 3.2 years. The correction of both the hallux valgus and the varus angle of the first metatarsal was found to be satisfactory. The advantages and disadvantages of the operation are discussed.
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Loveday DT, Barr LV, Loizou CL, Barton G, Smith G. A comparative prospective cohort health economic analysis comparing ankle fusion, isolated great toe fusion and hallux valgus surgery. Foot Ankle Surg 2018; 24:54-59. [PMID: 29413775 DOI: 10.1016/j.fas.2016.11.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 10/27/2016] [Accepted: 11/13/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND This study assessed the health economics and outcomes of three common foot and ankle operations. METHODS Between July 2013 and October 2014 all patients undergoing ankle fusion (AF) for osteoarthritis, first metatarsophalangeal joint fusion for osteoarthritis (MF) or hallux valgus surgery (HV) were included. Patients having additional procedures were excluded. Patients completed the Manchester-Oxford Foot Questionnaire (MOX-FQ), the EuroQol EQ-5D-5L questionnaire and the EQ-VAS on presentation and at least 6 months post-operatively. RESULTS 63 patients undergoing AF (n=22), MF (n=22), or HV (n=32) completed preoperative and postoperative questionnaires. 76 completed preoperative questionnaires and 63 completed the follow up questionnaires. The follow up questionnaires were completed at a median of 12 months (range 6-24 months) following surgery. The mean age at surgery was 59 years (range 26-85 years). Pre-operative MOX-FQ and EQ-5D-5L scores differed significantly between the three groups with AF and MF patients reporting worse scores compared to HV patients. MOX-FQ and EQ-5D-5L significantly improved in all groups from pre-operative levels. MOX-FQ AF from 53.8 (CI 56.8-50.8) to 22.9 (CI 30.9-14.9), MF from 43.0 (CI 46.4-39.6) to 12.1 (CI 18.3-5.9), HV from 35.4 (CI 39.0-31.7) to 15.6 (CI 21.1-10.1). EQ-5D-5L: AF from 0.30 (CI 0.43-0.17) to 0.66 (CI 0.77-0.55), MF from 0.45(CI 0.52-0.38) to 0.83 (CI 0.90-0.76), HV from 0.71(CI 0.74-0.68) to 0.82 (CI 0.88-0.76). There was no significant difference in the EQ-VAS suggesting it may not be representative of foot and ankle health. Health economics analysis using the EQ-5D-5L data to estimate quality-adjusted life years (QALYs) suggested all three procedures were favourable compared to threshold levels of cost-effectiveness. There were differences in estimated costs between the three operations with AF at £2950 (threshold cost <£5400) and MF at £1197 (threshold cost <£5780) and HV varying from £625 to £1688 (threshold cost <£1640). CONCLUSIONS This study reveals that the joint-specific (MOX-FQ) and generic health (EQ-5D-5L) outcome scores of patients improved after AF, MF and HV. The greatest benefit from surgery was gained in the arthritic patient groups. In the future, the use of large population patient reported outcome measures data may also potentially have implications for prioritisation of healthcare provision, acting as an indicator of foot and ankle surgical procedures that produce the most benefit to patients.
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Affiliation(s)
- David T Loveday
- Norfolk & Norwich University Hospital, Colney Lane, Norwich NR4 7UY, UK.
| | - Lynne V Barr
- Norfolk & Norwich University Hospital, Colney Lane, Norwich NR4 7UY, UK
| | | | - Garry Barton
- University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK
| | - George Smith
- Norfolk & Norwich University Hospital, Colney Lane, Norwich NR4 7UY, UK
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Abstract
Hallux-abducto-valgus or "bunion" surgery is one of the most common surgical procedures for the foot and ankle specialist. As our understanding of the hallux-abducto-valgus deformity has grown, it is becoming clear that the anatomic CORA of the deformity may lie at the tarsometatarsal joint. There is also the component of the 3-dimensional nature of the deformity that may be best addressed at this CORA. With these issues in mind, it was necessary to address the shortcomings of the traditional Lapidus procedure and progress toward more consistent, instrumented steps that could address the 3-dimensional nature of the deformity.
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Affiliation(s)
- W Bret Smith
- Orthopedics, University of South Carolina, Palmetto Health-USC Orthopedic Center, 104 Saluda Pointe Drive, Lexington, SC 29072, USA.
| | - Paul Dayton
- Department of Podiatric Medicine and Surgery, College of Podiatric Medicine and Surgery, Des Moines University, UnityPoint Clinic, Trinity Regional Medical Center, 3200 Grand Avenue, Des Moines, IA 50312, USA
| | - Robert D Santrock
- Department of Orthopaedics, West Virginia University, 1 Medical Center Drive, PO Box 9100, Morgantown, WV 26506-9600, USA
| | - Daniel J Hatch
- Department of Podiatric Medicine and Surgery, North Colorado PMS Residency, 1600 23rd Avenue, Greeley, CO 80634, USA
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Valero J, Moreno M, Gallart J, González D, Salcini JL, Gordillo L, Deus J, Lahoz M. A new surgical procedure for hallux limitus treatment: Double-V osteotomy on the base of the proximal phalanx of the hallux. Medicine (Baltimore) 2017; 96:e8127. [PMID: 28953644 PMCID: PMC5626287 DOI: 10.1097/md.0000000000008127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The purpose of this study was to evaluate the effectiveness of the new Double-V osteotomy of the first metatarsophalangeal joint (1MPJ) in patients with hallux limitus (HL).A study of 66 patients was performed, 33 patients were treated Cheilectomy and 33 were treated Double-V. All patients underwent an assessment of the passive mobility of the 1MPJ before the procedure, reevaluated 12 months later evaluating dorsiflexion, plantarflexion, and patients status using both the American Orthopaedic Foot and Ankle Society (AOFAS) for Hallux Metatarsophalangeal-Interphalangeal Scale.In comparing the improvement achieved regarding the increase of mobility obtained with surgical treatment, the feet operated with procedure Double-V gained significant degrees of movement increased in all analyzed parameters (P < .05). We achieved 13.33° more than average in dorsiflexion motion and 2.12° more than average in plantarflexion with regard to the feet that were operated with Cheilectomy procedure. Double-V scores on the AOFAS scale improved significantly (P = .000) 91.48 points postoperative, while with the following Cheilectomy only 79.30 points.This new surgical technique, easy to perform and with low complexity in surgical execution and a minimum of complications, produces better clinical and functional results that Cheilectomy alone.
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Affiliation(s)
- José Valero
- Department of Human Anatomy and Histology, School of Medicine, University of Zaragoza, Zaragoza
| | - Manuel Moreno
- Department of Human Anatomy and Histology, School of Medicine, University of Zaragoza, Zaragoza
| | - José Gallart
- Department of Human Anatomy and Histology, School of Medicine, University of Zaragoza, Zaragoza
| | - David González
- Department of Human Anatomy and Histology, School of Medicine, University of Zaragoza, Zaragoza
| | | | - Luis Gordillo
- Department of Podiatry, University of Sevilla, Sevilla
| | - Javier Deus
- Department of Surgery, Obstetrics and Gynecology, School of Medicine, University of Zaragoza, Zaragoza, Spain
| | - Manuel Lahoz
- Department of Human Anatomy and Histology, School of Medicine, University of Zaragoza, Zaragoza
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Usuelli FG, Tamini J, Maccario C, Grassi M, Tan EW. Bone-block arthrodesis procedure in failures of first metatarsophalangeal joint replacement. Foot Ankle Surg 2017; 23:163-167. [PMID: 28865584 DOI: 10.1016/j.fas.2017.03.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 02/10/2017] [Accepted: 03/12/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND The treatment for the failure of a first metatarsophalangeal joint (MTP1) prosthesis can be complex. There is no consensus regarding the ideal treatment. One of the main issues is the available bone stock after prosthesis removal. The aim of the study was to report the clinical and radiographic results for MTP1 arthrodesis with autologous calcaneus bone graft (bone-block fusion) as a revision procedure of a previous MTP1 implant failure. METHODS This study included 12 patients diagnosed with failure of a MTP1 prosthesis. All patients were treated with MTP1 arthrodesis using ipsilateral calcaneal bone graft. Patients were evaluated with the Foot Ankle Disability Index (FADI), the visual analogue pain scale (VAS) and AOFAS Hallux Metatarsophalangeal Interphalangeal scoring system (AOFAS-HMI), weight-bearing radiograph of the foot, and a computed tomography scan. The 1-2 intermetatarsal angle, hallux valgus angle, and first ray length were measured before surgery and at final follow-up. RESULTS Complications included 3 cases of arthrodesis nonunion, (1 symptomatic, 2 asymptomatic) with 2 of the 3 patients experiencing hardware failure and 1 superficial wound infection. The average FADI improved from 41.8 preoperatively to 84.6 at final follow-up (p<0.05); the average VAS improved from 8.5 preoperatively to 2 at final follow-up (p<0,05); the average AOFAS-HMI significantly improved from 50.7 preoperatively to 73.8 at final follow-up (p<0.05). The average length of the bone-block used was 14.3mm (range 11-19mm). The 1-2 intermetatarsal angle decreased from 9.5° preoperatively to 8.4° at final follow-up (p<0.05); hallux valgus angle improved from 19.7° preoperatively to 14.3° at final follow-up (p<0.05). CONCLUSIONS The management of a failed first metatarsophalangeal joint prosthesis remains controversial. Bone-block arthrodesis using ipsilateral calcaneal autograft appears to be a viable option restoring the bone loss, and avoiding hallux shortening. Nonunion is the most frequent complication with 25% of patients affected, but only 1/3 of patients with nonunion were symptomatic and required revision.
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Affiliation(s)
| | | | | | - Miriam Grassi
- Ospedale L. Sacco, divisione di Ortopedia e Traumatologia, Milan, Italy
| | - Eric W Tan
- University of Southern California, Los Angeles, CA, USA
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Liu H, Wang T, Zhang W, Qi R, Zhang N, Gu J. [Free grafting of big toe nail bed repairing defects of fingernail bed]. Zhonghua Zheng Xing Wai Ke Za Zhi 2017; 33:120-122. [PMID: 30070811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To investigate the feasibility and indication of free grafting of split big toe nail bed for defects of fingernail bed. METHODS From September 2008 to September 2011,13 cases (4 females and 9 males) with fingernail bed defects(aged 17-38,average,32) were treated with split big toe nail bed. The split big toe nail was harvested according to the defects size without bone exposure at donor site. RESULTS Three grafted nail beds were necrotic completely and reconstructed with flaps. The 2 grafted nail bed was partial loss and healed after dressing. All the other grafted nail bed survived completely with primarily healing both in donor sites and recipient sites. The patients were followed up for 6-30 months(average,14 months).The therapeutic effect was graded as excellent in 8 cases, good in 2 cases and poor in 14 cases(good rate,76.9%).The nail matrix was excellent in 8 cases,good in 1 case and poor in 1 case(good rate,90%).The toe nails in donor sites grew well. CONCLUSIONS The single fingernail defect with intact nail matrix can be reconstructed by split toe nail bed graft with good cosmetic and functional effect. There is no malfunction at donor site. The indication should be selected.
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Abstract
BACKGROUND Although more than 1500 publications on hallux valgus can be found in the current literature, none of them have reported on the course of pain resolution after hallux valgus surgery. Thus, this study aimed to investigate pain resolution after hallux valgus surgery and to identify predictive factors associated with residual pain at 6 months after surgery. METHODS We prospectively followed up 308 patients who underwent hallux valgus surgery at a tertiary hospital at 6 months and 2 years after surgery. Multivariate logistic regression analysis was performed to evaluate the risk factors associated with residual pain after surgery. RESULTS Ninety-four patients (31%) had some degree of residual pain at 6 months after surgery. After excluding 4 patients who developed osteoarthritis of the first metatarsophalangeal joint over the next 18 months, 73 of the remaining 90 (81%) experienced improvement in visual analog scale (VAS) by the 2-years follow-up. Their median VAS improved from 4 (interquartile range [IQR] 3, 5) at 6 months to 0 (IQR 0, 3) at 2 years (P < .001). A higher preoperative VAS increased the risk of having persistent pain at 6 months after sugery (odds ratio [OR] 1.388, 95% confidence interval [CI] 1.092, 1.764, P = .007), whereas a higher preoperative Mental Component Score of SF-36 (MCS) reduced this risk (OR 0.952, 95% CI 0.919, 0.987, P = .007). CONCLUSIONS As much as 31% of patients will have residual pain at 6 months after surgery. Preoperative VAS and MCS are predictors for residual pain. However, these patients will continue to improve over the next 18 months, with 71% of them being pain free at 2 years after surgery. LEVEL OF EVIDENCE Level II, prospective comparative study.
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Affiliation(s)
| | | | - Lei Jiang
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | | | - Kevin Koo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
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