Surgery in Advanced Charcot-Marie-Tooth Disease

Foot & Ankle ◽  
1984 ◽  
Vol 4 (5) ◽  
pp. 267-273 ◽  
Author(s):  
Nathaniel Gould
Keyword(s):  
Metatarsophalangeal Joint ◽  
Extensor Tendon ◽  
Flexor Hallucis Longus ◽  
Great Toe ◽  
First Metatarsophalangeal Joint ◽  
Charcot Marie Tooth ◽  
Charcot Marie Tooth Disease ◽  
First Metatarsal ◽  
Tooth Disease

Crippling equinocavovarus position of the foot in advanced Charcot-Marie-Tooth disease with its attendant metatarsalgia tender calluses and rigidity creates painful, limited, hobbling ambulation with lowered work and general activity tolerance. The object of the surgeries is to convert this foot into a plantigrade, more flexible, painless unit. Surgery consists of plantar fasciotomies off the tubercle of the os caleis and also transversely through the middle of the longitudinal arch. Dorsally angulated green-stick osteotomies are performed at the bases of all the metatarsals. A Jones operation with transfer of the long extensor great toe tendon through the neck and head of the first metatarsal and arthrodesis of the IP joint of the great toe complete the surgery. Often it is necessary to do Bunnell repair lengthening of the flexor hallucis longus tendon. Occasionally, the first metatarsophalangeal joint needs dorsal capsulotomy and lengthening of the short extensor tendon. Variations in and simplicity of techniques are demonstrated with a case report. Ten patients (eight men and two women: 18 feet), ranging in age from 18 to 46 years (average age, 29 years), with a 3- to 6-year follow-up are herein reported. Correction has been maintained in the oldest case.

The Simple Bunion: Anatomy at the Metatarsophalangeal Joint of the Great Toe

Foot & Ankle ◽  
1984 ◽  
Vol 4 (5) ◽  
pp. 229-240 ◽  
Author(s):  
Richard Alvarez ◽  
Ray J. Haddad ◽  
Nathaniel Gould ◽  
Saul Trevino
Keyword(s):  
Metatarsophalangeal Joint ◽  
Valgus Deformity ◽  
Metatarsal Osteotomy ◽  
Great Toe ◽  
First Metatarsophalangeal Joint ◽  
First Metatarsal ◽  
Hallux Valgus Deformity ◽  
Sesamoid Bones ◽  
Proper Interpretation

The pathomechanics for the development of the hallux valgus deformity takes place at the first metatarsophalangeal joint-the sesamoid complex. The sesamoid complex consists of seven muscles, eight ligaments, and two sesamoid bones. When the first metatarsal escapes the complex and drifts medially, the sesamoids remain twisted in situ, several of the ligaments “fail,” and others contract. The authors propose reduction of the metatarsus primus varus by first metatarsal osteotomy and appropriate ligament releases and plications to restore alignment. A detailed understanding of the pathomechanics is essential for proper interpretation of the problems and anticipated lasting surgeries.

The Mayday Distal First Metatarsal Osteotomy for Hallux Valgus: A Review After the Introduction of a New Instrument

1997 ◽  
Vol 18 (1) ◽  
pp. 3-7 ◽  
Author(s):  
G.D. Terzis ◽  
F. Kashif ◽  
M.A.S. Mowbray
Keyword(s):  
Hallux Valgus ◽  
Metatarsophalangeal Joint ◽  
Metatarsal Osteotomy ◽  
Distal Fragment ◽  
Short Term ◽  
First Metatarsophalangeal Joint ◽  
First Metatarsal ◽  
Satisfactory Outcome ◽  
New Instrument

We present the short-term follow-up of 55 symptomatic hallux valgus deformities in 38 patients, treated operatively with a modification of the spike distal first metatarsal osteotomy, as described by Gibson and Piggott in 1962. The age range of the patients was 17 to 72 years at the time of surgery. The postoperative follow-up period was 12 to 55 months. Excellent and good clinical and radiographic results were recorded in 96.2% of our patients. Two of the patients (3.8%) were dissatisfied; one of them complained of metatarsalgia after the procedure, and the other had stiffness of the metatarsophalangeal joint and metatarsalgia that had been present before surgery. Three others (5.45%) required revision after early postoperative displacement but were asymptomatic subsequently. We concluded that our technique is an effective method of treating mild hallux valgus deformities with the advantages of simplicity, no shortening of the first metatarsal, and no risk of dorsal tilting of the distal fragment. Hallux valgus (lateral deviation of the great toe) is not a single disorder, as the name implies, but a complex deformity of the first ray that sometimes may involve the lesser toes. More than 130 procedures exist for the surgical correction of hallux valgus, which means that no treatment is unique. No single operation is effective for all bunions. 5 , 22 , 29 The objectives of surgical treatment are to reduce pain, to restore articular congruency, and to narrow the forefoot without impairing function, by transferring weight to the lesser metatarsals either by shortening or by dorsal tilting of the first metatarsal. 5 , 19 , 24 , 27 Patient selection is important for a satisfactory outcome after surgery of any kind, and our criteria were age, degree of deformity, presence of arthrosis, and subluxation of the first metatarsophalangeal joint. 1 , 5 , 13 , 19 – 21 , 24 , 29 In this study, we present a new method of treating hallux valgus that has been used at Mayday University Hospital since 1990. The technique was first described at the British Orthopaedic Foot Surgery Society, Liverpool, November 1990, 7 and we now present the short-term follow-up results. The procedure is essentially a modification of the spike osteotomy of the neck of the first metatarsal, as described by Gibson and Piggott. 9 It has the advantages of simplicity, no shortening of the first metatarsal, and no risk of dorsal displacement of the distal fragment.

Fifteen-year longitudinal follow-up of a patient with severe early-onset Charcot-Marie-Tooth disease type 2A

2018 ◽  
Vol 57 (5) ◽  
pp. E126-E128
Author(s):  
Brett A. McCray ◽  
William Hurst ◽  
Thomas O. Crawford ◽  
Thomas E. Lloyd
Keyword(s):  
Early Onset ◽  
Disease Type ◽  
Charcot Marie Tooth ◽  
Charcot Marie Tooth Disease ◽  
Tooth Disease

Atypical Medial Dislocation of the First Metatarsophalangeal Joint

1998 ◽  
Vol 19 (9) ◽  
pp. 624-626 ◽  
Author(s):  
Leo Massari ◽  
Tommaso Ventre ◽  
Antonio lirillo
Keyword(s):  
Motor Vehicle ◽  
Motor Vehicle Accident ◽  
Metatarsophalangeal Joint ◽  
Complete Recovery ◽  
Great Toe ◽  
Cast Immobilization ◽  
First Metatarsophalangeal Joint ◽  
Unusual Event ◽  
Vehicle Accident

Medial dislocation of the great toe without fracture or sesamoid separation is an unusual event. We are reporting such a case which occurred in a man after a motor vehicle accident. The patient was treated with closed reduction and cast immobilization. The patient recovered all his activities after 30 days. Three-year follow-up showed a complete recovery, clinically and radiographically, with only slight radiographic signs of osteoarthritis, which was present also in the contralateral foot.

Silastic Ball Spacer Arthroplasty in the Management of Hallux Valgus and Hallux Rigidus

Foot & Ankle ◽  
1989 ◽  
Vol 10 (2) ◽  
pp. 61-64 ◽  
Author(s):  
N. S. Broughton ◽  
A. Doran ◽  
B. F. Meggitt
Keyword(s):  
Hallux Valgus ◽  
Young Patients ◽  
Metatarsophalangeal Joint ◽  
Hallux Rigidus ◽  
New Bone Formation ◽  
Great Toe ◽  
First Metatarsophalangeal Joint ◽  
Proximal Migration ◽  
Original Concept

Sixty-two feet in 39 patients who were treated by insertion of a silastic ball spacer prosthesis into the first metatarsophalangeal joint for hallux valgus or hallux rigidus have been reviewed with a follow-up time of between 2 and 6 years. Twenty-one results (34%) were excellent, 27 (43%) were fair, 13 (21%) were poor, and one was revised. Seventeen feet (27%) had some metatarsalgia at followup. Results were disappointing in the young patients; in 19 cases of hallux valgus under the age of 45, 8 were either poor or had been revised. The original concept of the silastic ball spacer was to maintain great toe length and prevent proximal migration of the sesamoids. However 60% of these feet showed settling of the prosthesis or new bone formation around the prosthesis and 54% had more than 2 mm proximal migration of the sesamoid bones. The symptomatic results in these patients were similar to those in whom great toe length had been successfully maintained. The silastic ball spacer infrequently achieves its aims, however maintenance of hallux length does not seem to be important in the symptomatic result.

Treatment of Hallux Valgus by Oblique Osteotomy of the First Metatarsal

Foot & Ankle ◽  
1992 ◽  
Vol 13 (8) ◽  
pp. 447-452 ◽  
Author(s):  
Kosaku Mizuno ◽  
Masataka Hashimura ◽  
Mayako Kimura ◽  
Kazushi Hirohata
Keyword(s):  
Hallux Valgus ◽  
Metatarsophalangeal Joint ◽  
Valgus Deformity ◽  
X Rays ◽  
Great Toe ◽  
First Metatarsal ◽  
Oblique Osteotomy ◽  
Hallux Valgus Deformity ◽  
Valgus Angle

This paper describes a simple technique of oblique osteotomy of the first metatarsal for treatment of symptomatic hallux valgus deformity. The osteotomy is performed at a 30° angle from the long axis of the metatarsal shaft. The head of the metatarsal is then displaced laterally to provide correction of the hallux valgus. This is an uncomplicated procedure for the treatment of hallux valgus. From 1984 through 1989, 53 feet in 31 patients were treated with an oblique osteotomy of the first metatarsal. A total of 49 feet in 27 patients were followed up more than 2 years. The follow-up x-rays and clinical examinations revealed a good result in 43 feet. In six feet of three patients, all of whom had simultaneous oblique osteotomies of both the first and second metatarsals, a fair or poor result was obtained. It was learned that oblique osteotomy for hallux valgus greater than 40° provided insufficient correction of the valgus angle or limitation of motion at the metatarsophalangeal joint of the great toe.

Triple Arthrodesis in the Treatment of Fixed Cavovarus Deformity in Adolescent Patients with Charcot-Marie-Tooth Disease

Foot & Ankle ◽  
1992 ◽  
Vol 13 (1) ◽  
pp. 1-6 ◽  
Author(s):  
David C. Mann ◽  
John D. Hsu
Keyword(s):  
Residual Deformity ◽  
Triple Arthrodesis ◽  
Charcot Marie Tooth ◽  
Charcot Marie Tooth Disease ◽  
Adolescent Patients ◽  
The Face ◽  
Progressive Disorder ◽  
Recurrent Deformity ◽  
Tooth Disease

Ten adolescent patients with Charcot-Marie-Tooth disease (12 feet) were evaluated an average of 7 years, 7 months following triple arthrodesis (TA) for the treatment of cavovarus deformity. The TA was the primary or index bone procedure. At follow-up, five feet were plantigrade, asymptomatic, and radiographically fused at all three joints. Three feet were plantigrade and asymptomatic, but two had talonavicular pseudarthrosis and one had calcaneocuboid pseudarthrosis. Three feet were radiographically fused at all three joints, but in nonplantigrade positions and symptomatic. One foot required a revision TA. In general, TA offers adolescent Charcot-Marie-Tooth patients a stable plantigrade foot in the face of a progressive disorder. The residual deformity, revision, and pseudarthrosis rates are similar to those for adults. Postoperative pain was related to a nonplantigrade foot and not to the presence of pseudarthrosis. It is not known whether a nonplantigrade foot was a result of incomplete surgical correction or recurrent deformity due to progressive muscle imbalance.

scholarly journals Changes of gait pattern in children with Charcot-Marie-Tooth disease type 1A: a 18 months follow-up study

2013 ◽  
Vol 10 (1) ◽  
pp. 65 ◽  
Author(s):  
Maurizio Ferrarin ◽  
Tiziana Lencioni ◽  
Marco Rabuffetti ◽  
Isabella Moroni ◽  
Emanuela Pagliano ◽  
...  
Keyword(s):  
Gait Pattern ◽  
Disease Type ◽  
Charcot Marie Tooth ◽  
Charcot Marie Tooth Disease ◽  
Follow Up Study ◽  
Tooth Disease
Sign in / Sign up

Export Citation Format

Share Document