Results of External Fixation and Metatarsophalangeal Joint Fixation With K-Wire in Brachymetatarsia

Background: Brachymetatarsia is a rare foot deformity caused by the premature closure of the metatarsal physis. It may result in functional as well as cosmetic alterations, which may require operative management. Methods: A prospective study examining outcomes of 48 cases of brachymetatarsia with gradual bone lengthening at a rate of 1 mm/d using an external fixator and metatarsophalangeal joint fixation was performed. The difference between the length before treatment and after external fixator removal was measured. The patients were assessed at 2, 4, 6, and 8 weeks postoperatively; at the end of the period of distraction; and 1 year after surgery. The total number of patients was 26, and surgery was performed in 48 metatarsals. The mean age was 17.0 ± 4.1 (range, 11-24) years, and all were female. Results: The fourth metatarsal was the most frequently affected, representing 98% of the cases; the third metatarsal represented the other 2%. The average length gained was 18.6 ± 6.7 mm, and the average length gained as a proportion of the original metatarsal length was 38.2% ± 3.1% (range, 13%-24%). The mean healing time was 71.0 (range, 64-104) days, and the mean healing index (healing time divided by centimeters of length gained [d/cm]) was 38.4 (range, 38.2-50.1) d/cm. Conclusion: Gradual bone lengthening at a rate of 1 mm/d using an external fixator and intramedullary nailing was a safe and efficient method, representing a minimally invasive procedure with a low incidence of complications and satisfactory results for the patient. Level of Evidence: Level IV, retrospective case series.

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Plantar Plate Repair for Lesser Metatarsophalangeal Joint Instability

Foot & Ankle International ◽

10.1177/1071100716679110 ◽

2016 ◽

Vol 38 (3) ◽

pp. 234-242 ◽

Cited By ~ 23

Author(s):

Wesley W. Flint ◽

David M. Macias ◽

James R. Jastifer ◽

Jesse F. Doty ◽

Christopher B. Hirose ◽

...

Keyword(s):

Joint Instability ◽

Case Series ◽

Metatarsophalangeal Joint ◽

Retrospective Case ◽

Dorsal Approach ◽

Level Of Evidence ◽

Plantar Plate ◽

Radiographic Outcomes ◽

Pull Out ◽

The Mean

Background: Lesser metatarsophalangeal (MTP) joint instability is a common cause of forefoot pain. Advances in operative technique and instrumentation have made it possible to anatomically treat plantar plate tears through a dorsal approach. Our goal was to evaluate the subjective, functional, and radiographic outcomes of plantar plate repair (PPR) from a dorsal approach. Methods: A prospective case series was performed evaluating the results of PPR in 97 feet with 138 plantar plate tears. Patients underwent PPR from a dorsal approach with a Weil osteotomy. We followed patients at regular intervals for 12 months and collected data preoperatively and postoperatively with respect to visual analog scale (VAS) scores, MTP range of motion (ROM), paper pull-out test, American Orthopaedic Foot & Ankle Society (AOFAS) scores, satisfaction, and radiographic measures. Results: Eighty percent of patients scored “good” to “excellent” satisfaction scores at 12 months. The mean VAS pain score preoperatively was 5.4/10, and postoperatively was 1.5/10. The mean AOFAS scores increased from 49 to 81 points following surgery. The mean MTP ROM preoperatively was 43 degrees and postoperatively 31 degrees. Forty-two percent of toes passed the paper pull out test prior to surgery and 54% at 12 months. Mean metatarsal shortening was 2.4/3.1/1.2 mm for the second, third, and fourth metatarsals, respectively. The mean MTP joint angles preoperatively were 2/4.9/–1.3 degrees and postoperatively were 7.4/9.6/0.2 degrees, respectively, for the second, third, and fourth MTP joints. Conclusion: We found that the plantar plate could be repaired through a dorsal approach with reliable outcomes. PPR was a viable option to anatomically restore the ligamentous support in the unstable lesser MTP joint. Level of Evidence: Level IV, retrospective case series.

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Functional Outcome of Endoscopic Plantar Fasciotomy

Foot & Ankle International ◽

10.3113/fai.2012.0037 ◽

2012 ◽

Vol 33 (1) ◽

pp. 37-43 ◽

Cited By ~ 26

Author(s):

Lucas Bader ◽

Ken Park ◽

Yang Gu ◽

Martin J. O'Malley

Keyword(s):

Case Series ◽

Nonoperative Treatment ◽

Retrospective Case ◽

Level Of Evidence ◽

Superficial Infection ◽

Duration Of Symptoms ◽

Number Of Patients ◽

The Mean ◽

Symptom Group ◽

Plantar Fasciotomy

Background: The majority of cases of plantar fasciitis can be treated nonoperatively; however, a small number of patients remain refractory to nonoperative treatment and operative intervention is indicated. Historically, open treatment has been recommended, but more recently endoscopic plantar fasciotomy (EPF) has produced promising results. Methods: Forty-eight patients (56 feet) were identified who underwent endoscopic plantar fasciotomy. Forty-one patients (49 feet) were available for followup. There were 15 men and 26 women, with an average age of 53.8 (range, 42 to 68) years. The mean followup time was 49.5 (range, 6 to 142) months. An AOFAS Hind foot Scale was used for analysis. The influence of gender, duration of symptoms, severity of symptoms, and bilateral verses unilateral release were examined. Results: Pain resolved completely in 37 feet, decreased in 11 feet, and increased in one foot. The mean postoperative AOFAS Hindfoot score improved 39 points (54 to 93, p < 0.001). Patients with severe symptoms achieved higher mean improvement than the moderate symptom group ( p < 0.0001). Patients with symptoms greater than 24 months trended towards lower mean improvement and lower post operative AOFAS Hindfoot scores. Both gender and laterality did not significantly influence outcome. There was one superficial infection, one third and fourth metatarsal stress fracture in the same patient, and transient lateral hindfoot pain in five patients. Conclusion: EPF was an effective operation with reproducible results, low complication rate, and little risk of iatrogenic nerve injury with proper technique. Level of Evidence: IV, Retrospective Case Series

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First-Tarsometatarsal Joint Alignment After First-Metatarsophalangeal Joint Arthrodesis for Hallux Valgus

Foot & Ankle Orthopaedics ◽

10.1177/24730114211008514 ◽

2021 ◽

Vol 6 (2) ◽

pp. 247301142110085

Author(s):

Christopher Traynor ◽

James Jastifer

Keyword(s):

Hallux Valgus ◽

Case Series ◽

Metatarsophalangeal Joint ◽

Retrospective Case ◽

Level Of Evidence ◽

First Metatarsophalangeal Joint ◽

First Metatarsal ◽

Metatarsal Angle ◽

Medial Cuneiform ◽

Radiographic Alignment

Background: Instability of the first-tarsometatarsal (TMT) joint has been proposed as a cause of hallux valgus. Although there is literature demonstrating how first-TMT arthrodesis affects hallux valgus, there is little published on how correction of hallux valgus affects the first-TMT joint alignment. The purpose of this study was to determine if correction of hallux valgus impacts the first-TMT alignment and congruency. Improvement in alignment would provide evidence that hallux valgus contributes to first-TMT instability. Our hypothesis was that correcting hallux valgus angle (HVA) would have no effect on the first-TMT alignment and congruency. Methods: Radiographs of patients who underwent first-MTP joint arthrodesis for hallux valgus were retrospectively reviewed. The HVA, 1-2 intermetatarsal angle (IMA), first metatarsal–medial cuneiform angle (1MCA), medial cuneiform–first metatarsal angle (MC1A), relative cuneiform slope (RCS), and distal medial cuneiform angle (DMCA) were measured and recorded for all patients preoperatively and postoperatively. Results: Of the 76 feet that met inclusion criteria, radiographic improvements were noted in HVA (23.6 degrees, P < .0001), 1-2 IMA (6.2 degrees, P < .0001), 1MCA (6.4 degrees, P < .0001), MC1A (6.5 degrees, P < .0001), and RCS (3.3 degrees, P = .001) comparing preoperative and postoperative radiographs. There was no difference noted with DMCA measurements (0.5 degrees, P = .53). Conclusion: Our findings indicate that the radiographic alignment and subluxation of the first-TMT joint will reduce with isolated treatment of the first-MTP joint. Evidence suggests that change in the HVA can affect radiographic alignment and subluxation of the first-TMT joint. Level of Evidence: Level IV, retrospective case series.

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Postarthroscopy Imaging in Femoroacetabular Impingement: Persistent Pain May Be Due to an Insufficient Correction of Preoperative Abnormalities

Joints ◽

10.1055/s-0037-1601411 ◽

2017 ◽

Vol 05 (01) ◽

pp. 021-026 ◽

Cited By ~ 1

Author(s):

Cosimo Tudisco ◽

Salvatore Bisicchia ◽

Sandro Tormenta ◽

Amedeo Taglieri ◽

Ezio Fanucci

Keyword(s):

Case Series ◽

Persistent Pain ◽

Retrospective Case ◽

Level Of Evidence ◽

Mean Values ◽

Center Edge ◽

Patient Groups ◽

The Mean ◽

Magnetic Resonance Imaging Mri

Purpose The purpose of this study was to evaluate the effect of correction of abnormal radiographic parameters on postoperative pain in a group of patients treated arthroscopically for femoracetabular impingement (FAI). Methods A retrospective study was performed on 23 patients affected by mixed-type FAI and treated arthroscopically. There were 11 males and 12 females with a mean age of 46.5 (range: 28–67) years. Center-edge (CE) and α angles were measured on preoperative and postoperative radiographic and magnetic resonance imaging (MRI) studies and were correlated with persistent pain at follow-up. Results The mean preoperative CE and α angles were 38.6 ± 5.2 and 67.3 ± 7.2 degrees, respectively. At follow-up, in the 17 pain-free patients, the mean pre- and postoperative CE angle were 38.1 ± 5.6 and 32.6 ± 4.8 degrees, respectively, whereas the mean pre- and postoperative α angles at MRI were 66.3 ± 7.9 and 47.9 ± 8.9 degrees, respectively. In six patients with persistent hip pain, the mean pre- and postoperative CE angles were 39.8 ± 3.6 and 35.8 ± 3.1 degrees, respectively, whereas the mean pre- and postoperative α angles were 70.0 ± 3.9 and 58.8 ± 2.6 degrees, respectively. Mean values of all the analyzed radiological parameters, except CE angle in patients with pain, improved significantly after surgery. On comparing patient groups, significantly lower postoperative α angles and lower CE angle were observed in patients without pain. Conclusion In case of persistent pain after arthroscopic treatment of FAI, a new set of imaging studies must be performed because pain may be related to an insufficient correction of preoperative radiographic abnormalities. Level of Evidence Level IV, retrospective case series.

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Clinical and functional outcomes of tarsal coalition resection to correct rigid flat foot

Journal of the Foot & Ankle ◽

10.30795/jfootankle.2021.v15.1537 ◽

2021 ◽

Vol 15 (2) ◽

pp. 115-119

Author(s):

Rodrigo Guimarães Huyer ◽

Mário Sérgio Paulillo Cillo ◽

Carlos Daniel Cândido Castro Filho ◽

Hallan Douglas Bertelli ◽

Marcelo Morelli Girondo ◽

...

Keyword(s):

Case Series ◽

Categorical Variables ◽

Continuous Variables ◽

Tarsal Coalition ◽

Retrospective Case ◽

Aofas Score ◽

Level Of Evidence ◽

Flat Foot ◽

Flat Feet ◽

The Mean

Objective: This study used the AOFAS score to assess the clinical functional results of patients who underwent tarsal coalition resection. Methods: This was a retrospective case series of patients who underwent tarsal coalition resection to correct rigid flat foot. Clinical and functional assessment was performed with the AOFAS score before and 6 months after surgical treatment. Descriptive analysis was performed for 7 patients (11 operated feet) using measurements of position and dispersion (mean, standard deviation, minimum, median and maximum value) for continuous variables and frequency tables (absolute and relative) for categorical variables. Results: The mean patient age was 10 years, 7 months, and the majority (71.43%) were male. The most affected joint was the calcaneonavicular. The right side was affected in 54.55% of the cases. The most frequent type of coalition was osseous (81.82% of the cases). The mean pre- and postoperative AOFAS scores were 32.7 and 70.2 points, respectively, which was a significant increase. Conclusion: The increased scores after coalition resection was considered the main change between the two assessments. Thus, it can be concluded that in rigid flat feet without severe hind- or forefoot deformities for which conservative treatment failed, bar resection should be the surgical procedure of choice. Level of Evidence IV; Therapeutic Studies; Case Series.

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Radiographic and Clinical Outcomes of the Salto Talaris Total Ankle Arthroplasty

Foot & Ankle International ◽

10.1177/1071100720947030 ◽

2020 ◽

Vol 41 (12) ◽

pp. 1519-1528

Author(s):

Jonathan Day ◽

Jaeyoung Kim ◽

Martin J. O’Malley ◽

Constantine A. Demetracopoulos ◽

Jonathan Garfinkel ◽

...

Keyword(s):

Clinical Outcomes ◽

Case Series ◽

Total Ankle Arthroplasty ◽

Retrospective Case ◽

Level Of Evidence ◽

Ankle Arthroplasty ◽

Patient Reported ◽

The Mean ◽

Component Revision

Background: The Salto Talaris is a fixed-bearing implant first approved in the US in 2006. While early surgical outcomes have been promising, mid- to long-term survivorship data are limited. The aim of this study was to present the survivorship and causes of failure of the Salto Talaris implant, with functional and radiographic outcomes. Methods: Eighty-seven prospectively followed patients who underwent total ankle arthroplasty with the Salto Talaris between 2007 and 2015 at our institution were retrospectively identified. Of these, 82 patients (85 ankles) had a minimum follow-up of 5 (mean, 7.1; range, 5-12) years. The mean age was 63.5 (range, 42-82) years and the mean body mass index was 28.1 (range, 17.9-41.2) kg/m2. Survivorship was determined by incidence of revision, defined as removal/exchange of a metal component. Preoperative, immediate, and minimum 5-year postoperative AP and lateral weightbearing radiographs were reviewed; tibiotalar alignment (TTA) and the medial distal tibial angle (MDTA) were measured to assess coronal talar and tibial alignment, respectively. The sagittal tibial angle (STA) was measured; the talar inclination angle (TIA) was measured to evaluate for radiographic subsidence of the implant, defined as a change in TIA of 5 degrees or more from the immediately to the latest postoperative lateral radiograph. The locations of periprosthetic cysts were documented. Preoperative and minimum 5-year postoperative Foot and Ankle Outcome Score (FAOS) subscales were compared. Results: Survivorship was 97.6% with 2 revisions. One patient underwent tibial and talar component revision for varus malalignment of the ankle; another underwent talar component revision for aseptic loosening and subsidence. The rate of other reoperations was 21.2% ( n = 18), with the main reoperation being exostectomy with debridement for ankle impingement ( n = 12). At final follow-up, the average TTA improved 4.4 (± 3.8) degrees, the average MDTA improved 3.4 (± 2.6) degrees, and the average STA improved 5.3 (± 4.5) degrees. Periprosthetic cysts were observed in 18 patients, and there was no radiographic subsidence. All FAOS subscales demonstrated significant improvement at final follow-up. Conclusions: We found the Salto Talaris implant to be durable, consistent with previous studies of shorter follow-up lengths. We observed significant improvement in radiographic alignment as well as patient-reported clinical outcomes at a minimum 5-year follow-up. Level of Evidence: Level IV, retrospective case series.

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Preliminary Outcomes of Calcaneal Lengthening in Adolescent Flatfoot in Müller-Weiss Disease

Foot & Ankle International ◽

10.1177/1071100719833928 ◽

2019 ◽

Vol 40 (7) ◽

pp. 803-807 ◽

Cited By ~ 4

Author(s):

Abdel-Salam Abdel-Aleem Ahmed ◽

Mahmoud Ibrahim Kandil ◽

Eslam Abdelshafi Tabl

Keyword(s):

Treatment Options ◽

Case Series ◽

Deformity Correction ◽

Functional Results ◽

The Body ◽

Retrospective Case ◽

Level Of Evidence ◽

Duration Of Symptoms ◽

The Mean ◽

Calcaneal Lengthening

Background: Müller-Weiss disease (MWD) remains a controversial painful foot condition without consensus on its pathogenesis or a gold standard treatment modality. The aim of the study was to evaluate the outcomes of calcaneal lengthening in adolescent patients with symptomatic MWD with flatfoot. Methods: The study included 13 feet of 7 patients including 5 females and 2 males who were treated from March 2012 until June 2015 by calcaneal lengthening. The mean age was 15.6 years. The mean duration of symptoms was 13.5 months. The body mass index (BMI) averaged 28.9 kg/m2 at presentation. The patients were followed up for a mean of 37.8 months. Results: The osteotomy healed in all cases after a mean of 7.2 weeks. The second foot was operated on after an average of 11.5 months. The mean talometatarsal-1 angle improved from 39.8 degrees preoperatively to 5.9 degrees. The mean preoperative calcaneal pitch angle of 7.5 degrees increased to an average of 17.8 degrees postoperatively. The mean American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot Score was improved from 61.9 preoperatively to 94.2 postoperatively. Four patients had occasional exertional pain. Four feet had mild residual forefoot abduction. Arthrodesis was not needed in any case by the last follow-up. Conclusion: Early diagnosis of MWD with flatfoot was important and allowed for nonfusion treatment options. Calcaneal lengthening osteotomy in selected MWD cases achieved satisfactory outcomes with pain control, deformity correction, and improvement of the functional results. Level of Evidence: Level IV, retrospective case series.

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Lateral Transfer of the Flexor Digitorum Longus for Peroneal Tendinopathy

Foot & Ankle International ◽

10.1177/1071100719853297 ◽

2019 ◽

Vol 40 (9) ◽

pp. 1012-1017 ◽

Cited By ~ 1

Author(s):

Thomas I. Sherman ◽

Kimberly Koury ◽

Jakrapong Orapin ◽

Lew C. Schon

Keyword(s):

Average Power ◽

Case Series ◽

Peroneal Tendon ◽

Flexor Digitorum Longus ◽

Retrospective Case ◽

Level Of Evidence ◽

Function Index ◽

The Mean ◽

Flexor Digitorum

Background: Few studies have reported midterm outcomes after single-stage flexor digitorum longus (FDL) tendon transfer to the lateral foot for irreparable rupture of the peroneal tendons. Methods: Over a 7-year period (2008-2015), 25 consecutive patients underwent transfer of the FDL to the fifth metatarsal for irreparable peroneal tendon tears. Of these, 15 patients were available for inclusion with a mean follow-up of 53.7 ± 23.3 months, mean age at surgery of 48.4 years, and mean body mass index (BMI) of 29.8 kg/m2. Patients completed the pain visual analog scale (VAS), Foot Function Index (FFI), Short Musculoskeletal Function Assessment (SMFA), and Foot and Ankle Ability Measure (FAAM) and participated in range of motion, peak force, and peak power testing. Results: All 15 patients were satisfied with their surgery and reported a reduction in their pain level with a decreased VAS of 5.6 ± 2.5. The mean FFI was 12.8 ± 9.2, the SMFA Function Index was 12.4 ± 8, and the mean SMFA Bothersome Index was 11.5 ± 11. The mean FAAM was 86.4 ± 9.7. Patients had on average 58% less eversion and 28% less inversion compared with the nonoperative side. Isometric peak torque and isotonic peak velocity were 38.4% and 28.8% less compared with the contralateral side, respectively. The average power in the operative limb was diminished by 56% compared with the nonoperative limb. Conclusion: In this small case series with midterm follow-up, FDL transfer to the lateral foot for significant, irreparable peroneal tendinopathy was an effective and durable treatment option. Level of Evidence: Level IV, retrospective case series.

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Management of Juvenile Hallux Valgus Deformity: the role of combined Hemiepiphysiodesis

BMC Musculoskeletal Disorders ◽

10.1186/s12891-019-2867-7 ◽

2019 ◽

Vol 20 (1) ◽

Author(s):

Ming-Hung Chiang ◽

Ting-Ming Wang ◽

Ken N. Kuo ◽

Shier-Chieg Huang ◽

Kuan-Wen Wu

Keyword(s):

Hallux Valgus ◽

Skeletal Maturity ◽

Proximal Phalanx ◽

Case Series ◽

Large Degree ◽

Retrospective Case ◽

Level Of Evidence ◽

Hallux Valgus Deformity ◽

The Mean

Abstract Background This study aimed to investigate the efficacy of percutaneous hemiepiphysiodesis for gradual correction of symptomatic juvenile hallux valgus (HV) deformity. Methods Between 2012 to 2014, 24 patients with symptomatic juvenile HV were treated by combined percutaneous medial drilling hemiepiphysiodesis of the first proximal phalanx and lateral transphyseal screw hemiepiphysiodesis of the first metatarsal at our institution. Twenty-one of 24 patients fulfilled inclusion criteria had a complete radiological and clinical follow-up of at least 2 years. Preoperative and postoperative radiographs of the feet were reviewed for measurements of hallux valgus angle (HVA), intermetatarsal angle (IMA), proximal metatarsal articular angle (PMAA), proximal phalangeal articular angle (PPAA), and metatarsal length ratio (MTLR). Clinical outcomes were assessed using the AOFAS hallux metatarsophalangeal-interphalangeal score. Results The study included 21 consecutive patients (37 ft) for analysis. The mean age at surgery was 12.0 years (SD = 1.3) and mean follow-up after surgery was 35.1 months (SD = 6.0). With the data available, the HV deformity improved in terms of the reduction of HVA by a mean of 4.7 degrees (P < .001) and the reduction of IMA by 2.2 degrees (P < .001). The PMAA and PPAA also improved significantly in the anteroposterior plane; however, the PMAA difference was insignificant in lateral plane as expected. The mean difference in the MTLR was 0.00 (P = .216) which was indicative of no length discrepancy between first and second metatarsals. The AOFAS score increased from 68.7 to 85.2 (P < .001). In correlation analysis, time to physeal closure was significantly correlated with the final HVA change (r = −.611, P = .003). Conclusion Although combined hemiepiphysiodesis does not create a large degree of correction as osteotomy, yet it did improve HV deformity with adequate growth remaining in our series. It is a procedure that can be of benefit to patients with symptomatic juvenile HV from this minimal operative approach before skeletal maturity. Level of evidence Level IV, retrospective case series.

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Radiographic Assessment of Relative First Metatarsal Length Following Modified Lapidus Procedure

Foot & Ankle International ◽

10.1177/1071100720924016 ◽

2020 ◽

Vol 41 (8) ◽

pp. 972-977 ◽

Cited By ~ 1

Author(s):

Wessel Greeff ◽

Andrew Strydom ◽

Nikiforos Pandelis Saragas ◽

Paulo Norberto Faria Ferrao

Keyword(s):

Hallux Valgus ◽

Sagittal Plane ◽

Case Series ◽

Relative Length ◽

Long Term Results ◽

Retrospective Case ◽

Level Of Evidence ◽

First Metatarsal ◽

Patient Reported ◽

The Mean

Background: The modified Lapidus is a surgical procedure for managing moderate to severe hallux valgus, especially in the presence of first tarsometatarsal joint arthritis or hypermobility. It has good long-term results but reportedly can lead to transfer metatarsalgia due to inherent shortening of the first metatarsal. Methods: A retrospective analysis of all adult patients who underwent a modified Lapidus procedure during a 3-year period was performed. Clinical notes were evaluated to look for nonunion or any other complications related to the surgery. Pre- and postoperative standard weightbearing radiographs were used to establish the relative metatarsal length (RML), intermetatarsal angle (IMA), hallux valgus angle (HVA), and distal metatarsal articular angle (DMMA). A total of 69 modified Lapidus procedures were identified, with 32 included in the study. Results: The mean pre- and postoperative RMLs were −0.8 and −4.9 mm, respectively. The average RML shortening due to the procedure was −4.1 ( P < .0001). The mean pre- and postoperative IMAs were 15 and 5 degrees, respectively ( P < .0001). The mean pre- and postoperative HVAs were 33 and 9 degrees, respectively ( P < .0001). One patient reported transfer metatarsalgia, which was attributed to elevation of the first metatarsal. Conclusion: We found a statistically significant degree of shortening of the relative length of the first metatarsal without any clinically significant metatarsalgia. The low rate of transfer metatarsalgia following the modified Lapidus procedure could be attributed to the sagittal plane correction and stability obtained by performing a first tarsometatarsal fusion. Level of Evidence: Level IV, retrospective case series.

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