scholarly journals Effect of Mini-invasive Floating Metatarsal Osteotomy on Plantar Pressure in Patients With Diabetic Plantar Metatarsal Head Ulcers

2020 ◽  
pp. 107110072097609
Author(s):  
Eran Tamir ◽  
Michael Tamar ◽  
Moshe Ayalon ◽  
Shlomit Koren ◽  
Noam Shohat ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Plantar Pressure ◽  
Case Series ◽  
Metatarsal Head ◽  
Metatarsal Osteotomy ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Retrospective Case Series ◽  
Pressure Time ◽  
Peak Plantar Pressure

Background: Distal metatarsal osteotomy has been used to alleviate plantar pressure caused by anatomic deformities. This study’s purpose was to examine the effect of minimally invasive floating metatarsal osteotomy on plantar pressure in patients with diabetic metatarsal head ulcers. Methods: We performed a retrospective case series of prospectively collected data on 32 patients with diabetes complicated by plantar metatarsal head ulcers without ischemia. Peak plantar pressure and pressure time integrals were examined using the Tekscan MatScan prior to surgery and 6 months following minimally invasive floating metatarsal osteotomy. Patients were followed for complications for at least 1 year. Results: Peak plantar pressure at the level of the osteotomized metatarsal head decreased from 338.1 to 225.4 kPa ( P < .0001). The pressure time integral decreased from 82.4 to 65.0 kPa·s ( P < .0001). All ulcers healed within a mean of 3.7 ± 4.2 weeks. There was 1 recurrence (under a hypertrophic callus of the osteotomy) during a median follow-up of 18.3 months (range, 12.2-27). Following surgery, adjacent sites showed increased plantar pressure and 4 patients developed transfer lesions (under an adjacent metatarsal head); all were managed successfully. There was 1 serious adverse event related to surgery (operative site infection) that resolved with antibiotics. Conclusion: This study showed that the minimally invasive floating metatarsal osteotomy successfully reduced local plantar pressure and that the method was safe and effective, both in treatment and prevention of recurrence. Level of Evidence: Level III, retrospective case series of prospectively collected data.

scholarly journals Distal Chevron Osteotomy Increases Anatomic Intermetatarsal Angle in Hallux Valgus

2020 ◽  
Vol 5 (4) ◽  
pp. 247301142096071
Author(s):  
Jeremy Y. Chan ◽  
Naudereh Noori ◽  
Stephanie Chen ◽  
Glenn B. Pfeffer ◽  
Timothy P. Charlton ◽  
...  
Keyword(s):  
Hallux Valgus ◽  
Case Series ◽  
Metatarsal Osteotomy ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Intermetatarsal Angle ◽  
First Metatarsal ◽  
Retrospective Case Series ◽  
Chevron Osteotomy ◽  
Anatomic Axis

Background: Distal chevron metatarsal osteotomy (DCO) is a common technique to address hallux valgus (HV), which involves coronal translation of the capital fragment resulting in a nonanatomic first metatarsal. The purpose of this study was to evaluate the radiographic effect of the DCO on the anatomic vs the mechanical axis of the first metatarsal. Our hypothesis was that patients undergoing DCO would have improvement in the mechanical metatarsal axis but worsening of the anatomic axis. Methods: This was a retrospective case series of consecutive patients who underwent DCO for HV. The primary outcomes were the change in anatomic first–second intermetatarsal angle (a1-2IMA) vs mechanical first–second intermetatarsal angle (m1-2IMA). Secondary outcomes included the change in hallux valgus angle (HVA) and medial sesamoid position. Results: 40 feet were analyzed with a mean follow-up of 21.2 weeks. The a1-2IMA increased significantly (mean, 4.1 degrees) whereas the m1-2IMA decreased significantly (mean, 4.6 degrees) following DCO. There was a significant improvement in HVA (mean, 12.5 degrees). Medial sesamoid position was improved in 21 feet (52.5%). Patients with no improvement in sesamoid position were found to have a larger increase in a1-2IMA (mean, 4.7 vs 3.5 degrees, P = .03) and less improvement in m1-2IMA (mean, 3.8 vs 5.2 degrees, P = .02) compared to patients with improvement in sesamoid position. Conclusion: Distal chevron osteotomy for HV was associated with worsening of the anatomic axis of the first metatarsal despite improvements in the mechanical metatarsal axis, HVA, and medial sesamoid position. Greater worsening of the anatomic axis was associated with less improvement of sesamoid position. Our findings may suggest the presence of intermetatarsal instability, which could limit the power of DCO in HV correction for more severe deformities and provide a mechanism for HV recurrence. Level of Evidence: Level IV, retrospective case series.

Screws-Only Primary Subtalar Arthrodesis for Calcaneus Fractures

2022 ◽  
pp. 107110072110586
Author(s):  
Ainsley K. Bloomer ◽  
R. Randall McKnight ◽  
Nicholas R. Johnson ◽  
David M. Macknet ◽  
Meghan K. Wally ◽  
...  
Keyword(s):  
Case Series ◽  
Retrospective Case ◽  
Worker's Compensation ◽  
Level Of Evidence ◽  
Worker’S Compensation ◽  
Subtalar Arthrodesis ◽  
Sinus Tarsi ◽  
Retrospective Case Series ◽  
Sinus Tarsi Approach ◽  
Calcaneus Fractures

Background: The management of displaced intraarticular calcaneus fractures (DIACFs) is a difficult problem with disappointing results from open reduction internal fixation (ORIF). Alternatively, ORIF with primary subtalar arthrodesis (PSTA) has gained increasing popularity. The purpose of this study is to review patient-centered and radiographic outcomes of ORIF plus PSTA using only screws through a sinus tarsi approach. Methods: A retrospective study of patients who underwent ORIF+PSTA for DIACFs was conducted. The same surgical technique was used in all cases consisting of only screws; no plates were used. Delayed surgeries past 8 weeks were excluded. Demographic and radiographic data were collected including worker’s compensation claims. Plain radiographs were used to characterize injuries and review outcomes. Results: Seventy-nine DIACFs underwent PSTA with a median follow-up of 200 days (n = 69 patients). Median time to weightbearing was 57.5 days postoperatively. Ten fractures were documented as Sanders II, 36 as Sanders III, and 32 as Sanders IV. Sixty-eight fractures (86.1%) achieved fusion on radiographs at a median of 126.5 (range, 54-518) days. Thirty-nine fractures (57.3%) demonstrated radiographic fusion in all 3 predefined locations. Nine of the 14 worker’s compensation patients returned to work within the period of observation. There were 8 complications: 3 requiring a secondary operation. Eleven of 79 fractures treated did not go on to achieve radiographic union. Conclusion: In this retrospective case series, we found that screws-only primary subtalar arthrodesis for the treatment of DIACFs through a sinus tarsi approach was associated with relatively high rates of return to work and radiographic fusion. Level of Evidence: Level IV, retrospective case series.

Three-Dimensional Analysis of the First Metatarsal Bone in Minimally Invasive Distal Linear Metatarsal Osteotomy for Hallux Valgus

2019 ◽  
Vol 41 (1) ◽  
pp. 84-93 ◽  
Author(s):  
Hiroyuki Seki ◽  
Satoshi Oki ◽  
Yasunori Suda ◽  
Kenichiro Takeshima ◽  
Tetsuro Kokubo ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Hallux Valgus ◽  
Morphological Changes ◽  
Case Series ◽  
Metatarsal Bone ◽  
Ct Scans ◽  
Metatarsal Osteotomy ◽  
Level Of Evidence ◽  
3 Dimensional ◽  
First Metatarsal

Background: Modified Bösch osteotomy (distal linear metatarsal osteotomy [DLMO]) is one of the minimally invasive correctional surgeries for hallux valgus. The 3-dimensional correctional angles and distances of the first metatarsal bone in DLMO have not been clarified. The purpose of this study was to analyze the 3-dimensional postoperative morphological changes of the first metatarsal bone in DLMO. Methods: Twenty patients (30 feet) who underwent DLMO were enrolled. Preoperative plain radiographs and computed tomography (CT) scans of the feet were examined. Postoperative radiographs and CT scans were also obtained after bone union. The surface data of the pre- and postoperative first metatarsals were reconstructed from the CT data. The positions of the distal ends of the first metatarsals described with respect to the proximal ends were calculated using CT surface-matching technique. Results: The distal end of the first metatarsal after DLMO was significantly supinated (10.2 ± 6.0 degrees, P < .001), adducted (6.0 ± 11.8 degrees, P = .004), dorsiflexed (11.1 ± 10.9, P < .001), shortened (7.4 ± 2.5 mm, P < .001), elevated (2.3 ± 3.1 mm, P = .001), and laterally shifted (8.2 ± 3.0 mm, P < .001) compared to the preoperative metatarsal distal end. Supination correction demonstrated a significant correlation with adduction correction ( r = 0.659, P < .001) on correlation analyses between these parameters. Conclusion: The 3-dimensional corrections of the first metatarsal bone after DLMO were evaluated. Pronation and abduction were successfully corrected. Furthermore, adduction correction might be an important factor affecting correction of pronation. Level of Evidence: Level IV, retrospective case series.

Syndesmotic Fixation Utilizing a Novel Screw: A Retrospective Case Series Reporting Early Clinical and Radiographic Outcomes

2019 ◽  
Vol 13 (5) ◽  
pp. 397-403 ◽  
Author(s):  
Derek Stenquist ◽  
Brian T. Velasco ◽  
Patrick K. Cronin ◽  
Jorge Briceño ◽  
Christopher P. Miller ◽  
...  
Keyword(s):  
Weight Bearing ◽  
Case Series ◽  
Break Point ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Radiographic Outcomes ◽  
Retrospective Case Series ◽  
Screw Breakage ◽  
Tissue Stabilization

Background. Syndesmotic disruption occurs in 20% of ankle fractures and requires anatomical reduction and stabilization to maximize outcomes. Although screw breakage is often asymptomatic, the breakage location can be unpredictable and result in painful bony erosion. The purpose of this investigation is to report early clinical and radiographic outcomes of patients who underwent syndesmotic fixation using a novel metal screw designed with a controlled break point. Methods. We performed a retrospective review of all patients who underwent syndesmotic fixation utilizing the R3lease Tissue Stabilization System (Paragon 28, Denver, CO) over a 12-month period. Demographic and screw-specific data were obtained. Postoperative radiographs were reviewed, and radiographic parameters were measured. Screw loosening or breakage was documented. Results. 18 patients (24 screws) met inclusion criteria. The mean follow-up was 11.7 months (range = 6.0-14.7 months). 5/24 screws (21%) fractured at the break point. No screw fractured at another location, nor did any fracture prior to resumption of weight bearing; 19 screws did not fracture, with 8/19 intact screws (42.1%) demonstrating loosening. There was no evidence of syndesmotic diastasis or mortise malalignment on final follow-up. No screws required removal during the study period. Conclusion. This study provides the first clinical data on a novel screw introduced specifically for syndesmotic fixation. At short-term follow up, there were no complications and the R3lease screw provided adequate fixation to allow healing and prevent diastasis. Although initial results are favorable, longer-term follow-up with data on cost comparisons and rates of hardware removal are needed to determine cost-effectiveness relative to similar implants. Level of Evidence: Level IV: Retrospective case series

Sever’s Disease: What Does the Literature Really Tell Us?

2008 ◽  
Vol 98 (3) ◽  
pp. 212-223 ◽  
Author(s):  
Rolf W. Scharfbillig ◽  
Sara Jones ◽  
Sheila D. Scutter
Keyword(s):  
Health Professionals ◽  
Case Series ◽  
Review Of The Literature ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Comprehensive Review ◽  
Musculoskeletal Conditions ◽  
Low Level ◽  
Retrospective Case Series

Background: Sever’s disease is typical of many musculoskeletal conditions where observational annotations have slowly been accepted as fact with the passing of years. Acceptance of these nontested observations means that health professionals seeking information on this condition access very low-level evidence, mainly being respectable opinion or poorly conducted retrospective case series. Methods: A comprehensive review of the literature was undertaken gathering available articles and book references relating to Sever’s disease. This information was then reviewed to present what is actually known about this condition. Results: Respectable opinion and poorly conducted retrospective case series make up the majority of evidence on this condition. Conclusion: The level of evidence for most of what we purport to know about Sever’s disease is at such a level that prospective, well-designed studies are a necessity to allow any confidence in describing this condition and its treatment. (J Am Podiatr Med Assoc 98(3): 212–223, 2008)

Proximal Spherical Metatarsal Osteotomy for the Foot with Severe Hallux Valgus

2008 ◽  
Vol 29 (10) ◽  
pp. 1025-1030 ◽  
Author(s):  
Yasuhito Tanaka ◽  
Yoshinori Takakura ◽  
Tsukasa Kumai ◽  
Kazuya Sugimoto ◽  
Akira Taniguchi ◽  
...  
Keyword(s):  
Hallux Valgus ◽  
Plantar Flexion ◽  
Case Series ◽  
Osteotomy Site ◽  
Metatarsal Osteotomy ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Tarsometatarsal Joint ◽  
Combined Operations ◽  
Severe Hallux Valgus

Background: A proximal spherical metatarsal osteotomy was devised to correct not only varus deviation of the first metatarsal, but also dorsiflexion. We expected to increase the medial longitudinal arch by adding plantar flexion at the osteotomy site. To investigate the limitations of this procedure for feet with severe hallux valgus, a followup study was performed on patients with preoperative hallux valgus angles greater than or equal to 40 degrees. Materials and Methods: Forty-eight feet in 37 patients (10 male, 27 female) (60 years; range, 20 to 84 years) were investigated. Mean followup was 4 years and 1 month, ranging from 2 to 8 years. The spherical osteotomy was performed using a curved chisel. A distal soft tissue procedure was done at the same time. Twenty feet received combined operations for their combined deformities. Results: While 81% of patients were satisfied with the results, 50% of those with preoperative hallux valgus angles greater than or equal to 50 degrees had postoperative hallux valgus angle greater than or equal to 20 degrees. In these patients, correction of metatarsus primus varus was good, but correction of valgus deviation of the hallux was fair. Mean correction toward plantar flexion was 1.5 degrees and no increase in arch height was achieved. Conclusion: The proximal spherical osteotomy could consistently achieve satisfactory results for the patients with hallux valgus angles less than 50 degrees. However, the corrections were worse in feet with more severe deformities. Furthermore, plantarflexion at the osteotomy site was offset by displacement at the first tarsometatarsal joint. If plantarflexion is indispensable, arthrodesis of the tarsometatarsal joint is recommended. Level of Evidence: IV, Retrospective Case Series

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