Lesser Metatarsal Head with Avascular Necrosis and Revision PIPJ Distraction Arthrodesis

Hammertoes ◽  
2019 ◽  
pp. 403-413
Author(s):  
Jacob Wynes
Keyword(s):  
Avascular Necrosis ◽  
Metatarsal Head

Avascular necrosis of the first metatarsal head and atherosclerosis: a case report

2003 ◽  
Vol 9 (1) ◽  
pp. 41-43
Author(s):  
F Steenbrugge ◽  
E Van Ovost ◽  
P Burssens ◽  
K Verstraete
Keyword(s):  
Case Report ◽  
Avascular Necrosis ◽  
Metatarsal Head ◽  
First Metatarsal

Avascular necrosis of the first metatarsal head. A different perspective

1999 ◽  
Vol 89 (9) ◽  
pp. 441-453 ◽  
Author(s):  
AS Banks
Keyword(s):  
Avascular Necrosis ◽  
Critical Review ◽  
Metatarsal Head ◽  
Valgus Deformity ◽  
Clinical Findings ◽  
Potential Complication ◽  
First Metatarsal

Avascular necrosis of the first metatarsal head has been reported as a potential complication associated with osteotomies at the first metatarsal head for repair of hallux abducto valgus deformity. However, most if not all of the radiographic and clinical findings associated with avascular necrosis at this level may also be explained by other processes. A critical review of avascular necrosis of the first metatarsal head is presented in conjunction with a discussion of alternative etiologies for the radiographic and clinical findings that may be noted following capital osteotomies.

scholarly journals Outcomes following Subchondroplasty in the First Metatarsal Head

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0043
Author(s):  
Akhil Sharma ◽  
Craig C. Akoh ◽  
Selene G. Parekh
Keyword(s):  
Bone Marrow ◽  
Calcium Phosphate ◽  
Avascular Necrosis ◽  
Early Stage ◽  
Metatarsal Head ◽  
Continuous Variables ◽  
Foot And Ankle ◽  
Exclusion Criteria ◽  
First Metatarsal ◽  
Vas Scores

Category: Midfoot/Forefoot; Other Introduction/Purpose: Patients with subchondral bone marrow lesions often present with arthritic symptoms causing severe discomfort. Recently, subchondroplasty has been offered to treat such patients who suffer from symptoms of bone marrow edema. Calcium phosphate is percutaneously injected into these edematous regions to stabilize damaged bone and aid in healing. Subchondroplasty has been used successfully in the knee for femoral and tibial plateau injuries. However, its use in foot and ankle orthopaedics is relatively limited. This procedure has shown short-term success in patients with painful edema of the talus, as well as patients with early stage avascular necrosis (AVN) in the second MTP joint and the cuboid. Here, we report outcomes of two patients who developed AVN as a result of subchondroplasty in foot and ankle surgery. Methods: A retrospective review of patients was performed in those patients who underwent subchondroplasty in their first metatarsal heads between January 2017 and April 2017. Exclusion criteria included patients lost to follow up. Following implementation of inclusion and exclusion criteria, two patient charts were reviewed. Patients were treated by a single surgeon at the same institution. Data collected included patient demographics (age, laterality, BMI, ASA class, comorbidities), preoperative and postoperative VAS scores, FAOS scores, and imaging. Patients were followed up in clinic for two years following the procedure. Data was then analyzed via mean, standard deviation, median, and range for continuous variables and counts with percentages for categorical data. Results: In both patients, VAS scores increased, and physical exam showed greater tenderness over the affected region. The corresponding MRIs showed development of avascular necrosis in the region of the first metatarsal joint where the subchondroplasty had occurred. Both patients consequently had to undergo revascularization procedures and required further operations to correct the condition. Conclusion: Ultimately, subchondroplasty over the first metatarsal head failed in our patients. Exposure to calcium phosphate exacerbated their condition, resulting in symptomatic AVN. Although literature for subchondroplasty in foot and ankle orthopaedics is limited, preliminary results are unfavorable for use in the first metatarsal joint. Therefore, more long term data needs to be gathered this area before implementing the procedure more widely in foot and ankle surgeries.

Freiberg’s Avascular Necrosis: A Case Report

2020 ◽  
Author(s):  
Amir Sabaghzadeh ◽  
Hossein Mohebi ◽  
Shiva Momen ◽  
Morteza Gholipour ◽  
Seyyed-Mohsen Hosseininejad
Keyword(s):  
Case Report ◽  
Avascular Necrosis ◽  
Metatarsal Head ◽  
Local Pain ◽  
Trauma History ◽  
Second Metatarsal ◽  
Previous Trauma ◽  
Uncommon Condition ◽  
Freiberg’S Disease

Background: Freiberg’s disease is an uncommon condition typified by bony infarction of the second metatarsal head with a vague multifactorial etiology which tends to mostly occur in women. Case Report: A 22-year-old woman presented with second metatarsal head local pain exacerbating while walking without any prominent previous trauma history; clinical and imaging workups revealed metatarsal head osteonecrosis of Freiberg’s infarction. Conclusion: It should be kept in mind that for those complaining of forefoot discomfort, especially in the region of metatarsal heads, Freiberg’s avascular necrosis (AVN) could be a potential pathology

Idiopathic Avascular Necrosis of First Metatarsal Head in a Pediatric Patient

2017 ◽  
Vol 56 (3) ◽  
pp. 683-686 ◽  
Author(s):  
Young-Uk Kwon ◽  
Jang-Seok Choi ◽  
Gyu-Min Kong ◽  
Byung-Ho Ha
Keyword(s):  
Avascular Necrosis ◽  
Pediatric Patient ◽  
Metatarsal Head ◽  
First Metatarsal

scholarly journals Introduction the revolving scarf osteotomy for treating severe hallux valgus with an increased distal metatarsal articular angle: a retrospective cohort study

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Xinwen Wang ◽  
Qian Wen ◽  
Yi Li ◽  
Cheng Liu ◽  
Kai Zhao ◽  
...  
Keyword(s):  
Hallux Valgus ◽  
Avascular Necrosis ◽  
Metatarsal Head ◽  
Foot Deformities ◽  
Metatarsal Osteotomy ◽  
Aofas Score ◽  
First Metatarsal ◽  
Scarf Osteotomy ◽  
Vas Score ◽  
Akin Osteotomy

Abstract Background Hallux valgus(HV) with an increased distal metatarsal articular angle (DMAA) is one of the most common foot deformities among adults. Double metatarsal osteotomy (DMO) is effective in treating severe HV deformity with an increased DMAA. However, this technique presents the risk of avascular necrosis (AVN) of the metatarsal head and transfer metatarsalgia due to shortening of the first metatarsal. The aim of this study was to introduce a surgical procedure defined as revolving scarf osteotomy (RSO) and compare the clinical and radiological results of RSO and DMO performed for treating severe HV with an increased DMAA. Methods First metatarsal osteotomies and Akin osteotomy were performed in 56 patients (62 ft) with severe HV with an increased DMAA in Honghui Hospital from January 2015 to December 2017. RSO was performed in 32 ft and DMO was performed in 30 ft. The Akin osteotomy was performed in both groups. The American Orthopedic Foot and Ankle Society (AOFAS) score, visual analogue scale (VAS) score, the hallux valgus angle (HVA), intermetatarsal angle (IMA), DMAA, and first metatarsal length (FML) and the rates of complications were compared preoperatively and postoperatively in the two groups. Results The mean AOFAS score, VAS score, HVA, IMA, and DMAA showed significant improvements in both groups after surgery, but with no significant differences between the two groups. The postoperative FML was significantly larger in the RSO group than in the DMO group (p < 0.001). One of the 30 ft (3.3%) in the DMO group exhibited transfer metatarsalgia at 12 months postoperatively, while another foot (3.3%) in same group had avascular necrosis of the metatarsal head. One of the 30 ft (3.1%) in the RSO group had hallux varus. Conclusions No differences in the clinical and radiographic results were observed between the two groups with severe HV and an increased DMAA. However, RSO does not cause shortening of the metatarsal and AVN of the metatarsal head. A long-term, randomized, controlled prospective study with a larger sample would provide higher-level evidence for confirming the clinical efficacy and safety of RSO.

Radiographic Changes in the First Metatarsal Head after Distal Chevron Osteotomy Combined with Lateral Release Through a Plantar Approach

1994 ◽  
Vol 15 (6) ◽  
pp. 285-292 ◽  
Author(s):  
Ruth Lourdes Thomas ◽  
Francisco J. Espinosa ◽  
E. Greer Richardson
Keyword(s):  
Range Of Motion ◽  
Avascular Necrosis ◽  
Metatarsal Head ◽  
Lateral Release ◽  
Metatarsal Osteotomy ◽  
First Metatarsal ◽  
Distal Metatarsal Osteotomy ◽  
Clinically Significant ◽  
Radiographic Changes

The purpose of this study was to evaluate the development of clinically significant avascular necrosis of the head of the first metatarsal after: (1) distal metatarsal osteotomy of the chevron configuration beginning apically at the center of the metatarsal head and extending into the head metatarsal neck junction and (2) release of the adductor hallucis muscle, the lateral capsulosesamoid ligament, and the lateral head of the flexor hallucis brevis via fibular sesamoidectomy in the majority of procedures (71/77). Although there were initial radiographic findings suspicious of avascular necrosis, subchondral lucencies (28 feet), mottling (40 feet), and focal lucencies (29 feet) in 76% of the feet, at final follow-up (12–43 months, average 25 months) this figure had fallen to 25%. The range of motion of the first metatarsophalangeal joint and articular symptoms were important in this study because of the assumption that these two parameters of evaluation would correspond to the severity of radiographic evidence of avascular necrosis. Only those patients (8 feet) with persistent mottling at final follow-up had a statistically significant decrease in the average range of motion ( P = .013), with 51° total arc of motion compared with 64° total arc of motion for the remainder. There were no patients with persistent radiographic changes suggesting avascular necrosis who complained of pain. We concluded from the radiographic and clinical data that if the primary blood supply to the capsule and head of the metatarsal (the first dorsal intermetatarsal artery) is preserved, an extensive lateral release combined with a distal metatarsal osteotomy of the chevron configuration are unlikely to cause clinically significant avascular necrosis of the first metatarsal head. By clinically significant, we refer to range of motion and articular pain.

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