1
|
Guo Z, Xiong B, Zhang L, Cao X, Sun X, Sun W. Advances in the Causes and Treatment of Floating Toes after the Weil Osteotomy: A Scoping Review. Orthop Surg 2024; 16:1257-1268. [PMID: 38693601 PMCID: PMC11144501 DOI: 10.1111/os.14061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 03/23/2024] [Accepted: 03/24/2024] [Indexed: 05/03/2024] Open
Abstract
The floating toe deformity is classified as a forefoot deformity wherein the distal portion of the toe does not establish touch with the ground, resulting in a suspended or elevated position while the finger is in a relaxed state. At first, it garnered considerable interest as a complication It is worth noting that this condition is particularly common in children under the age of 8, which usually disappears as the individual reaches maturity. Studies have shown that with the aggravation of floating toe deformity, its adverse effects on patients' gait and overall quality of life also increase. Despite the prevalence of floating toe deformity in clinical settings, there is a lack of comprehensive literature investigating its underlying causes and potential preventive strategies. This scope review follows the preferred reporting items for systematic reviews and meta-analyses extension for scoping reviews (PRISMA-ScR) statement guidelines for scope reviews. The literature was obtained from various full-text databases, including China National Knowledge Infrastructure Database (CNKI), Wanfang Database, PubMed, and Web of Science Database. Our search focused on published literature related to floating toes, Weil osteotomy, and distal metatarsal osteotomy, up until March 1, 2023. The literature search and data analysis are conducted by two independent reviewers. If there are any disagreements, a third researcher will participate in the discussion and negotiate a decision. Furthermore, two experienced foot and ankle surgeons conducted a thorough literature analysis for this review. Sixty-two articles were included. Through the clinical analysis of the structural changes of the forefoot before and after operation, the classification of floating toe was described, the causes of pathological floating toe were summarized, and the possible intervention measures for the disease were put forward under the advice of foot and ankle surgery experts. We comprehensively summarize the current knowledge system about the etiology of floating toe and put forward the corresponding intervention strategy. We recommend that future studies will focus on the improvement of surgical procedures, such as the combination of Weil osteotomy, proximal interphalangeal (PIP) arthrodesis and flexor tendon arthrodesis.
Collapse
Affiliation(s)
- Ziyan Guo
- Wangjing HospitalChina Academy of Chinese Medical SciencesBeijingChina
| | - Binglang Xiong
- Wangjing HospitalChina Academy of Chinese Medical SciencesBeijingChina
| | - Longwei Zhang
- Advanced ChemistrySchool of Science Xi'an Jiaotong‐liverpool UniversitySuzhouChina
| | - Xuhan Cao
- Wangjing HospitalChina Academy of Chinese Medical SciencesBeijingChina
| | - Xudong Sun
- Wangjing HospitalChina Academy of Chinese Medical SciencesBeijingChina
| | - Weidong Sun
- Wangjing HospitalChina Academy of Chinese Medical SciencesBeijingChina
| |
Collapse
|
2
|
Fernández-Vizcaino C, Naranjo-Ruiz C, Fernández-Ehrling N, García-Vicente S, Nieto-García E, Ferrer-Torregrosa J. Impact of Minimally Invasive Intra-Capsular Metatarsal Osteotomy on Plantar Pressure Decrease: A Cross-Sectional Study. J Clin Med 2024; 13:2180. [PMID: 38673452 PMCID: PMC11051111 DOI: 10.3390/jcm13082180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 03/28/2024] [Accepted: 04/08/2024] [Indexed: 04/28/2024] Open
Abstract
Background: Metatarsalgia is a common pathology that is initially treated conservatively, but failure to do so requires surgery, such as the minimally invasive distal metatarsal osteotomy (DICMO). Methods: In this prospective study of 65 patients with primary metatarsalgia who underwent DICMO, plantar pressures, American Orthopaedic Foot and Ankle Society MetaTarsoPhalangeal-InterPhalangeal scale (AOFAS-MTP-IP) and Visual Analog Scale (VAS) were evaluated pre-operatively and post-operatively and there was a subgroup in which an inclinometer was used to observe the importance of the inclination of the osteotomy. Results: The results show a significant reduction in plantar pressures after DICMO surgery without overloading the adjacent radii, especially in the subgroup with an inclinometer to guide the osteotomy. The AOFAS-MTP-IP scale evidenced a marked improvement in metatarsal function and alignment with scores close to normal. The VAS scale showed a substantial decrease in pain after DICMO osteotomy. Conclusions: DICMO, with an inclinometer for a 45° osteotomy, proved to be a safe and effective procedure for primary metatarsalgia, although further comparative studies are needed to confirm its superiority.
Collapse
Affiliation(s)
- Carlos Fernández-Vizcaino
- Podiatry Department, Faculty of Medicine and Health Sciences, Valencia Catholic University “San Vicente Mártir”, 46001 Valencia, Spain; (C.F.-V.); (C.N.-R.); (N.F.-E.); (E.N.-G.)
| | - Carmen Naranjo-Ruiz
- Podiatry Department, Faculty of Medicine and Health Sciences, Valencia Catholic University “San Vicente Mártir”, 46001 Valencia, Spain; (C.F.-V.); (C.N.-R.); (N.F.-E.); (E.N.-G.)
| | - Nadia Fernández-Ehrling
- Podiatry Department, Faculty of Medicine and Health Sciences, Valencia Catholic University “San Vicente Mártir”, 46001 Valencia, Spain; (C.F.-V.); (C.N.-R.); (N.F.-E.); (E.N.-G.)
| | - Sergio García-Vicente
- Admission and Clinical Documentation Unit, Sagunto Hospital, Generalitat Valenciana, Universidad Europea, 46001 Valencia, Spain;
| | - Eduardo Nieto-García
- Podiatry Department, Faculty of Medicine and Health Sciences, Valencia Catholic University “San Vicente Mártir”, 46001 Valencia, Spain; (C.F.-V.); (C.N.-R.); (N.F.-E.); (E.N.-G.)
| | - Javier Ferrer-Torregrosa
- Podiatry Department, Faculty of Medicine and Health Sciences, Valencia Catholic University “San Vicente Mártir”, 46001 Valencia, Spain; (C.F.-V.); (C.N.-R.); (N.F.-E.); (E.N.-G.)
| |
Collapse
|
3
|
Ram LM, Schippers P, Neun O, Gramlich Y, Herrmann E, Klug A, Hoffmann R, Fischer S. Radiographic Evidence of Sufficient Transverse Plane Alignment after Weil Osteotomy without Screw Fixation. J Clin Med 2024; 13:331. [PMID: 38256465 PMCID: PMC10816324 DOI: 10.3390/jcm13020331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 01/02/2024] [Accepted: 01/03/2024] [Indexed: 01/24/2024] Open
Abstract
Weil osteotomy is a proven procedure to restore the harmonic distal parabola of the forefoot. In addition to the proximal displacement of the head in the sagittal plane, a displacement in the transverse plane may be necessary, with the refixation of the displaced metatarsal head historically performed by screw fixation. We aimed to determine the radiological differences among 136 feet of 127 patients with 256 Weil osteotomies retrospectively enrolled and divided into groups with (n = 182) and without (n = 74) screw fixation. Demographic data, radiographic union, pre- and postoperative metatarsal angles, and differences in the dorsoplantar view were evaluated. The mean follow-up period was 3.6 months. The mean preoperative metatarsophalangeal angle was 9.24°, and the mean postoperative angle was 12.99°. The restoration of the transversal alignment plane was equally successful in both groups, with a mean extent of angle correction of 10.58°. No nonunions of the osteotomized metatarsals were observed. The radiographic comparisons revealed no significant difference between the groups (p > 0.05). However, visibility of the joint space of the metatarsophalangeal joint was achieved significantly more often in the group without screw fixation (p < 0.05). In the absence of bony malunion and the satisfactory restoration of a harmonious parabola of the forefoot, apparently there does not appear to be a necessity for regular screw fixation after Weil osteotomy based on the available data from the present study.
Collapse
Affiliation(s)
- Leona Marleen Ram
- Department for Trauma and Orthopaedic Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, 60389 Frankfurt, Germany
| | - Philipp Schippers
- Department of Orthopedics and Traumatology, University Medical Center of the Johannes Gutenberg, University Mainz, 55131 Mainz, Germany
| | - Oliver Neun
- Department of Foot and Ankle Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, 60389 Frankfurt, Germany
| | - Yves Gramlich
- Department for Trauma and Orthopaedic Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, 60389 Frankfurt, Germany
| | - Eva Herrmann
- Institut für Biostatistik und Mathematische Modellierung, Goethe-Universität Frankfurt am Main, Theodor-Stern-Kai 7, 60596 Frankfurt am Main, Germany
| | - Alexander Klug
- Department for Trauma and Orthopaedic Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, 60389 Frankfurt, Germany
| | - Reinhard Hoffmann
- Department for Trauma and Orthopaedic Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, 60389 Frankfurt, Germany
| | - Sebastian Fischer
- Department of Foot and Ankle Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, 60389 Frankfurt, Germany
| |
Collapse
|
4
|
The Conventional Weil Osteotomy Does Not Require Screw Fixation. J Clin Med 2023; 12:jcm12020428. [PMID: 36675357 PMCID: PMC9862780 DOI: 10.3390/jcm12020428] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 12/30/2022] [Accepted: 01/03/2023] [Indexed: 01/06/2023] Open
Abstract
The Weil osteotomy is an established procedure to reduce plantar pressure in chronic metatarsalgia. Historically, the refixation of the displaced metatarsal head is performed by screw fixation. We aimed to demonstrate that screw fixation is not always necessary. Between 2016 and 2021, 155 patients with 278 Weil osteotomies (20 males and 135 females, mean age: 63 years) were retrospectively enrolled. Group A (n = 96) underwent 195 Weil osteotomies with screw fixation; group B (n = 59), 83 without screw fixation. Demographic, Visual Analog Scale Foot and Ankle (VAS-FA), SF-12 questionnaire, and toe mobility data were recorded. The mean follow-up period was 4.5 years. The mean VAS-FA was 75.5; mean SF-12 physical component summary, 42.0; and mean SF-12 mental component summary, 51.0. The overall revision rate was 20% (group A: 25%, group B: 10.2%), primarily for arthrolysis of the metatarsophalangeal joint in group A. Clinical comparisons showed no significant difference between the groups (p > 0.05). The revision rate was significantly higher in group A (p < 0.05), with equal satisfaction in clinical outcomes. Based on the available data, the need for regular screw fixation after a Weil osteotomy cannot be justified.
Collapse
|
5
|
Chong XL, Drittenbass L, Dubois-Ferriere V, Assal M. Iatrogenic transfer metatarsalgia after hallux valgus surgery: a comprehensive treatment algorithm. EFORT Open Rev 2022; 7:618-627. [PMID: 36125013 PMCID: PMC9624479 DOI: 10.1530/eor-22-0043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Current literature has described many of the complications following hallux valgus surgery and their treatment options. Iatrogenic transfer metatarsalgia is a distinctive and challenging complication that has not been addressed in a comprehensive fashion yet. Iatrogenic transfer metatarsalgia may result from poor preoperative assessment, planning and/or surgical technique. We have classified the causes of iatrogenic transfer metatarsalgia based on a multiplanar assessment of the malalignment(s) and are recommending a comprehensive treatment algorithm to guide surgeons in addressing this complication. With this knowledge, surgeons may avoid potential pitfalls in the primary surgery that can result in iatrogenic transfer metatarsalgia and find the appropriate treatment option to correct them.
Collapse
Affiliation(s)
- Xue Ling Chong
- Centre Assal SA, Foot and Ankle Surgery Centre, La Colline, Geneva, Switzerland
| | - Lisca Drittenbass
- Centre Assal SA, Foot and Ankle Surgery Centre, La Colline, Geneva, Switzerland
| | | | - Mathieu Assal
- Centre Assal SA, Foot and Ankle Surgery Centre, La Colline, Geneva, Switzerland
| |
Collapse
|
6
|
de César PC, Torres AC, Oliani CHP, de Abreu MR. Influence of the Length Ratio Between Second and Third Metatarsals After Modified Weil Osteotomy on Clinical Outcomes. J Foot Ankle Surg 2022; 61:1007-1012. [PMID: 35183453 DOI: 10.1053/j.jfas.2022.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 05/15/2021] [Accepted: 01/10/2022] [Indexed: 02/03/2023]
Abstract
Metatarsalgia is a frequent foot disorder. The objective was to evaluate whether the length ratio between the second and the third metatarsals after Weil osteotomy influences clinical outcomes. This retrospective study included 37 patients (53 feet). Preoperative planning consisted of keeping the second metatarsal greater than or equal to the third metatarsal after Weil osteotomy of the second metatarsal or the second and third metatarsals. Based on postoperative weightbearing and digital AP radiographs after Weil osteotomy, we divided the patients into 2 groups: group 1, the second metatarsal was longer than or equal to the third metatarsal; and group 2, the second metatarsal was shorter than the third metatarsal. We investigated whether there were differences between the groups. In 35 (66%) feet, the second metatarsal was longer than or equal to the third metatarsal (group 1), and in 18 (34%) feet, the second metatarsal was shorter than the third metatarsal (group 2). Postoperative American Orthopaedic Foot and Ankle Society scores were 86.2 and 82.7, respectively (p = .32). Postoperative Visual Analog Scale scores were 1.26 and 1.67, respectively (p = .39). The sample showed 11.3% of transfer metatarsalgia to the third metatarsal. Group 1 had 9% of transfer metatarsalgia, whereas group 2 had 17% of transfer metatarsalgia (p = .40). The presence of a second metatarsal shorter than the third metatarsal, after Weil osteotomy of the second metatarsal or the second and third metatarsals, does not influence outcomes or incidence of transfer metatarsalgia to the third metatarsal.
Collapse
|
7
|
Bougiouklis D, Tyllianakis M, Deligianni D, Panagiotopoulos E. Comparison of the Weil and Triple Weil Osteotomies: A Clinical Retrospective Study. Cureus 2022; 14:e22220. [PMID: 35340462 PMCID: PMC8927858 DOI: 10.7759/cureus.22220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction: The Weil and triple Weil osteotomies are two widely used procedures in the surgical treatment of metatarsalgia. The aim of this comparative retrospective study was to evaluate the functional results and determine the complications of the two types of osteotomies in a series of patients who underwent surgery due to third rocker metatarsalgia. Material and methods: In this paper, 71 patients were included between September 2015 and October 2020. The average age was 58 years old (age range: 28-72). Of all the patients, 27 suffered from metatarsalgia due to systemic (extra-regional) or regional diseases were excluded. The remaining 44 patients, after six months of unsuccessful conservative treatment, underwent surgery. Based on the preoperative planning to restore the peripheral parabolic curve of the metatarsals, when a shortening of less than or equal to 3 mm was required, a Weil osteotomy was performed. However, when a shortening of more than 3 mm was required, a triple Weil osteotomy was performed. Therefore, two groups of patients were formed, and a total of 90 osteotomies were performed. During the postoperative period, all the patients were clinically and radiographically assessed. The American Orthopedic Foot and Ankle Society (AOFAS) score was used for the assessment of the functional result, while the pain was assessed using the Visual Analogue Scale (VAS). Results: The mean follow-up was 24 months. The average operative time for the Weil and the triple Weil osteotomies was 22.8 minutes and 31.5 minutes, respectively. In group A, preoperatively, the average AOFAS score was 31/100, and postoperatively, it was 89/100. In group B, the corresponding values were 30/100 and 93/100, respectively. In group A, the preoperative VAS score was 7.8/10, while the postoperative VAS score was 1.3/10. In group B, the corresponding values were 8.2/10 and 1.7/10, respectively. In group A, stiffness had a percentage equal to 60.9%, and a floating toe was noticed in 16 osteotomies. In group B, superficial infection represented the commonest complication, with an incidence of 25.6%. Conclusion: Both Weil and triple Weil osteotomies are effective procedures in the surgical treatment of patients who suffer from third-rocker metatarsalgia. In both cases, correct preoperative planning is of paramount importance for the outcome. However, in terms of the appearance of the floating toe, it seems that in cases where a ray’s shortening of more than 3 mm is required, the triple osteotomy is superior to the Weil osteotomy.
Collapse
|
8
|
Neunteufel E, Krenn S, Chraim M, Amann P, Greiner F, Kranzl A, Bock P. Minimally Invasive Distal Metatarsal Metaphyseal Osteotomy of the Lesser Toes: Clinical, Radiologic, and Pedobarographic Outcomes. Foot Ankle Int 2022; 43:153-163. [PMID: 34404241 DOI: 10.1177/10711007211034849] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The minimally invasive distal metatarsal metaphyseal osteotomy (DMMO) is a percutaneous operative technique with the aim to relieve the symptoms of metatarsalgia. To our knowledge, no previous research has analyzed both pre- and postoperative pedobarographic data including the changes in plantar pressure. METHODS Thirty patients (31 feet) were operated on with a DMMO and included in a prospective study. Clinical, radiologic, and pedobarographic outcomes were evaluated in comparison with the preoperative parameters. The American Orthopaedic Foot & Ankle Society (AOFAS) forefoot score, the Foot Function Index (FFI), the Foot and Ankle Outcome Score (FAOS), and a visual analog scale (VAS) for pain were used in order to assess clinical parameters. Radiographs were taken to compare metatarsal lengths. The pedobarographic analysis served to determine plantar peak pressure (PPP) beneath the metatarsophalangeal (MTP) joints. RESULTS All scores indicated a significant mean pre- to postoperative improvement (AOFAS = 31.9 points, FAOS = 16.3%, FFI = 24.3%, VAS pain = 4.1 points, VAS general limitation = 3.3 points) (P < .05). PPP was substantially reduced in the relevant area (M6 [plantar area beneath the second and third MTP joint] had a mean pre to post PPP = 14.15 N/cm2) and concurrently higher in the lateral and medial MTP joint areas (M5 mean pre to post = +14.37, M7 pre to post = +7.11). Our mean metatarsal shortening was 6.6 mm. However, our findings do not demonstrate a significant correlation between metatarsal length relationships and the prevalence of metatarsalgia. CONCLUSION Our results demonstrate a significant improvement in clinical scores and PPP. A statistically significant relation between metatarsal length and the prevalence of metatarsalgia was not found in this prospective case series. LEVEL OF EVIDENCE Level IV, case series.
Collapse
Affiliation(s)
| | - Sabine Krenn
- Orthopaedic Hospital Speising Vienna, Vienna, Austria
| | | | | | | | | | | |
Collapse
|
9
|
Tournemine S, Calé F, Cazeau C, Bauer T, Stiglitz Y. Shortening effect influence of Distal Minimally Invasive Metatarsal Osteotomy in primary metatarsalgia. INTERNATIONAL ORTHOPAEDICS 2021; 46:983-988. [PMID: 34417638 DOI: 10.1007/s00264-021-05146-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 07/16/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE In primary metatarsalgia, Distal Minimally invasive Metatarsal Osteotomy (DMMO) achieves a correct load distribution which is a factor in pain relief, but contrary to the elevation of the metatarsal head, shortening the metatarsal length has no influence on plantar-loading parameters, while the increased metatarsal length is a factor in the development of metatarsalgia. Thus, we hypothesized that metatarsalgia could be partly related to a functional imbalance between bone structure and soft tissues and pain relief after DMMO results from soft tissue relaxation. METHODS Many authors have highlighted the correlation between joint pressure and periarticular soft tissue tension. To test our hypothesis, we measured intra-operatively the MTPJ pressure of 19 patients suffering from primary metatarsalgia, before and after DMMO. This pressure is being analyzed as a reflection of joint decompression and forefoot soft tissue release. Many authors have highlighted the correlation between joint pressure and periarticular soft tissue tension. RESULTS Lower metatarsals presenting metatarsalgia show a significantly lower MTPJ pressure compared to asymptomatic rays, and DMMO induces a significant increase of MTPJ pressure. CONCLUSION Those variations reflect the functional imbalance between bone structure and soft tissue in primary metatarsalgia. The biomechanical rationale of the shortening effect of DMMO could therefore be explained by the release of forefoot soft tissue, which could take part in the pain relief by restoring this balance.
Collapse
Affiliation(s)
- Simon Tournemine
- Department of Orthopaedics, Ambroise Paré Hospital, AP-HP, Versailles Saint-Quentin-en-Yvelines University, 9 Avenue Charles de Gaulle, 92100, Boulogne-Billancourt, France
| | - Fabien Calé
- Department of Orthopaedics, Raymond Poincaré Hospital, AP-HP, Versailles Saint-Quentin-en-Yvelines University, 104 Boulevard Raymond Poincaré, 92380, Garches, France
| | - Cyrille Cazeau
- Clinique Victor Hugo, 5 rue du Dôme, 75116, Paris, France
- 1 Parvis de Notre Dame, Hôtel Dieu Hospital, 75001, Paris, France
| | - Thomas Bauer
- Department of Orthopaedics, Ambroise Paré Hospital, AP-HP, Versailles Saint-Quentin-en-Yvelines University, 9 Avenue Charles de Gaulle, 92100, Boulogne-Billancourt, France
| | - Yves Stiglitz
- Department of Orthopaedics, Raymond Poincaré Hospital, AP-HP, Versailles Saint-Quentin-en-Yvelines University, 104 Boulevard Raymond Poincaré, 92380, Garches, France.
- Clinique Victor Hugo, 5 rue du Dôme, 75116, Paris, France.
| |
Collapse
|
10
|
Togei K, Shima H, Yasuda T, Tsujinaka S, Nakamura G, Neo M. Plantar pressure distribution in hallux valgus feet after a first metatarsal proximal crescentic osteotomy with a lesser metatarsal proximal shortening osteotomy. Foot Ankle Surg 2021; 27:665-672. [PMID: 32917524 DOI: 10.1016/j.fas.2020.08.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 08/12/2020] [Accepted: 08/26/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Plantar pressure distribution after the first metatarsal proximal crescentic osteotomy (FMPCO) with lesser metatarsal proximal shortening osteotomy (LMPSO) for hallux valgus with metatarsalgia has not been previously described. METHODS The pre- (Pre) and postoperative (Post) groups comprised of 18 patients who underwent unilateral FMPCO with LMPSO; fifteen healthy volunteers constituted the control (C) group. For each of the 10 regions, peak pressure (Peak-P), maximum force (Max-F), contact time (Con-T), contact area (Con-A), and force-time integral (FTI) were measured. RESULTS The mean Peak-P of the second metatarsal head was significantly lower in the Post group than the Pre group. The mean Peak-P, Max-F, Con-T, and FTI were not significantly different between the Post and C groups. The mean Con-A was significantly lower in the Post group than the C group. CONCLUSION FMPCO with LMPSO may improve the plantar pressure of the central forefoot comparable to healthy subjects.
Collapse
Affiliation(s)
- Kosho Togei
- Department of Orthopedic Surgery, Osaka Medical College, 2-7, Daigaku-machi, Takatsuki 569-8686, Japan.
| | - Hiroaki Shima
- Department of Orthopedic Surgery, Osaka Medical College, 2-7, Daigaku-machi, Takatsuki 569-8686, Japan.
| | - Toshito Yasuda
- Department of Orthopedic Surgery, Osaka Medical College, 2-7, Daigaku-machi, Takatsuki 569-8686, Japan.
| | - Seiya Tsujinaka
- Department of Orthopedic Surgery, Osaka Medical College, 2-7, Daigaku-machi, Takatsuki 569-8686, Japan.
| | - Gen Nakamura
- Department of Orthopedic Surgery, Osaka Medical College, 2-7, Daigaku-machi, Takatsuki 569-8686, Japan.
| | - Masashi Neo
- Department of Orthopedic Surgery, Osaka Medical College, 2-7, Daigaku-machi, Takatsuki 569-8686, Japan.
| |
Collapse
|
11
|
Chopra V, Savage T, Kruse D, Stone P. Sagittal Chevron Shortening Osteotomy With Lateral Wedge for Treatment of Lesser Metatarsal Overload: A Case Report. J Foot Ankle Surg 2021; 60:374-377. [PMID: 33422444 DOI: 10.1053/j.jfas.2018.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Indexed: 02/03/2023]
Abstract
Metatarsalgia is a common problem that refers to the tenderness and pain beneath the forefoot. Many metatarsal shortening osteotomies have been described to alleviate metatarsal overload; however, these osteotomies have been associated with a high complication rate of floating toe deformity. We present a case study that describes an innovative technique for the treatment of lesser metatarsalgia that allows for the repositioning of the metatarsal head, using a stable screw fixation designed to minimize the common complication of the floating toe.
Collapse
Affiliation(s)
- Varun Chopra
- Resident, Highlands-Presbyterian/St. Luke's Podiatric Medicine and Surgery Residency Program, Colorado Health Foundation, Denver, CO
| | - Thomas Savage
- Attending, Highlands-Presbyterian/St. Luke's Podiatric Medicine and Surgery Residency Program, Colorado Health Foundation, Denver, CO
| | - Dustin Kruse
- Director of Research, Highlands-Presbyterian/St. Luke's Podiatric Medicine and Surgery Residency Program, Colorado Health Foundation, Denver, CO
| | - Paul Stone
- Program Director, Highlands-Presbyterian/St. Luke's Podiatric Medicine and Surgery Residency Program, Colorado Health Foundation, Denver, CO.
| |
Collapse
|
12
|
Joint-Preserving Surgery for Forefoot Deformities in Patients with Rheumatoid Arthritis: A Literature Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18084093. [PMID: 33924481 PMCID: PMC8068870 DOI: 10.3390/ijerph18084093] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 03/23/2021] [Accepted: 04/08/2021] [Indexed: 11/17/2022]
Abstract
The combination of first metatarsophalangeal joint arthrodesis and resection arthroplasty of all lesser metatarsal heads has been historically considered the golden standard treatment for rheumatoid forefoot deformities. However, as recent improved management of rheumatoid arthritis have reduced progression of joint destruction, the surgical treatments for rheumatoid forefoot deformities have gradually changed from joint-sacrificing surgery, such as arthrodesis and resection arthroplasty, to joint-preserving surgery. The aim of this literature review was to provide current evidence for joint-preserving surgery for rheumatoid forefoot deformities. We focused on the indications, specific outcomes, and postsurgical complications of joint-preserving surgery in this review.
Collapse
|
13
|
Fleischer AE, Klein EE, Bowen M, McConn TP, Sorensen MD, Weil L. Comparison of Combination Weil Metatarsal Osteotomy and Direct Plantar Plate Repair Versus Weil Metatarsal Osteotomy Alone for Forefoot Metatarsalgia. J Foot Ankle Surg 2021; 59:303-306. [PMID: 32130995 DOI: 10.1053/j.jfas.2019.08.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 08/20/2019] [Accepted: 08/25/2019] [Indexed: 02/03/2023]
Abstract
Although many surgeons believe that shortening osteotomies are appropriate in patients with metatarsalgia and long second metatarsals, there remains ambiguity regarding when to repair the injured plantar plate and when to leave it alone. We prospectively assessed consecutive adult subjects who underwent an isolated second Weil metatarsal osteotomy (WMO) or a WMO plus plantar plate repair (WMO + PPR) for sub-second metatarsophalangeal joint pain during a 3.5-year period at our practice. Eighty-six patients (86 feet: 21 WMO only and 65 WMO + PPR) with a mean age of 61 ± 11 years were followed for 1 year. Patients were assessed via use of the Foot and Ankle Outcome Score and radiographic parabola/alignment of the operative digit preoperatively and postoperatively. Patients in the WMO + PPR group demonstrated significant improvements preoperatively to postoperatively in 4 of the 5 FAOS subscales (Pain, Other Symptoms, Sport and Recreation Function, and Ankle- and Foot-Related Quality of Life [QoL], all p < .05) and had higher QoL and Pain subscale scores at 1 year compared with those in the WMO-only group (QoL: 68.6 ± 26.7 versus 49.7 ± 28.5, respectively [p = .01]; Pain: 83.2 ± 14.5 versus 73.6 ± 19.9, respectively [p = .04]). The WMO + PPR group tended to have higher-grade tears on intraoperative inspection (median 3, range 0 to 4) compared with those in the WMO group (median 1, range 0 to 3). There were otherwise no group differences in preoperative or postoperative radiographic parabola, alignment of the second toe, or complication rates. Our findings suggest that when a shortening osteotomy is performed, imbricating/repairing and advancing the plantar plate may be valuable regardless of injury grade in the plate.
Collapse
Affiliation(s)
- Adam E Fleischer
- Director of Research, Weil Foot and Ankle Institute, Mount Prospect, IL; Associate Professor, Dr. William M. Scholl College of Podiatric Medicine, North Chicago, IL.
| | - Erin E Klein
- Associate Director of Research, Weil Foot and Ankle Institute, Mount Prospect, IL
| | - Michael Bowen
- Surgeon, Fredericksburg Orthopedics Associates, Fredericksburg, VA
| | - Timothy P McConn
- Immediate Past Fellow, Weil Foot/Ankle & Orthopedic Institute, Advanced Surgical Fellowship, Mount Prospect, IL
| | - Matthew D Sorensen
- Fellowship Director, Weil Foot/Ankle & Orthopedic Institute, Advanced Surgical Fellowship, Mount Prospect, IL
| | - Lowell Weil
- CEO, Weil Foot and Ankle Institute, Mount Prospect, IL
| |
Collapse
|
14
|
Stolwijk NM, Keijsers NLW, Pasma JH, Nanhoe-Mahabier W, Duysens J, Louwerens JWK. Treatment of metatarsalgia based on claw toe deformity through soft tissue release of the metatarsophalangeal joint and resection of the proximal interphalangeal joint: Evaluation based on foot kinematics and plantar pressure distribution. Foot Ankle Surg 2020; 26:755-762. [PMID: 31623963 DOI: 10.1016/j.fas.2019.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 05/20/2019] [Accepted: 09/20/2019] [Indexed: 02/04/2023]
Abstract
INTRODUCTION This study investigated the effect of operative claw toe correction with release of the metatarsophalangeal (MTP) joint, repositioning of the plantar fat pad and resection of the proximal interphalangeal joint on foot kinematics, plantar pressure distribution and Foot Function Index (FFI). METHODS Prospective experimental study with pretest-posttest design. The plantar pressure, 3D foot kinematics and the FFI of 15 patients with symptomatic claw toes were measured three months before and 12months after surgery. Mean pressure, peak pressure and pressure time integral per sensor and various foot angles were calculated for the pre- and posttest and compared to a control group (N=15). RESULTS Claw toe patients have increased pressure under the distal part of the metatarsal head and less pressure under the proximal part of the metatarsal heads compared to healthy controls. After surgery, there was a redistribution of pressure, resulting in a significant decrease of pressure under the distal part and an increase under the proximal part of the metatarsal head, providing a more equal plantar pressure distribution. Except for some small areas under the forefoot, heel and toes, there were no significant differences in pressure distribution between the operated feet and controls. Small, but significant differences between the pre- and postoperative condition were found for the lateral arch angle, calcaneus/malleolus supination and tibio-talar flexion. The score on the FFI improved statistically significant. DISCUSSION These findings imply that the present operative procedure results in a more equal distribution of the plantar pressure under the forefoot and decrease of pain and offers successful treatment of metatarsalgia based on claw toe deformity.
Collapse
Affiliation(s)
- Niki M Stolwijk
- Research Department, Sint Maartenskliniek, Nijmegen, The Netherlands; HAN University of Applied Sciences, Musculoskeletal Rehabilitation Research Group, Nijmegen, Kapittelweg 33, Nijmegen, The Netherlands.
| | - Noël L W Keijsers
- Research Department, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Jantsje H Pasma
- Orthopaedic Research Group, Haga Hospital, The Hague, The Netherlands
| | | | - Jacques Duysens
- Research Department, Sint Maartenskliniek, Nijmegen, The Netherlands; Research Center for Movement Control and Neuroplasticity, Department of Biomedical Kinesiology, Katholieke Universiteit Leuven, Leuven, Belgium
| | | |
Collapse
|
15
|
Wagner E, O’Connell LA, Radkievich R, Caicedo N, Mococain P, Wagner P. Incidence of and Functional Significance of Floating Toe After Weil Osteotomy. FOOT & ANKLE ORTHOPAEDICS 2019; 4:2473011419891956. [PMID: 35097355 PMCID: PMC8697231 DOI: 10.1177/2473011419891956] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Background: The most frequent complication after Weil osteotomies is a floating toe deformity, but there are no reports about its effect on the patient. In this study, we analyzed the consequences of floating toe deformities after the performance of a modified Weil osteotomy (MWO) or a modified Weil osteotomy with interphalangeal fixation (MWOIF). Methods: We performed a retrospective review with a prospective follow-up of 50 patients (98% women, 120 rays) who underwent MWO (65 rays) or MWOIF (55 rays), with a mean age of 54 ± 12 years and a minimum follow-up of 4 years (mean of 6 years). We analyzed the presence of floating toe deformity in MWO and MWOIF and the outcomes measured by the subjective satisfaction, Lower Extremity Functional Scale (LEFS), American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score, and quality of prehension force between patients with or without floating toe deformity. Results: The mean floating toe incidence was of 57%, with no significant difference between operative techniques (48% MWO, 67% MWOIF; P = .053). Our analysis did not show differences in satisfaction, LEFS and AOFAS scores, or grip strength between the group of patients with or without floating toes. Conclusion: The presence of a floating toe deformity was more frequent than generally believed but did not have a meaningful impact on the patient’s satisfaction or functional outcomes measured by the AOFAS and LEFS scales. There was no clear correlation between operative technique, floating toe, and quality of prehension force. Level of Evidence: Level III, retrospective comparative series.
Collapse
Affiliation(s)
- Emilio Wagner
- Department of Orthopaedic Surgery, Clínica Alemana de Santiago-Universidad del Desarrollo, Santiago, Chile
| | - Luis A. O’Connell
- Department of Orthopaedic Surgery, Clínica Alemana de Santiago-Universidad del Desarrollo, Santiago, Chile
| | - Ruben Radkievich
- Department of Orthopaedic Surgery, Clínica Alemana de Santiago-Universidad del Desarrollo, Santiago, Chile
| | - Nathaly Caicedo
- Department of Orthopaedic Surgery, Clínica Alemana de Santiago-Universidad del Desarrollo, Santiago, Chile
| | - Pablo Mococain
- Department of Orthopaedic Surgery, Clínica Alemana de Santiago-Universidad del Desarrollo, Santiago, Chile
| | - Pablo Wagner
- Department of Orthopaedic Surgery, Clínica Alemana de Santiago-Universidad del Desarrollo, Santiago, Chile
| |
Collapse
|
16
|
Abstract
Two theories exist in the development of central or transfer metatarsalgia. First, as the severity of hallux valgus increases, there is mechanical overload of the second metatarsal. Second, increased relative lesser metatarsal length is thought to contribute to metatarsalgia. It is imperative, in the treatment of first ray disorders (hallux valgus or hallux rigidus), to not overshorten the first ray when addressing the first ray pathologic condition. Treatment of metatarsalgia in the setting of failed hallux valgus correction can be treated with both conservative and surgical options.
Collapse
Affiliation(s)
- Angela K Walker
- Orthopedic Surgeons, Inc, 2790 Clay Edwards Drive, Suite 650, Kansas City, MO 64116, USA.
| | - Thomas G Harris
- Congress Orthopedic Associates, 800 South Raymond, 2nd Floor, Pasadena, CA 91105, USA; Foot and Ankle Surgery, UCLA Harbor Medical Center, 1000 W Carson Street, Torrance, CA 90502, USA
| |
Collapse
|
17
|
Abstract
Weil osteotomy (WO) is the most common technique worldwide for the treatment of mechanical metatarsalgia. The main indication for WO is propulsive/third rocker metatarsalgia that is in relation with an abnormal length of a certain metatarsal with respect to the neighboring metatarsals in the frontal plane. Most clinical studies have showed good to excellent results after WO. However, complications such as floating toes led to evolution of WO and the development of the triple-cut WO that allows for shortening coaxial to the shaft without plantar translation of metatarsal head. Other variations of WO may treat other forefoot disorders.
Collapse
Affiliation(s)
- Manuel Monteagudo
- Orthopaedic Foot and Ankle Unit, Orthopaedic and Trauma Department, Hospital Universitario Quirónsalud Madrid, Faculty Medicine UEM Madrid, Madrid, Spain.
| | - Ernesto Maceira
- Orthopaedica Foot and Ankle Unit, Complejo Hospitalario La Mancha Centro, Av de la Constitución 3, 13600, Alcázar de San Juan, Ciudad Real, Spain
| |
Collapse
|
18
|
Rivero-Santana A, Perestelo-Pérez L, Garcés G, Álvarez-Pérez Y, Escobar A, Serrano-Aguilar P. Clinical effectiveness and safety of Weil's osteotomy and distal metatarsal mini-invasive osteotomy (DMMO) in the treatment of metatarsalgia: A systematic review. Foot Ankle Surg 2019; 25:565-570. [PMID: 30321939 DOI: 10.1016/j.fas.2018.06.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 06/25/2018] [Accepted: 06/27/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND Weil's osteotomy (WO) is the most applied surgical treatment for metatarsalgia, a persistent pain in the lesser metatarsals' heads. We aim to review its effectiveness and safety compared to the percutaneous technique known as distal metatarsal mini-invasive osteotomy (DMMO). METHODS Systematic review in Medline, Pubmed, Embase, Cinahl and Cochrane Library. We included studies that directly compared WO and DMMO for the treatment of primary metatarsalgia. Data on pain, function, complications and patients' satisfaction were extracted and narratively synthesized. RESULTS Four retrospective studies were identified. There were no significant differences in clinical effectiveness or patients' satisfaction. Time to bone healing was significantly longer for DMMO, whereas WO showed more wound problems and metatarsophalangeal stiffness. Other complications were infrequent in the two procedures. CONCLUSION Evidence on the direct comparison of WO and DMMO is scarce and of low quality. Randomized studies are needed in order to control for potential confounders.
Collapse
Affiliation(s)
- Amado Rivero-Santana
- Canary Islands Foundation of Health Research, Bco. de la Ballena, s/n, 35019 Las Palmas de GC, Spain; Health Services Research on Chronic Patients Network, Camino Candelaria, 44, El Rosario, 38109 Tenerife, Spain; Center for Biomedical Research of the Canary Islands, Campus Ciencias de La Salud, s/n, 38071 San Cristobal de La Laguna, Spain.
| | - Lilisbeth Perestelo-Pérez
- Health Services Research on Chronic Patients Network, Camino Candelaria, 44, El Rosario, 38109 Tenerife, Spain; Center for Biomedical Research of the Canary Islands, Campus Ciencias de La Salud, s/n, 38071 San Cristobal de La Laguna, Spain; Evaluation Unit of the Canary Islands Health Service, Camino Candelaria, 44, El Rosario, 38109 Tenerife, Spain.
| | - Gerardo Garcés
- Department of Orthopedics, Hospital Perpetuo Socorro, C/León y Castillo, 407, 35007 Las Palmas de Gran Canaria, Spain; School of Medicine, University of Las Palmas de Gran Canaria, Paseo Blas Cabrera Felipe, s/n, 35016 Las Palmas de Gran Canaria, Spain.
| | - Yolanda Álvarez-Pérez
- Canary Islands Foundation of Health Research, Bco. de la Ballena, s/n, 35019 Las Palmas de GC, Spain; Health Services Research on Chronic Patients Network, Camino Candelaria, 44, El Rosario, 38109 Tenerife, Spain; Center for Biomedical Research of the Canary Islands, Campus Ciencias de La Salud, s/n, 38071 San Cristobal de La Laguna, Spain.
| | - Antonio Escobar
- Health Services Research on Chronic Patients Network, Camino Candelaria, 44, El Rosario, 38109 Tenerife, Spain; Research Unit, Hospital Basurto, Montevideo Etorb., 18, 48013 Bilbao, Spain.
| | - Pedro Serrano-Aguilar
- Health Services Research on Chronic Patients Network, Camino Candelaria, 44, El Rosario, 38109 Tenerife, Spain; Center for Biomedical Research of the Canary Islands, Campus Ciencias de La Salud, s/n, 38071 San Cristobal de La Laguna, Spain; Evaluation Unit of the Canary Islands Health Service, Camino Candelaria, 44, El Rosario, 38109 Tenerife, Spain.
| |
Collapse
|
19
|
Clinical and radiological outcomes after Weil osteotomy compared to distal metatarsal metaphyseal osteotomy in the treatment of metatarsalgia-A prospective study. Foot Ankle Surg 2019; 25:488-494. [PMID: 30321960 DOI: 10.1016/j.fas.2018.03.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Revised: 03/04/2018] [Accepted: 03/05/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND The distal metatarsal metaphyseal osteotomy (DMMO) may have lower complication rates than the Weil osteotomy (WO) due to its extraarticular location and its minimal invasive nature. This study compares the clinical and radiological outcomes and complications after DMMO and WO. METHODS We compared 30 patients with WO (Group A) to 30 patients with DMMO (Group B). Ten males and 50 females with a mean age of 57.7 were included. 45 WOs and 73 DMMOs were evaluated in 60 patients. Allocation to Group A or B were random, indications comparable. The outcome was measured clinically using the Visual Analogue Scale Foot and Ankle and radiologically with an average follow up period of 13 months. RESULTS Clinical examination six weeks postoperatively showed swelling of the forefoot in 66.7% for Group A and in 73.3% for Group B. Swelling subsided in the course of time, but postoperative stiffness, lack of toe purchase and range of motion deficits did not change in the course of time. All osteotomies healed. The VAS-FA improved for both groups. Tourniquet time and operating time were lower and radiation doses higher in Group B. CONCLUSIONS The DMMO resulted in a comparable patient satisfaction and comparable radiological healing compared to WO and appears to be a valid alternative to the WO.
Collapse
|
20
|
Abstract
Surgical bone reconstructive procedures of the foot and ankle in diabetic patients must be considered when performing evaluation of a diabetic foot for patients with preulcerative lesions and preexisting wounds. Preventive deformity correction can reduce the potential risk of ulceration, infection, and possible amputation in a patient with an at-risk foot type. It can also expedite wound healing and prevent further breakdown in a patient with lower extremity ulcerations. This article discusses different types of surgical bone reconstructive procedures as preventive and prophylactic deformity corrections to reduce osseous deformity, minimize preulcerative lesions, and increase limb-salvage rates in the compromised patient.
Collapse
|
21
|
Malhotra K, Joji N, Mordecai S, Rudge B. Minimally invasive distal metaphyseal metatarsal osteotomy (DMMO) for symptomatic forefoot pathology - Short to medium term outcomes from a retrospective case series. Foot (Edinb) 2019; 38:43-49. [PMID: 30634162 DOI: 10.1016/j.foot.2018.12.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 12/14/2018] [Accepted: 12/18/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND Minimally invasive distal metaphyseal metatarsal osteotomy (DMMO) may be used to treat metatarsalgia and forefoot pathology. Few large series report its results or examine the degree of metatarsal shortening with this technique. The clinical and radiographic results of a cohort of patients treated with DMMOs at our unit are reported. METHODS This was a single-centre retrospective study looking at the outcome of consecutive patients undergoing DMMOs. Demographics, radiological and clinical outcomes, complications and patient reported outcome measures (PROMs) were analysed. RESULTS DMMOs on 106 toes in 43 feet were included. Mean age was 60.2±10.2 years and median follow-up was 38 months. Concurrent procedures were performed in 26 cases (60%). DMMO was performed on multiple toes in 42 cases (97%). Mean shortening achieved was 3.6±2.2mm, 4.1±1.6mm, and 3.6±1.6mm for the second, third and fourth metatarsals respectively. Mean time to fusion was 11.4±7.8 weeks and union occurred in 105 toes (99%). The single non-union was asymptomatic at 12 months. Two patients required a subsequent additional DMMO for transfer metatarsalgia. Minor complications were seen in 11 patients (26%). At final follow-up PROMs data was available for 42 cases: mean MOxFQ was 28.8±27.6, mean EQ-5D was 0.789±0.225, mean EQ-VAS was 68.5±20.3, mean VAS-Pain score was 3.1±2.8, and patients were satisfied overall in 40 cases (95%). CONCLUSIONS The authors demonstrate excellent radiological and clinical outcomes in the short to medium term with DMMOs and present data on metatarsal shortening achieved with this technique.
Collapse
Affiliation(s)
- Karan Malhotra
- Foot and Ankle Unit, West Hertfordshire Hospitals NHS Trust, Vicarage Road, Watford WD18 0HB, UK.
| | - Nikita Joji
- Foot and Ankle Unit, West Hertfordshire Hospitals NHS Trust, Vicarage Road, Watford WD18 0HB, UK
| | - Simon Mordecai
- Foot and Ankle Unit, Barnet & Chase Farm Hospitals, Wellhouse Lane, Barnet EN5 3DJ, UK
| | - Ben Rudge
- Foot and Ankle Unit, West Hertfordshire Hospitals NHS Trust, Vicarage Road, Watford WD18 0HB, UK
| |
Collapse
|
22
|
Magnan B, Bonetti I, Negri S, Maluta T, Dall'Oca C, Samaila E. Percutaneous distal osteotomy of lesser metatarsals (DMMO) for treatment of metatarsalgia with metatarsophalangeal instability. Foot Ankle Surg 2018; 24:400-405. [PMID: 29409206 DOI: 10.1016/j.fas.2017.04.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Revised: 02/02/2017] [Accepted: 04/13/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND Clinical and radiological results of percutaneous distal metatarsal minimally invasive osteotomy (DMMO) of the lesser rays for surgical treatment of primary metatarsalgia due to plantar overpressure with metatarsophalangeal instability are described. The aim of this prospective study was to assess the efficacy, feasibility and safety of this minimally invasive surgical (MIS) technique, verifying the possibility to lower the complication rate related to surgical exposures, to reduce operating times with comparable functional and cosmetic results to those reported with traditional open procedures. METHODS Hundred and six consecutive percutaneous distal osteotomies without fixation (DMMO) of the second, third or fourth metatarsal bones were performed in 57 patients (70ft) with a mean age at the surgery of 60.2 years (30-81) for treatment of metatarsalgia with metatarsophalangeal instability. Patients were clinically assessed with the AOFAS and Coughlin's Scores, the latter classifying the results in relation to the patient's subjective satisfaction. RESULTS The mean follow-up was of 45.0±13.3months (24-68). All patients reported the disappearance or reduction of the pain that they had experienced prior to the operation around the metatarsal heads. The mean overall AOFAS score improved from 42.7±13.4 points (9-77) to 92.8±8.6 points (44-100) at the time of final follow-up. Patient subjective satisfaction according to Coughlin's classification was excellent in 62ft (88.6%), good in 7ft (10.0%), fair in 0ft and poor in one foot (1.4%). CONCLUSIONS We consider the percutaneous distal lesser metatarsal osteotomy without fixation (DMMO) a reliable surgical option in metatarsalgia due to metatarsophalangeal instability in early stages as in grade I and II according to Coughlin classification.
Collapse
Affiliation(s)
- Bruno Magnan
- Orthopaedic Department, University of Verona School of Medicine, Italy.
| | - Ingrid Bonetti
- Orthopaedic Department, University of Verona School of Medicine, Italy.
| | - Stefano Negri
- Orthopaedic Department, University of Verona School of Medicine, Italy.
| | - Tommaso Maluta
- Orthopaedic Department, University of Verona School of Medicine, Italy.
| | - Carlo Dall'Oca
- Orthopaedic Department, University of Verona School of Medicine, Italy.
| | - Elena Samaila
- Orthopaedic Department, University of Verona School of Medicine, Italy.
| |
Collapse
|
23
|
Ali Z, Karim H, Wali N, Naraghi R. The inter- and intra-rater reliability of the Maestro and Barroco metatarsal length measurement techniques. J Foot Ankle Res 2018; 11:47. [PMID: 30127858 PMCID: PMC6097434 DOI: 10.1186/s13047-018-0289-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Accepted: 07/31/2018] [Indexed: 11/10/2022] Open
Abstract
Background The relationship between metatarsal length and various forefoot pathologies is a topic of contention in Orthopaedics. The results of such investigations have been shown to depend on the method of metatarsal length measurement used. The aim of this study was to assess the inter- and intra-rater reliability of the Maestro and Barroco metatarsal length measurement techniques. Methods A retrospective and quantitative study was performed on 15 randomly selected radiographs to determine the reliability of the two measurement techniques across all five metatarsals (M1 to M5). This was done at one week apart for three weeks by three raters. The intraclass correlation coefficient (ICC), and the 95% lower confidence limit (95% LCL) were calculated. Results The Maestro and Barroco techniques produced high to very high ICC vlaues for length measurements across all metatarsals. The 95% lower confidence limit for inter-rater measurements ranged between 0.92–0.98 for Maestro’s and 0.86–0.99 for Barroco’s technique. For intra-rater measurements the 95% LCL ranged between 0.83–0.99 for Maestro’s and 0.75–0.99 for Barroco’s technique. Conclusions Our study found that both the Maestro and Barroco methods of measurements produced high to very high inter- and intra-rater reliability. Both methods may be suitable for the use of peri-operative planning and clinical research relating metatarsal length and forefoot pathology. Besides having a more simplistic method of application, the novel Barroco technique is comparable to the more established Maestro method in both repeatability and reproducibility.
Collapse
Affiliation(s)
- Zainab Ali
- University of Western Australia, School of Surgery, Podiatric Medicine, Crawley, Western Australia 6009 Australia
| | - Hassan Karim
- University of Western Australia, School of Surgery, Podiatric Medicine, Crawley, Western Australia 6009 Australia
| | - Navid Wali
- University of Western Australia, School of Surgery, Podiatric Medicine, Crawley, Western Australia 6009 Australia
| | - Reza Naraghi
- University of Western Australia, School of Surgery, Podiatric Medicine, Crawley, Western Australia 6009 Australia
| |
Collapse
|
24
|
Krenn S, Albers S, Bock P, Mansfield C, Chraim M, Trnka HJ. Minimally Invasive Distal Metatarsal Metaphyseal Osteotomy of the Lesser Toes: Learning Curve. Foot Ankle Spec 2018; 11:263-268. [PMID: 29298501 DOI: 10.1177/1938640017750251] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Minimally invasive surgery has a shorter surgical time, and in this study we focus on minimally invasive distal metatarsal metaphyseal osteotomy (DMMO). The operation seems to be less complex but requires a high learning curve. We report on our first patients to underline the need for extensive training and great awareness for the risks in the early learning stages. METHODS We evaluated 27 patients (mean age = 60.9 years) with a mean follow-up time of 7.2 months. Indication was metatarsalgia, intractable plantar keratosis, and the (sub-)luxation of the metatarsophalangeal joint. Clinical results were evaluated with the 12-item Short Form (SF-12), Foot Function Index (FFI), Foot and Ankle Ability Measure (FAAM), and the American Orthopaedic Foot and Ankle Score (AOFAS). Radiographs and pedobarographic analysis were obtained. RESULTS Scores ranged closely to standard value (AOFAS 88.07 points; FFI 93%; FAAM 36.4 points; SF-12 31.27 points). Pedobarography showed significant differences in several forefoot areas. We encountered nonunion/malunion and necrosis of the metatarsal head. CONCLUSIONS The aim of this study was to demonstrate the need for intensive training before practicing DMMO. Results show that minimally invasive DMMO requires a high learning curve. Correct handling of the burr is associated with a lot of training. Wrong handling can lead to nonunion/malunion or necrosis. LEVELS OF EVIDENCE Therapeutic, Level IV: Case series.
Collapse
Affiliation(s)
- Sabine Krenn
- Orthopaedic Hospital Speising Vienna, Vienna, Austria (SK, PB, CM, MC, HJT).,Fußzentrum Vienna, Vienna, Austria (SA, HJT)
| | - Sascha Albers
- Orthopaedic Hospital Speising Vienna, Vienna, Austria (SK, PB, CM, MC, HJT).,Fußzentrum Vienna, Vienna, Austria (SA, HJT)
| | - Peter Bock
- Orthopaedic Hospital Speising Vienna, Vienna, Austria (SK, PB, CM, MC, HJT).,Fußzentrum Vienna, Vienna, Austria (SA, HJT)
| | - Clemens Mansfield
- Orthopaedic Hospital Speising Vienna, Vienna, Austria (SK, PB, CM, MC, HJT).,Fußzentrum Vienna, Vienna, Austria (SA, HJT)
| | - Michel Chraim
- Orthopaedic Hospital Speising Vienna, Vienna, Austria (SK, PB, CM, MC, HJT).,Fußzentrum Vienna, Vienna, Austria (SA, HJT)
| | - Hans-Joerg Trnka
- Orthopaedic Hospital Speising Vienna, Vienna, Austria (SK, PB, CM, MC, HJT).,Fußzentrum Vienna, Vienna, Austria (SA, HJT)
| |
Collapse
|
25
|
Fleischer AE, Hshieh S, Crews RT, Waverly BJ, Jones JM, Klein EE, Weil L, Weil LS. Association Between Second Metatarsal Length and Forefoot Loading Under the Second Metatarsophalangeal Joint. Foot Ankle Int 2018; 39:560-567. [PMID: 29374967 DOI: 10.1177/1071100717753829] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Metatarsal length is believed to play a role in plantar plate dysfunction, although the mechanism through which progressive injury occurs is still uncertain. We aimed to clarify whether length of the second metatarsal was associated with increased plantar pressure measurements in the forefoot while walking. METHODS Weightbearing radiographs and corresponding pedobarographic data from 100 patients in our practice walking without a limp were retrospectively reviewed. Radiographs were assessed for several anatomic relationships, including metatarsal length, by a single rater. Pearson correlation analyses and multiple linear regression models were used to determine whether metatarsal length was associated with forefoot loading parameters. RESULTS The relative length of the second to first metatarsal was positively associated with the ratio of peak pressure beneath the respective metatarsophalangeal joints ( r = 0.243, P = .015). The relative length of the second to third metatarsal was positively associated with the ratios of peak pressure ( r = 0.292, P = .003), pressure-time integral ( r = 0.249, P = .013), and force-time integral ( r = 0.221, P = .028) beneath the respective metatarsophalangeal joints. Although the variability in loading predicted by the various regression analyses was not large (4%-14%), the relative length of the second metatarsal (to the first and to the third) was maintained in each of the multiple regression models and remained the strongest predictor (highest standardized β-coefficient) in each of the models. CONCLUSIONS Patients with longer second metatarsals exhibited relatively higher loads beneath the second metatarsophalangeal joint during barefoot walking. These findings provide a mechanism through which elongated second metatarsals may contribute to plantar plate injuries. LEVEL OF EVIDENCE Level III, comparative study.
Collapse
Affiliation(s)
- Adam E Fleischer
- 1 Weil Foot and Ankle Institute, Des Plaines, IL, USA.,2 Dr. William M. Scholl College of Podiatric Medicine, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Shenche Hshieh
- 3 Rhode Island Hospital/Brown University, Providence, RI, USA
| | - Ryan T Crews
- 4 Center for Lower Extremity Ambulatory Research at Dr. William M. Scholl College of Podiatric Medicine, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | | | - Jacob M Jones
- 2 Dr. William M. Scholl College of Podiatric Medicine, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Erin E Klein
- 1 Weil Foot and Ankle Institute, Des Plaines, IL, USA
| | - Lowell Weil
- 1 Weil Foot and Ankle Institute, Des Plaines, IL, USA
| | | |
Collapse
|
26
|
Abstract
Many different distal metatarsal osteotomies have been described in the surgical treatment of metatarsalgia. The surgeon should use such osteotomies judiciously, and indeed, in the author's experience, they are infrequently required and are certainly not a first port of call. In cases where nonoperative treatments have failed, a thorough understanding of the causes of metatarsalgia and a detailed clinical assessment of the patient are essential if good surgical outcomes are to be achieved. If using distal metatarsal osteotomies as part of the surgical plan, then the author favors extra-articular percutaneous osteotomies to minimize postoperative stiffness.
Collapse
|
27
|
Fraser EJ, Sullivan M, Panti JP, Rositano P, Walton J, Fung S. Computed tomography measurements of the lesser metatarsal heads: Anatomic considerations for surgeons performing distal metatarsal osteotomies. Foot Ankle Surg 2017; 23:230-235. [PMID: 29202980 DOI: 10.1016/j.fas.2016.05.321] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Revised: 04/24/2016] [Accepted: 05/25/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND The purpose of the current study was to provide a standardized, anatomical description of the lesser metatarsals to assist surgeons when planning distal metatarsal surgery and fixation. METHODS Eighty CT scans were included for assessment, based on a priori power analysis. Patient age was a mean 52.7±16.6 years (24-83). Metatarsals two through five were assessed in all patients. Three independent observers completed measurements for all metatarsals. Three measurements were made on all metatarsals, including a vertical height and metatarsal head and neck measurements. Statistical analysis was performed (alpha value 0.05). Inter-observer reliability was assessed for all measurements and intra-class correlation (ICC) reported. RESULTS A sequential decrease in metatarsal measurements was noted from the second to the fifth metatarsal. A mean vertical height measurement of 16.1±1.4mm (range, 13.4-19.4) was recorded for the second metatarsal, decreasing 13.0±1.1mm (range, 10.3-16.1) for fifth. There were no significant differences in metatarsal measurements based on gender in our study. Similar patient and metatarsal variability was seen head and neck measurements. Intraclass correlation coefficients (ICC) for metatarsal measurements were greater than 0.9 [95% CI; 0.936-0.991] correlation, denoting an 'excellent' interobserver reliability. CONCLUSION This study provides a baseline anatomical description of the distal metatarsals. These findings, including the variation found between patients and between metatarsal two through five, are relevant to surgeons planning and performing distal metatarsal osteotomies.
Collapse
Affiliation(s)
| | | | | | | | - Judie Walton
- University of New South Wales, Faculty of Medicine, Sydney, Australia
| | | |
Collapse
|
28
|
Efficacy of pedobarographic analysis to evaluate proximal medial gastrocnemius recession in patients with gastrocnemius tightness and metatarsalgia. INTERNATIONAL ORTHOPAEDICS 2017; 41:2281-2287. [PMID: 28861633 DOI: 10.1007/s00264-017-3621-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 08/14/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE Proximal medial gastrocnemius recession (PMGR) is a surgical procedure performed in patients with gastrocnemius tightness (GT). The purpose of this study is to evaluate the efficacy of pedobarographic analysis on PMGR in patients with GT and metatarsalgia. METHODS This prospective study included 52 patients diagnosed with GT treated surgically with PMGR and 49 non-operated upon patients (control group). A total of 55 PMGRs (three bilateral) were performed as an isolated or combined procedure in the treatment group. Passive ankle dorsiflexion with knee flexion and extension was evaluated in all patients. In addition, pedobarographic analysis was performed before and after surgery. RESULTS Median preoperative ankle dorsiflexion was -10.0° (equinus) with extended knee and 10.0° with flexed knee and postoperative differences in median ankle dorsiflexion was 12.5° (extended knee) (p = 0.000) and 5.0° (flexed knee) (p = 0.002). After the PMGR, the median area of the contact surface (-3.0 cm2) (p = 0.009), the maximum (-13,239.0 Pa) (p = 0.019) and mean pressure (-2,942.0 Pa) and the forefoot force (-70.0 N) (p = 0.000) decreased. An increase in hindfoot force (20.0 N), hindfoot bearing time (4.0 ms) (p = 0.005), and forefoot bearing time (1.0 ms) was also observed. CONCLUSIONS Pedobarographic analysis is an efficient tool to evaluate surgical procedures that assess metatarsal overload. PMGR is an effective surgical procedure to improve passive ankle range of motion and decrease forefoot plantar overload.
Collapse
|
29
|
|
30
|
Pascual Huerta J, Arcas Lorente C, García Carmona FJ. La osteotomía de Weil: una revisión comprensiva. REVISTA ESPAÑOLA DE PODOLOGÍA 2017. [DOI: 10.1016/j.repod.2017.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
|
31
|
Chowdhary A, Drittenbass L, Stern R, Assal M. Technique tip: Simultaneous first metatarsal lengthening and metatarsophalangeal joint fusion for failed hallux valgus surgery with transfer metatarsalgia. Foot Ankle Surg 2017; 23:e8-e11. [PMID: 28159053 DOI: 10.1016/j.fas.2015.12.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 11/20/2015] [Accepted: 12/16/2015] [Indexed: 02/04/2023]
Abstract
BACKGROUND Failed hallux valgus surgery may result in residual or recurrent hallux valgus, and as well transfer metatarsalgia. The present technical tip concerns the combination of fusion of the first metatarsophalangeal (MTP) joint and lengthening of the first metatarsal (MT) through a scarf osteotomy. MATERIALS AND METHODS Six patients underwent the presented technique, all for the indication of failed hallux valgus surgery with shortening of the first MT and degenerative changes in the 1st MTP joint. RESULTS Follow-up at six months revealed all patients had complete healing of the osteotomy and arthrodesis sites. They were all asymptomatic and fully active, completely satisfied with the outcome. CONCLUSIONS Combined fusion of the first MTP joint and lengthening of the first MT through a scarf osteotomy results in an excellent outcome in patients with failed hallux valgus surgery with shortening of the first MT and degenerative changes in the 1st MTP joint.
Collapse
Affiliation(s)
- Ashwin Chowdhary
- Center for Surgery of the Foot & Ankle, Clinique La Colline, Av. de Beau-Séjour 6, Geneva 1206, Switzerland.
| | - Lisca Drittenbass
- Center for Surgery of the Foot & Ankle, Clinique La Colline, Av. de Beau-Séjour 6, Geneva 1206, Switzerland
| | - Richard Stern
- Center for Surgery of the Foot & Ankle, Clinique La Colline, Av. de Beau-Séjour 6, Geneva 1206, Switzerland
| | - Mathieu Assal
- Center for Surgery of the Foot & Ankle, Clinique La Colline, Av. de Beau-Séjour 6, Geneva 1206, Switzerland; Faculté de Médecine, University of Geneva Medical Center, Rue Gabrielle-Perret-Gentil 4, Geneva 1205, Switzerland
| |
Collapse
|
32
|
Abstract
The causes of metatarsalgia are classified as primary, secondary, and iatrogenic. Anatomical and biomechanical considerations separate "static" from "propulsive" forms of metatarsalgia. The physical examination should be combined with an assessment of weight-bearing radiographs and, if needed, of ultrasound or magnetic resonance imaging scans. The first-line treatment is conservative (stretching exercises, footwear modification, insoles, and lesion debridement). Soft-tissue surgical procedures (gastrocnemius muscle recession, tendon transfer, and plantar plate repair) should also be considered. Among the various types of metatarsal osteotomy, the Weil procedure is reliable. Percutaneous methods are being developed but require evaluation. A treatment algorithm can be developed based on whether the hallux is normal or abnormal. Metatarsalgia due to inflammatory disease requires a specific treatment strategy.
Collapse
Affiliation(s)
- J-L Besse
- Université Lyon 1, IFSTTAR, LBMC UMR-T 9406, Laboratoire de Biomécanique et Mécanique des Chocs, 69675 Bron cedex, France; Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Service de Chirurgie Orthopédique et Traumatologique, 69495 Pierre-Bénite cedex, France.
| |
Collapse
|
33
|
Yeo NEM, Loh B, Chen JY, Yew AKS, Ng SY. Comparison of early outcome of Weil osteotomy and distal metatarsal mini-invasive osteotomy for lesser toe metatarsalgia. J Orthop Surg (Hong Kong) 2016; 24:350-353. [PMID: 28031504 DOI: 10.1177/1602400315] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
PURPOSE To compare the 6-month outcome of Weil osteotomy with distal metatarsal mini-invasive osteotomy (DMMO) in 33 patients with lesser toe metatarsalgia. METHODS Records of 33 patients who underwent Weil osteotomy (n=20, 41 toes) or DMMO (n=13, 22 toes) for lesser toe metatarsalgia by a single surgeon were reviewed. 25 of them had a concurrent procedure on the 1st toe. Outcome at 6 months was assessed using the visual analogue score (VAS) for pain, American Orthopaedic Foot and Ankle Society (AOFAS) lesser toe metatarsophalangeal-interphalangeal (MTP-IP) score, and the RAND-36 score. RESULTS The 2 groups were comparable in terms of age, gender, and preoperative MTP joint range of motion (ROM), VAS for pain, AOFAS lesser toe MTPIP score, and RAND-36 scores. At 6 months, the Weil osteotomy group had a higher RAND-36 (mental) score (92 vs. 78, p=0.026), and the DMMO group had a higher percentage of toes with greater MTP joint ROM (p=0.043). All patients achieved bone union within 6 months. Two patients in the DMMO group had prolonged oedema until 3 months post-surgery. CONCLUSION DMMO is a safe and reliable alternative to Weil osteotomy for metatarsalgia and can preserve ROM of the MTP joints.
Collapse
|
34
|
Abstract
Deformities of the lesser toes are common and can be associated with significant morbidity. These deformities are often multiple, and numerous treatment strategies have been described in the literature.The goal of surgical treatment is to improve symptoms by restoring alignment and function, and avoiding recurrence. In order to achieve this, it is essential for the treating surgeon to understand the normal anatomy and pathology of the various deformities.There is a paucity of prospective studies and randomised-controlled trials assessing the efficacy of specific interventions.We describe the normal anatomy and biomechanics of the lesser toes, and the pathology of commonly adult deformities. The rationale behind various treatment strategies is discussed and the results of published literature presented. Algorithms for the management of lesser toe deformities based on current literature are proposed. Cite this article: Malhotra K, Davda K, Singh D. The pathology and management of lesser toe deformities. EFORT Open Rev 2016;1:409-419. DOI: 10.1302/2058-5241.1.160017.
Collapse
Affiliation(s)
- Karan Malhotra
- Foot & Ankle Unit, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, UK
| | - Kinner Davda
- Foot & Ankle Unit, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, UK
| | - Dishan Singh
- Foot & Ankle Unit, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, UK
| |
Collapse
|
35
|
Lee HS, Kim YC, Choi JH, Chung JW. Weil and Dorsal Closing Wedge Osteotomy for Freiberg's Disease. J Am Podiatr Med Assoc 2016; 106:100-8. [PMID: 27031545 DOI: 10.7547/14-065] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Weil osteotomy is a type of distal osteotomy for the treatment of lesser metatarsalgia by shortening the metatarsal length. We applied Weil and dorsal closing wedge osteotomy for the treatment of Freiberg's disease. METHODS Between September 1, 2006, and December 31, 2011, we performed Weil and dorsal closing wedge osteotomy of the second metatarsal in 15 feet of 15 patients (12 women, three men) diagnosed as having Freiberg's disease. The mean patient age was 29 years (range, 19-51 years), and mean follow-up was 47 months (range, 36-72 months). Postoperative shortening of the metatarsal length was measured by comparing preoperative and postoperative radiographs. Visual analog scale scores, American Orthopedic Foot and Ankle Society lesser metatarsophalangeal-interphalangeal scores, and the passive range of motion of the metatarsophalangeal joint were evaluated at 24 months. RESULTS The mean postoperative shortening of the metatarsal length was 3.2 mm. The mean visual analog scale and American Orthopedic Foot and Ankle Society scores were 7.2 and 52.4 points preoperatively and 2.1 and 78.2 points at 24 months, respectively (P < .05). The mean range of motion of the metatarsophalangeal joint increased from 29.4° preoperatively to 46.5° postoperatively (P < .05). Various degrees of remodeling were observed at the dorsum of the metatarsal head at 24 months. CONCLUSIONS Weil and dorsal closing wedge osteotomy of the metatarsal seems to be effective for treating Freiberg's disease. It improves pain and function in terms of shortening the metatarsal length and restoring the metatarsophalangeal joint.
Collapse
Affiliation(s)
- Hwa-Sung Lee
- Department of Orthopedic Surgery, The Catholic University of Korea, Seoul, Korea
| | - Yoon-Chung Kim
- Department of Orthopedic Surgery, The Catholic University of Korea, Seoul, Korea
| | - Jae-Hoon Choi
- Department of Orthopedic Surgery, The Catholic University of Korea, Seoul, Korea
| | - Jin-Wha Chung
- Department of Orthopedic Surgery, The Catholic University of Korea, Seoul, Korea
| |
Collapse
|
36
|
Aydogan U, Moore B, Andrews SH, Roush EP, Kunselman AR, Lewis GS. Comparison of Proximal and Distal Oblique Second Metatarsal Osteotomies with Varying Achilles Tendon Tension: Biomechanical Study in a Cadaver Model. J Bone Joint Surg Am 2015; 97:1945-51. [PMID: 26631995 PMCID: PMC4657221 DOI: 10.2106/jbjs.o.00216] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The optimal surgery for reducing pressure under the second metatarsal head to treat metatarsalgia is unknown. We tested our hypothesis that a proximal oblique dorsiflexion osteotomy of the second metatarsal would decrease second-metatarsal plantar pressures in a cadaver model with varying Achilles tendon tension. We also tested the plantar pressure effects of two popular techniques of distal oblique osteotomy. METHODS Twelve fresh-frozen feet from six cadavers were randomly assigned to either the distal osteotomy group (a classic distal oblique osteotomy followed by a modified distal oblique osteotomy) or proximal metatarsal osteotomy group. Each specimen was tested intact and then after the osteotomy or osteotomies. The feet were loaded with 0, 300, and 600 N of Achilles tendon tension and a 400-N ground reaction force. Plantar pressures were measured by a pressure sensitive mat and analyzed in sections located under each metatarsal. RESULTS The proximal metatarsal osteotomy significantly reduced average pressures beneath the second metatarsal head during both 300 and 600 N of Achilles tendon loading by an average of 19.4 and 29.7 kPa, respectively (p < 0.05). The modified distal oblique osteotomy significantly decreased these pressures during 600 N of Achilles tendon loading, by a mean of 20.2 kPa, which was to a lesser extent than the proximal metatarsal osteotomy. Interestingly, the classic distal oblique osteotomy was not found to have significant effects on pressures beneath the second metatarsal head. CONCLUSIONS The proximal oblique dorsiflexion metatarsal osteotomy may be the most effective procedure for decreasing plantar pressures under the second metatarsal. The modified distal oblique osteotomy may be the second most effective. CLINICAL RELEVANCE The findings of this biomechanical study help shed light on which of the common second metatarsal osteotomies are best for decreasing plantar pressures.
Collapse
Affiliation(s)
- Umur Aydogan
- Penn State Hershey Bone and Joint Institute, 30 Hope Drive, Hershey, PA 17033. E-mail address for U. Aydogan:
| | - Blake Moore
- Penn State Hershey Bone and Joint Institute, 30 Hope Drive, Hershey, PA 17033. E-mail address for U. Aydogan:
| | - Seth H. Andrews
- Department of Orthopaedics and Rehabilitation (S.H.A., E.P.R., and G.S.L.) and Department of Public Health Sciences (A.R.K.), Penn State Hershey College of Medicine, 500 University Drive, Hersey, PA 17033. E-mail address for G.S. Lewis:
| | - Evan P. Roush
- Department of Orthopaedics and Rehabilitation (S.H.A., E.P.R., and G.S.L.) and Department of Public Health Sciences (A.R.K.), Penn State Hershey College of Medicine, 500 University Drive, Hersey, PA 17033. E-mail address for G.S. Lewis:
| | - Allen R. Kunselman
- Department of Orthopaedics and Rehabilitation (S.H.A., E.P.R., and G.S.L.) and Department of Public Health Sciences (A.R.K.), Penn State Hershey College of Medicine, 500 University Drive, Hersey, PA 17033. E-mail address for G.S. Lewis:
| | - Gregory S. Lewis
- Department of Orthopaedics and Rehabilitation (S.H.A., E.P.R., and G.S.L.) and Department of Public Health Sciences (A.R.K.), Penn State Hershey College of Medicine, 500 University Drive, Hersey, PA 17033. E-mail address for G.S. Lewis:
| |
Collapse
|
37
|
DeSandis B, Ellis SJ, Levitsky M, O'Malley Q, Konin G, O'Malley MJ. Rate of Union After Segmental Midshaft Shortening Osteotomy of the Lesser Metatarsals. Foot Ankle Int 2015; 36:1190-5. [PMID: 25967256 DOI: 10.1177/1071100715585560] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Current literature reports excellent rates of union following various lesser metatarsal osteotomy techniques. However, it is our experience that segmental midshaft shortening osteotomies heal very slowly and have a greater potential for nonunion than has previously been reported. The purpose of this study was to assess union rates and report the time required for segmental midshaft shortening osteotomies to achieve radiographic union. METHODS We reviewed the charts and postoperative radiographs of 58 patients (representing 91 osteotomies) who underwent segmental midshaft shortening osteotomies with internal fixation between January 2009 and December 2013. Radiographs were reviewed to determine when union was achieved. Union was defined as the bridging of 2 or more cortices in the anteroposterior, lateral, and oblique radiographic views. Osteotomies were classified as delayed union if they were not healed at 3 months postoperatively and nonunions if they were not healed at 6 months postoperatively. RESULTS Overall, 27 of 91 osteotomies met our radiographic classification of union and were healed by 3 months (29.7%). Sixty-nine of the 91 osteotomies healed by 6 months (75.8%) and were considered delayed unions. Twenty-two osteotomies were not healed yet and therefore were considered nonunions (24.2%). Of the 22 nonunions, 7 healed in an additional 2 months (8 months) for an overall healing percentage of 83.5%, (76 of 91). By 10 months, 6 more nonunions were healed (overall healing percentage of 90.1%, 82 of 91). Three additional nonunions went on to heal by 12.9 months, yielding a final union rate of 93.4% (85 of 91), while 6 were still considered nonunions (6.6%). CONCLUSION We report that a significant percentage of segmental midshaft metatarsal shortening osteotomies experienced delayed unions and nonunions. These findings contrast those previously reported in the literature that metatarsal osteotomies have very low nonunion rates. These results support our hypothesis that these osteotomies require a prolonged amount of time to achieve bony healing and that they have a higher tendency to develop delayed and nonunions than previously reported. LEVEL OF EVIDENCE Level IV, retrospective case series.
Collapse
|
38
|
Abstract
Central metatarsal osteotomy is an effective approach in alleviating pain oriented to the forefoot. The procedures individually are straightforward in the isolated scenario. A working knowledge of the specific and unique pathobiomechanics is imperative when considering surgical intervention for the given pathologic scenario. Treating only the pain focus generally underserves the pathology and does not address the high point of the deformity. The surgeon must be cognizant of the complication potpourri, prepare the patient expectations, and engage a level of proactivity against sequelae to ensure the best possible and most predictable outcome.
Collapse
Affiliation(s)
- Matthew D Sorensen
- Weil Foot & Ankle Institute, Golf River Professional Building, 1455 East Golf Road, Des Plaines, IL 60016, USA.
| | - Lowell Weil
- Weil Foot & Ankle Institute, Golf River Professional Building, 1455 East Golf Road, Des Plaines, IL 60016, USA
| |
Collapse
|
39
|
|
40
|
Abstract
Metatarsalgia, pain around the metatarsophalangeal joints, may arise from mechanical causes spontaneously or iatrogenically. Nonunion or malunion of the first metatarsal can transfer weight-bearing forces and overload the lesser metatarsals. Transfer metatarsalgia after failed hallux valgus surgery is troublesome and more prevalent than would be expected. Clinical examination of the patient allows identifying the type of transfer metatarsalgia and pathomechanics involved. This review focuses on transfer metatarsalgia after hallux valgus surgery and provides a basic understanding of the pathomechanics, clinical examination, and image studies. It also addresses the options for both conservative and surgical treatment of this challenging condition.
Collapse
Affiliation(s)
- Ernesto Maceira
- Faculty of Medicine, Universidad Europea Madrid, Calle Diego De Velazquez, 28223 Pozuelo De Alarcon, Madrid, Spain; Orthopaedic Foot and Ankle Unit, Orthopaedic and Trauma Department, Hospital Universitario Quirón Madrid, Madrid, Spain
| | - Manuel Monteagudo
- Faculty of Medicine, Universidad Europea Madrid, Calle Diego De Velazquez, 28223 Pozuelo De Alarcon, Madrid, Spain; Orthopaedic Foot and Ankle Unit, Orthopaedic and Trauma Department, Hospital Universitario Quirón Madrid, Madrid, Spain.
| |
Collapse
|
41
|
Rose B, Bowman N, Edwards H, Rajaratnam SS, Armitage AR, Skyrme AD. Lengthening scarf osteotomy for recurrent hallux valgus. Foot Ankle Surg 2014; 20:20-5. [PMID: 24480494 DOI: 10.1016/j.fas.2013.08.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Revised: 08/06/2013] [Accepted: 08/22/2013] [Indexed: 02/04/2023]
Abstract
BACKGROUND We describe using the scarf osteotomy to correct a recurrent hallux valgus deformity and lengthen the shortened first metatarsal in symptomatic iatrogenic first brachymetatarsia. METHODS Thirty-six lengthening scarf osteotomies were undertaken in 31 patients. Clinical and radiographic measures were taken pre and postoperatively. RESULTS Mean age at presentation was 53.4 years, and mean followup 3.9 years. The mean lengthening achieved was 4.9mm. All osteotomies united with no complications. The mean IMA reduction was 4.0° (p<0.001) and HVA 13.0° (p<0.001). The mean AOFAS score increase was 33.8 (p<0.001). There was a positive trend but no correlation (r=0.28) between amount of metatarsal lengthening and AOFAS score change. CONCLUSIONS We describe the largest lengthening scarf osteotomy series for recurrent hallux valgus with iatrogenic first brachymetatarsia. The results suggest the procedure is successful, with a low complication rate. We anticipate that restoring first metatarsal length and alignment may reduce biomechanical transfer metatarsalgia over time.
Collapse
Affiliation(s)
- Barry Rose
- Eastbourne District General Hospital, East Sussex, UK.
| | | | - Huw Edwards
- Eastbourne District General Hospital, East Sussex, UK
| | | | | | | |
Collapse
|
42
|
Trask DJ, Ledoux WR, Whittaker EC, Roush GC, Sangeorzan BJ. Second metatarsal osteotomies for metatarsalgia: a robotic cadaveric study of the effect of osteotomy plane and metatarsal shortening on plantar pressure. J Orthop Res 2014; 32:385-93. [PMID: 24243763 DOI: 10.1002/jor.22524] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Accepted: 10/21/2013] [Indexed: 02/04/2023]
Abstract
Symptom relief of recalcitrant metatarsalgia can be achieved through surgical shortening of the affected metatarsal, thus decreasing plantar pressure. Theoretically an oblique metatarsal osteotomy can be oriented distal to proximal (DP) or proximal to distal (PD). We characterized the relationship between the amount of second metatarsal shortening, osteotomy plane, and plantar pressure. We hypothesized that the PD osteotomy is more effective in reducing metatarsal peak pressure and pressure time integral. We performed eight DP and eight PD second metatarsal osteotomies on eight pairs of cadaveric feet. A custom designed robotic gait simulator (RGS) generated dynamic in vitro simulations of gait. Second metatarsals were incrementally shortened, with three trials for each length. We calculated regression lines for peak pressure and pressure time integral vs. metatarsal shortening. Shortening the second metatarsal using either osteotomy significantly affected the metatarsal peak pressure and pressure time integral (first and third metatarsal increased, p < 0.01 and <0.05; second metatarsal decreased, p < 0.01). Changes in peak pressure (p = 0.0019) and pressure time integral (p = 0.0046) were more sensitive to second metatarsal shortening with the PD osteotomy than the DP osteotomy. The PD osteotomy plane reduces plantar pressure more effectively than the DP osteotomy plane.
Collapse
Affiliation(s)
- Darrin J Trask
- Department of Veterans Affairs RR&D Center of Excellence for Limb Loss Prevention and Prosthetic Engineering, VA Puget Sound Health Care System, Seattle, Washington, 98108; School of Medicine, University of Washington, Seattle, WA, 98195
| | | | | | | | | |
Collapse
|
43
|
Abstract
BACKGROUND Among the various operative treatments of Morton's neuroma, deep transverse metatarsal ligament (DTML) release has been performed for decompression of neuroma. However, the main lesion of Morton's neuroma is located between the metatarsal head and the metatarsophalangeal (MTP) joint and more distal than the DTML. Hence we performed the metatarsal shortening osteotomy along with DTML release for decompression of neuroma, and investigated the clinical outcomes of it and compared the outcomes with those of DTML release alone. METHODS We retrospectively reviewed 84 consecutive patients (86 neuromas) who underwent surgery for a Morton's neuroma between February 2008 and March 2011. The first 46 neuroma (group A) were treated with DTML release alone, and the next 40 neuroma (group B) underwent the metatarsal shortening osteotomy with DTML release. Clinical outcomes were compared between the groups and the associations between clinical outcomes and neuroma size were assessed. RESULTS Clinical outcomes were significantly improved after surgery in both groups but there were significant differences in clinical outcomes between the 2 groups at final follow-up. There were significant correlations between neuroma size and outcomes in group A, whereas no significant correlations were found between neuroma size and outcomes in group B. CONCLUSION The metatarsal shortening osteotomy with DTML release resulted in better outcomes compared with DTML release alone in patients with Morton's neuromas. LEVEL OF EVIDENCE Level III, retrospective comparative series.
Collapse
|
44
|
Louwerens JWK, Schrier JCM. Rheumatoid forefoot deformity: pathophysiology, evaluation and operative treatment options. INTERNATIONAL ORTHOPAEDICS 2013; 37:1719-29. [PMID: 23892468 PMCID: PMC3764283 DOI: 10.1007/s00264-013-2014-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Accepted: 06/25/2013] [Indexed: 10/26/2022]
Abstract
Despite recent advances in pharmacological management of rheumatoid arthritis, forefoot deformity, with its symptoms, remains a common problem, often requiring operative treatment. Typical deformities in these patients comprise hallux valgus and deformity of the lesser metatarsophalangeal (MTP) joints and toes. With regard to the lesser rays the standard operative procedure, advocated for the disabling forefoot pain in these patients, remains metatarsal head resection. It should be considered that with increasing success of pharmacological treatment the degree of forefoot deformity in these patients is becoming less and that resection of the lesser MTP joints is becoming more and more superfluous. This supports a trend towards metatarsal head-preserving surgery. The optimal treatment of the hallux deformity remains unclear. Fusion of the first MTP joint is, generally, recommended. This article will discuss the current surgical options in rheumatoid forefoot pathology.
Collapse
Affiliation(s)
- Jan Willem K Louwerens
- Department of Orthopaedic Surgery, Foot and Ankle Reconstruction Unit, St Maartenskliniek, Nijmegen, The Netherlands.
| | | |
Collapse
|
45
|
Holinka J, Schuh R, Hofstaetter JG, Wanivenhaus AH. Temporary Kirschner wire transfixation versus strapping dressing after second MTP joint realignment surgery: a comparative study with ten-year follow-up. Foot Ankle Int 2013; 34:984-9. [PMID: 23493774 DOI: 10.1177/1071100713478406] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Instability of the second metatarsophalageal (MTP) joint is a common disorder of the forefoot and can be addressed operatively. The objective of this study was to compare a temporary K-wire fixation (tKW) to a postoperative strapping dressing (SD) after realignment surgery of second MTP instability in combination with correction of claw toe deformity. METHODS Fifty-four consecutive patients with metatarsal index plus or neutral and a collective total of 62 operative interventions were examined at 10 years postoperatively. The operative intervention included dorsal capsulotomy, incision of the extensor hood, and lengthening of the extensor tendon. All operations were carried out at a single institution by orthopedic surgeons experienced in foot surgery. One team preferred fixation with tKW, whereas the other team used only noninvasive SD for postoperative management. The assessment included the American Orthopaedic Foot & Ankle Society (AOFAS) metatarsophalangeal-interphalangeal score as well as the visual analogue scale (VAS) for pain. Kaplan Meier analysis with recurrence of subluxation as the end point was performed, and plain radiographs of the forefoot were investigated. RESULTS Survival without recurrence of second MTP subluxation was significantly higher in the tKW group (93%) compared with the SD group (88%) (P < .001). There was no statistical significant difference in pre- to postoperative AOFAS and VAS pain between the 2 groups. CONCLUSION Temporary K-wire fixation had a significantly lower recurrence rate of second MTP subluxation compared with postoperative SD for postoperative alignment management in second MTP instability. LEVEL OF EVIDENCE Level III, therapeutic study.
Collapse
|
46
|
Klein EE, Weil L, Weil LS, Knight J. The underlying osseous deformity in plantar plate tears: a radiographic analysis. Foot Ankle Spec 2013; 6:108-18. [PMID: 23091286 DOI: 10.1177/1938640012463060] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Plantar plate tears can cause pain and deformity of the forefoot. The purpose of this study is to correlate common radiographic findings with observed intra-operative pathology in patients with plantar plate pathology. METHODS Bilateral weight-bearing radiographs were reviewed for 88 patients (106 feet) who underwent surgical repair of suspected plantar plate pathology. Parameters reviewed included the first intermetatarsal angle, the metatarsus adductus angle, the second and third metatarsophalangeal angles, splaying of the second and third toes, evaluation of the metatarsal parabola by 3 different methods, the first and second lateral declination angles, and the second lateral metatarsophalangeal angle. RESULTS Of 106 feet, 97 had intra-operative plantar plate tears. The radiographs of patients with plantar plate tears had an increased amount of digital splay on the anteroposterior radiograph compared to patients without pathology. For patients with unilateral plantar plate pathology, the metatarsal parabola of the symptomatic foot was compared with that of the asymptomatic foot. A significantly increased second metatarsal protrusion distance as measured by 2 different methods was noted in the symptomatic foot. Odds ratios revealed that patients with an intermetatarsal angle >12, medial deviation of the second toe, and splaying of the digits were more likely to be diagnosed with a plantar plate tear intra-operatively. CONCLUSION Although radiographs do not definitively diagnose plantar plate tears, understanding osseous forefoot architecture will aid with diagnosis in the absence of other osseous pathology. Furthermore, these data suggest that parabola should be corrected to maintain long-term correction of plantar plate pathology. LEVEL OF EVIDENCE Prognostic, Level II.
Collapse
Affiliation(s)
- Erin E Klein
- Weil Foot and Ankle Institute, Des Plaines, IL 60016, USA
| | | | | | | |
Collapse
|
47
|
Menz HB, Fotoohabadi MR, Munteanu SE, Zammit GV, Gilheany MF. Plantar pressures and relative lesser metatarsal lengths in older people with and without forefoot pain. J Orthop Res 2013; 31:427-33. [PMID: 22987209 DOI: 10.1002/jor.22229] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2011] [Accepted: 08/16/2012] [Indexed: 02/04/2023]
Abstract
Forefoot pain is a common problem in older people. We determined whether plantar pressures during gait and the relative lengths of the lesser metatarsals differ between older people with and without plantar forefoot pain. Dynamic plantar pressure assessment during walking was undertaken using the Tekscan MatScan® system in 118 community-dwelling older people (44 males and 74 females), mean age 74 (standard deviation=5.9) years, 43 (36%) of whom reported current or previous plantar forefoot pain. The relative lengths of metatarsals 1-5 were determined from weightbearing X-rays. Participants with current or previous plantar forefoot pain exhibited significantly (p=0.032) greater peak plantar pressure under metatarsal heads 3-5 (1.93 ± 0.41 kg/cm(2) vs. 1.74 ± 0.48 kg/cm(2) ). However, no differences were found in relative metatarsal lengths between the groups. These findings indicate that older people with forefoot pain generate higher peak plantar pressures under the lateral metatarsal heads when walking, but do not exhibit relatively longer lesser metatarsals. Other factors may be responsible for the observed pressure increase, such as reduced range of motion of the metatarsophalangeal joints and increased stiffness of plantar soft tissues.
Collapse
Affiliation(s)
- Hylton B Menz
- La Trobe University, Bundoora, Victoria 3086, Australia.
| | | | | | | | | |
Collapse
|
48
|
Abstract
Background Numerous metatarsal osteotomies have been developed for the treatment of Freiberg's disease. The purpose of this study was to evaluate the clinical outcomes of modified Weil osteotomy in the treatment of Freiberg's disease. Methods From November 2001 to July 2008, nineteen patients (twenty feet), treated surgically for Freiberg's disease, were included in this study. The average age of the patients was 33.6 years (range, 17 to 62 years), the mean follow-up period was 71.6 months (range, 41 to 121 months). Clinical outcomes were evaluated according to visual analogue scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) lesser metatarsophalangeal-interphalangeal scale, the patients' subjective satisfaction and range of motion (ROM) of metatarsophalangeal (MTP) joint. In the radiologic evaluation, initial metatarsal shortening by Freiberg's disease compared to opposite site, metatarsal shortening after modified Weil osteotomy compared with preoperative radiography and term for radiologic union were observed. Results VAS showed improvement from 6.2 ± 1.4 to 1.4 ± 1.5 at last follow-up (p < 0.0001). Points of AOFAS score increased from 63.3 ± 14.9 to 80.4 ± 5.6 (p < 0.0001). ROM of MTP joints also improved from 31.3 ± 10.1 to 48.3 ± 13.0 degrees at last follow-up (p < 0.0001). According to Smillie's classification system, there was no significant improvement of VAS, AOFAS score and ROM between early stages (stage I, II, and III) and late stages (stage IV and V). Out of twenty cases, nineteen (95%) were satisfied, reporting excellent or good results. Conclusions Modified Weil osteotomy is believed to be a useful method for the treatment of Freiberg's disease, not only in the early stages but also in the late stages. It relieves pain and improves function via shortening of metatarsals and restoration of MTP joint congruency.
Collapse
Affiliation(s)
- Jiyoun Kim
- Department of Orthopaedic Surgery, Busan Veterans Hospital, Busan, Korea
| | | | | | | |
Collapse
|
49
|
Barg A, Courville XF, Nickisch F, Bachus KN, Saltzman CL. Role of collateral ligaments in metatarsophalangeal stability: a cadaver study. Foot Ankle Int 2012; 33:877-82. [PMID: 23050713 DOI: 10.3113/fai.2012.0877] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Lesser metatarsophalangeal joint (MTPJ) instability is a common complaint. The role each of the collateral structures play in maintaining joint stability is unknown. METHODS Twenty-six fresh-frozen cadaver lesser MTPJ's were tested for instability with the amount of force necessary to translate the joint 3 mm dorsally. Specimens were tested with 1) intact collateral ligaments, 2) transected accessory collateral or proper collateral ligaments (ACL or PCL), 3) repaired ACL or PCL, 4) transected ACL and PCL, 5) repaired ACL and PCL, and 6) transferred interosseous (IO) tendon. Student t-tests were performed to test for statistical significance (p value less than 0.05). RESULTS The mean force required for 3 mm of dorsal displacement was 25 ± 13 N (range, 11 to 52 N) in the 26 specimens. Transecting either the ACL alone or the ACL and PCL led to the most instability versus transecting the PCL alone. Repairing both ligaments improved stability. The IO tendon transfer was comparable to the direct repair of the PCL but was inferior to the direct repair of the ACL. CONCLUSION Both ACL and PCL have a stabilizing effect on the MTPJ. However, the ACL was more important since primary transection of the ACL led to more instability and additional transection of the PCL in an ACL deficient model did not lead to significantly more instability. CLINICAL RELEVANCE Direct repairs of both structures improved the stability of the joint but not back to normal. IO tendon transfer is a possible adjunct to collateral ligament repairs, but in itself is not sufficient to restore stability.
Collapse
Affiliation(s)
- Alexej Barg
- University of Utah, Orthopaedics, Salt Lake City, UT 84108, USA
| | | | | | | | | |
Collapse
|
50
|
Popelka S, Hromádka R, Vavřík P, Barták V, Popelka S, Sosna A. Hypermobility of the first metatarsal bone in patients with rheumatoid arthritis treated by Lapidus procedure. BMC Musculoskelet Disord 2012; 13:148. [PMID: 22906022 PMCID: PMC3517407 DOI: 10.1186/1471-2474-13-148] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2012] [Accepted: 07/13/2012] [Indexed: 01/18/2023] Open
Abstract
Background Foot deformities and related problems of the forefoot are very common in patients with rheumatoid arthritis. The laxity of the medial cuneometatarsal joint and its synovitis are important factors in the development of forefoot deformity. The impaired joint causes the first metatarsal bone to become unstable in the frontal and sagittal planes. In this retrospective study we evaluated data of patients with rheumatoid arthritis who underwent Lapidus procedure. We evaluated the role of the instability in a group of patients, focusing mainly on the clinical symptoms and X-ray signs of the instability. Methods The study group included 125 patients with rheumatoid arthritis. The indications of the Lapidus procedure were a hallux valgus deformity greater than 15 degrees and varus deformity of the first metatarsal bone with the intermetatarsal angle greater than 15 degrees on anterio-posterior weight-bearing X-ray. Results Data of 143 Lapidus procedures of 125 patients with rheumatoid arthritis, who underwent surgery between 2004 and 2010 was evaluated. Signs and symptoms of the first metatarsal bone instability was found in 92 feet (64.3%) in our group. The AOFAS score was 48.6 before and 87.6 six months after the foot reconstruction. Nonunion of the medial cuneometatarsal joint arthrodesis on X-rays occurred in seven feet (4.9%). Conclusion The Lapidus procedure provides the possibility to correct the first metatarsal bone varus position and its instability, as well as providing the possibility to achieve a painless foot for walking. We recommend using the procedure as a preventive surgery in poorly symptomatic patients with rheumatoid arthritis in case of the first metatarsal bone hypermobility.
Collapse
Affiliation(s)
- Stanislav Popelka
- 1st Orthopaedic Clinic, 1st Faculty of Medicine, Charles University in Prague, V Úvalu 84, Prague 5, 150 06, Czech Republic.
| | | | | | | | | | | |
Collapse
|