Reconstructive Operations in Static Foot Deformity

In 92 patients with static foot deformities of II-IV degrees 159 operations were performed. Surgical treatment had for an object to eliminate first ray adduction and stabilize of forefoot. Follow-up within 1-5 years after operation showed that in static platypodia of II degree the resection of exostosis in combination with subcapital wedge-shaped resection of first metatarsal did not prevent the recurrence of great toe valgus deviation. The more effective method was operation by Shede-Brandes and corrective osteotomies of first metatarsal methaphysis using bone graft or porous implant. Fixation of fragments was performed by S-shaped bow with shape memory. In static platypodia of III degree good long-term functional result was achieved after double osteotomy by Logroscino. In patients with static platypodia of IV degree good results were achieved in combination of Logroscino operation with synostosis of first-second or first-third metatarsals by tightening bow with shape memory foot.

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Normative Distribution of First Metatarsal Axial Rotation

Foot & Ankle International ◽

10.1177/10711007211001015 ◽

2021 ◽

pp. 107110072110010

Author(s):

Jesse Steadman ◽

Neil Bakshi ◽

Christopher Arena ◽

Richard Leake ◽

Alexej Barg ◽

...

Keyword(s):

Plain Radiograph ◽

Axial Rotation ◽

Valgus Deformity ◽

Intraobserver Reliability ◽

Foot Deformities ◽

Level Of Evidence ◽

Mean Values ◽

First Metatarsal ◽

Hallux Valgus Deformity ◽

First Ray

Background: First metatarsal (M1) axial rotation is recognized as a clinically relevant component of hallux valgus deformity. Methods to realign the M1 in 3 dimensions have been developed. One goal of these operations is to restore normal rotation of the first ray. The aim of this study is to provide estimates for the normal distribution of M1 rotation in patients without relevant anatomic pathology. Methods: Using stringent clinical and radiographic criteria, we evaluated a set of plain radiograph and weightbearing computed tomography (WBCT) images of 62 feet from a consecutive patient database. Subjects included had normal foot alignment without bunion symptoms. M1 rotation of each foot was measured using 2 unique methods (Saltzman et al and Kim et al methods). Measurement of rotation was performed by 2 observers from coronal WBCT images. Mean values and confidence intervals (CIs) of M1 rotation were calculated for each method. Inter- and intraobserver reliability values were also reported. Results: Mean M1 rotation values of 2.1 degrees (95% CI: 0.9-3.4) and 6.1 degrees (95% CI: 4.4-7.8) were identified using the Saltzman et al and Kim et al methods, respectively. Inter- and intraobserver reliability values were interpreted as excellent for both methods. Conclusion: In this study, we describe the natural distribution of the M1 axial rotation in subjects without bunion or other identifiable bony foot deformities. This information should provide a normative reference for surgeons correcting rotational issues of the first metatarsal. Level of Evidence: Level III.

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Use of small cannulated screws for fixation in foot surgery

Journal of the American Podiatric Medical Association ◽

10.7547/87507315-90-5-240 ◽

2000 ◽

Vol 90 (5) ◽

pp. 240-246 ◽

Cited By ~ 3

Author(s):

AE Burns

Keyword(s):

Effective Means ◽

Bone Screws ◽

Cannulated Screws ◽

Implant Fixation ◽

Foot Surgery ◽

Fixation Failure ◽

Untoward Event ◽

Patient Noncompliance

Use of cannulated bone screws, as compared with use of traditional bone screws, has been reported to decrease surgical time, allow for more precise screw placement, and reduce sources of error. Cannulation of the smaller-size screws that are routinely used in foot surgery has not been available until the last few years. This article reports on the use of the small cannulated screws manufactured by Alphatec Manufacturing, Inc (Palm Desert, California). The screw sizes available in the Mini Lag Screw System are 2.7, 3.5, and 4.0 mm. A long-term clinical and radiographic prospective evaluation of 70 procedures performed on 49 patients was conducted. The follow-up time for all patients was 2 years. None of the 70 implants fractured, and seven procedures (in seven patients) resulted in some type of implant-fixation failure. All of the fixation failures, however, appeared to be related to an untoward event or patient noncompliance. These smaller cannulated screws proved to be a reliable and effective means of fixation in foot surgery.

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Congenital Talipes Equinovarus (CTEV)

e-CliniC ◽

10.35790/ecl.v8i2.30180 ◽

2020 ◽

Vol 8 (2) ◽

Author(s):

Richardo J. Laloan ◽

Andreissanto C. Lengkong

Keyword(s):

Surgical Treatment ◽

Quantitative Measurement ◽

Foot Deformities ◽

Congenital Talipes Equinovarus ◽

Talipes Equinovarus ◽

Long Term Follow Up ◽

Congenital Talipes ◽

Non Surgical Treatment

Abstract: Congenital talipes equinovarus (CTEV) is a type of foot deformities characterized with hindfoot varus, adducted metatarsus, wide arched of the foot (cavus), and equinus. Its incidence is 1.2% per 1000 births annually. Around 80% of cases occur as idiopathic type and the remaining 20% is associated with other anomaly conditions. Genetic component is considered to play a role in the occurrence of CTEV. However, up to this day, there is no exact underlying etiology that defines the exact pathogenesis of CTEV. The evolving etiology nowadays is still multifactorial. Management of CTEV varies from non-surgical treatment to surgical treatment. A number of scoring and grading using qualitative and quantitative measurement are being used nowadays to assess the severity of CTEV because this deformity needs long-term follow-up due to its tendency to relapse.Keywords: congenital talipes equinovarus, clubfoot Abstrak: Congenital talipes equinovarus (CTEV), dikenal juga dengan true clubfoot, merupakan deformitas pada kaki yang ditandai oleh adanya bentuk varus kaki belakang, adduksi metatarsus, dan adanya bentuk lengkungan kaki yang lebar (cavus) serta equinus. CTEV merupakan salah satu dari deformitas kaki pada saat lahir dengan insidensi 1,2% per 1000 kelahiran hidup per tahunnya. Pada 80% kasus terjadi secara idiopatik dan 20% dikaitkan dengan kondisi-kondisi lain. Komponen genetik diduga berperan pada CTEV, namun, sampai saat ini, belum ada etiologi pasti yang menjelaskan patogenesis CTEV. Etiologi yang berkembang sampai saat ini bersifat multifaktorial. Tatalaksana pasien CTEV bervariasi mulai dari non-operatif maupun operatif. Sejumlah pengukuran kualitatif maupun kuantitatif telah dikembangkan untuk menilai keparahan CTEV berhubung kondisi deformitas ini membutuhkan follow-up jangka panjang karena mempunyai kecenderungan untuk relaps.Kata kunci: congenital talipes equinovarus, clubfoot

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The Donor Foot in Free Toe or Joint Transfers

Journal of Hand Surgery (European Volume) ◽

10.1054/jhsb.2000.0397 ◽

2000 ◽

Vol 25 (4) ◽

pp. 382-384 ◽

Cited By ~ 11

Author(s):

X. B. YANG ◽

Y. D. GU

Keyword(s):

Metatarsophalangeal Joint ◽

Foot Deformities ◽

Case Review ◽

Dorsal Aspect ◽

Mild Reduction ◽

Second Toe

Eighty-four cases of free second toe, multiple toe or second metatarsophalangeal joint transfers were studied by case review and follow-up. The function of the donor foot had recovered completely within 6 months in 89% of patients. The wounds on the donor foot healed in 2–3 weeks in 90% of patients. Slight numbness on the dorsal aspect of the donor foot, intolerance to cold, mild reduction in push-off, scar tenderness and pain or swelling occurred in only a few patients and generally were not considered of significance. Multiple toe transfers created more donor problems in terms of healing and appearance. Some foot deformities with plantar callosities were observed at long term review. However, all patients were capable of work and normal activities.

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Mitchell Osteotomy for Hallux Valgus: Long-term Follow-up and Gait Analysis

Foot & Ankle ◽

10.1177/107110078300300402 ◽

1983 ◽

Vol 3 (4) ◽

pp. 189-196 ◽

Cited By ~ 70

Author(s):

Kurt D. Merkel ◽

Yoshihisa Katoh ◽

Einer W. Johnson ◽

Edmund Y. S. Chao

Keyword(s):

Retrospective Study ◽

Gait Analysis ◽

Hallux Valgus ◽

Age Groups ◽

Intermetatarsal Angle ◽

First Metatarsal ◽

Long Term Follow Up

In this retrospective study of 96 Mitchell first-metatarsal osteotomies performed on 69 patients with an average follow-up of 7 years, we found that more than 86% were completely satisfied and that the procedure was equally effective in all age groups. Excessive first metatarsal shortening, dorsiflexion of the osteotomy, and failure to correct the intermetatarsal angle to 10° or less correlated with poorer results. This study demonstrates a relationship between metatarsal shortening and osteotomy plan-tarflexion. Gait analysis demonstrated that these patients do not have normal foot mechanics postoperatively.

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Comparative characteristics of reconstructive surgery and percutaneous balloon dilatation in the treatment of high benign strictures of the bile ducts

Annaly khirurgicheskoy gepatologii = Annals of HPB surgery ◽

10.16931/1995-5464.20202137-144 ◽

2020 ◽

Vol 25 (2) ◽

pp. 137-144

Author(s):

S. A. Trifonov ◽

Yu. A. Kovalenko ◽

A. B. Varava ◽

R. Z. Ikramov ◽

Yu. A. Stepanova ◽

...

Keyword(s):

Bile Ducts ◽

Treatment Options ◽

Long Term Results ◽

High Recurrence Rate ◽

Percutaneous Interventions ◽

Percutaneous Balloon ◽

Reconstructive Operations ◽

Type 3

Aim: to compare the long-term results of various surgical treatment options for patients with high benign strictures of the bile ducts.Materials and methods. From 2012 to 2018, 87 patients with strictures of different levels according to the classification of E.I. Halperinwas observed. A stricture of type «0» was detected in 23 patients, type «−1» in 20, type «−2» in 31, type «−3» in 13 (E3 – 43, E4 – 31, E5 – 13 according to classification Bismuth-Strasberg). Open reconstructive interventions were performed in 63 patients, 24 percutaneous endobiliary ones.Results. Long-term results were traced in 77 (89%) patients, the follow-up period after reconstructive operations was 4.7 ± 1.6 years, after percutaneous – 2.0 ± 1.4 years. Excellent and good results according to the Terblanche classification were achieved in 31 (58%) patients after open reconstructive operations and in 18 (78%) after percutaneous transhepatic biliary drainage.Conclusion. Technically the most difficult for reconstructive and percutaneous interventions on the bile ducts with a high recurrence rate are strictures of types «−2» and «−3» (E4 and E5). A comparative analysis of the long-term results of percutaneous and open interventions showed a statistically significant advantage of percutaneous interventions compared with reconstructive (p = 0.05).

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Modified osteotomy with elevation of the first metatarsal

Scientific Journal of the Foot & Ankle ◽

10.30795/scijfootankle.2018.v12.784 ◽

2018 ◽

Vol 12 (2) ◽

pp. 140-144

Author(s):

Daniel Kamura Bueno ◽

Rafael Trevisan Ortiz ◽

Tarsis Padula Dos Santos ◽

Rafael Barban Sposeto ◽

Rodrigo Sousa Macedo ◽

...

Keyword(s):

Case Series ◽

Technical Difficulty ◽

Foot Deformities ◽

Modified Technique ◽

Level Of Evidence ◽

Radiographic Findings ◽

First Metatarsal ◽

Screw Breakage ◽

First Ray ◽

And Gender

Objective: The main objective of this study is to describe the preliminary results of modified osteotomy with elevation of the first metatarsal to repair cavovarus foot deformities. Methods: In a five-case series, radiographic findings related to the modified osteotomy with elevation of the first ray were analysed.Results: Five patients who underwent a modified osteotomy with elevation were followed up for a minimum of six months. One hundred percent consolidation rates were observed, with no complications related to the materials, such as screw breakage, screw loosening and/or pseudoarthrosis (0% of the cases), regardless of age and gender. Conclusion: The modified technique generates an osteotomy plane that is more horizontal, reducing the technical difficulty and resulting in less risk of loss of fixation during passage of the screw. Using a single screw for fixation reduces the cost of the procedure and pseudarthrosis rates. Level of Evidence IV; Therapeutic Studies; Case series.

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Management of congenital talipes equino varus using Ponseti method: 3 year follow up in 166 club feet

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20172890 ◽

2017 ◽

Vol 3 (4) ◽

pp. 775

Author(s):

Rahul Bansal ◽

Angad Jolly ◽

P. B. Mohammed Farook ◽

Idris Kamran ◽

Syed Wahaj ◽

...

Keyword(s):

Club Foot ◽

Ponseti Method ◽

Foot Deformities ◽

Non Invasive ◽

Bilateral Involvement ◽

The Past ◽

Pirani Score ◽

Congenital Talipes

Background: Our aim was to study the effectiveness of Ponseti method using Pirani score in children with club foot treated over the past three years at our hospital.Methods: We studied 111 children with 166 idiopathic club feet who were treated at our teaching hospital between period of January 2012 and January 2017.The foot deformities were assessed using Pirani score at the time of first visit and the scores were recorded with each subsequent visit, with each casting and manipulation until correction of deformity. Tenotomy was performed on all the idiopathic club feet and continued with Steenbeek foot abduction brace (FAB) and the scores were recorded with every follow up and the progress was noted. All the relevant data in terms of treatment and demographics were recorded with dates and maintained.Results: Total of 166 feet of 111 children was treated out of which 72 were males and 39 were females. 55 children had bilateral involvement remaining were unilateral. Mean Pirani score was 5.5 (range 4-6) when the treatment was started. On an average 5.7 casts (range 3-9) were required before preforming a tenotomy. Tenotomy was performed on all the feet (100%) with idiopathic club foot. Foot abduction orthosis was given to all the patients and 108 patients (97.3%) were compliant. Mean Pirani score after three years of treatment was 0.26. Skin complications like blister formation were seen in three children during the course of the treatment. Four patients did not follow up and defaulted. Three patients had relapse or worsening of Pirani score. The recurrence or worsening of scores is thought to be due to poor compliance while using the foot abduction brace.Conclusions: Ponseti method of treatment for CTEV is very effective, simple, non-invasive and convenient with excellent outcomes over long term with no significant complications.

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Changes in loading distribution in patients with Charcot foot during long-term follow-up

Diabetes Mellitus ◽

10.14341/dm9388 ◽

2018 ◽

Vol 21 (2) ◽

pp. 99-104

Author(s):

Anastasia G. Demina ◽

Vadim B. Bregovskiy ◽

Irina A. Karpova ◽

Tatiana L. Tcvetkova

Keyword(s):

Foot Deformities ◽

Charcot Foot ◽

Maximal Increase ◽

Custom Made ◽

Long Term Follow Up ◽

Maximal Peak ◽

Peak Pressures ◽

Different Parts

Background. The inactive stage of the diabetic Charcot arthropathy foot (CA) is characterised by fixed foot deformities and an absence of inflammation. However, it remains unclear if the shape of the foot and its biomechanics change during long-term follow-up. Aim. To evaluate changes in loading distribution of the affected foot, in patients with inactive CA, during long-term follow-up. Materials and methods. Twenty seven patients with unilateral inactive CA (19 females, 8 males) were studied. Computer pedography (emed AT, novel gmbh) was performed and baseline and the last studies were analysed. Maximal peak pressures (PP) were obtained for the first and the last studies and the percentage of the PP change was calculated for the total follow-up period and for periods: 24 months, 2448 months, 48 months. Results. PP increased: under the hallux 50%; 1st metatarsal30.7%; 2nd toe20%; 2nd toe6%; midfoot9%. PP decreased under 35 toes up to 67%. Significant changes at the first period were found under 35 toes only (62%). The increase in loading under the other parts of the foot appeared at 24 months; however, these changes became significant between 24 and 48 months and peaked after 48 months of follow-up. The maximal increase of PP was noticed under the hallux, the 2nd toe, metatarsals 13 and the midfoot. Conclusions. We revealed the gradual redistribution of PP, under the different parts of the foot, in patients with inactive CA. This redistribution reflects changes in the shape of the affected foot. The loading increased under the hallux, the 2nd toe and the corresponding metatarsals, 3rd metatarsal and midfoot, and decreased under the 35 toes. These changes increased during the follow-up, becoming more pronounced after 4 or more years. Our data may be useful for constructing custom-made footwear for patients with CA.

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Assessment of Partial First-Ray Resections and Their Tendency to Progress to Transmetatarsal Amputations

Journal of the American Podiatric Medical Association ◽

10.7547/1020412 ◽

2012 ◽

Vol 102 (5) ◽

pp. 412-416 ◽

Cited By ~ 13

Author(s):

John Kadukammakal ◽

Sydney Yau ◽

William Urbas

Keyword(s):

Surgical Intervention ◽

Metatarsophalangeal Joint ◽

Foot Deformities ◽

First Metatarsophalangeal Joint ◽

First Metatarsal ◽

Diabetic Foot Infections ◽

First Ray ◽

Initial Procedure ◽

Transmetatarsal Amputation ◽

Mean Time

Background: Diabetic foot infections tend to lead to amputation. Partial first-ray resections are used to help salvage the foot and maintain bipedal ambulation. Losing the first metatarsophalangeal joint has biomechanical consequences that lead to further foot deformities and result in more proximal amputations of the ipsilateral limb, such as a transmetatarsal amputation. Methods: We reviewed 48 patients (32 male and 16 female; mean age = 62.44) who underwent 50 partial first-ray resections between April 1, 2003, and July 31, 2009. These partial first-ray resections were done at various levels of the first metatarsal. We hypothesize that partial first-ray resections that require further bone resection will lead to poor biomechanics that can result in further amputation. Results: We found that out of 50 partial first-ray resections, 24 cases required further surgical intervention, 12 of which were a transmetatarsal amputation (TMA) (mean time between partial first-ray resection and TMA = 282.08 days). Forty-eight percent of patients did not require further surgical intervention and were considered a success. Conclusions: Partial first-ray resections are not highly successful. Our study found a higher success rate compared to a previous study done by Cohen et al in 1991. Partial first-ray amputations can be a good initial procedure to salvage the foot and prolong a patient’s bipedal ambulatory status, thereby lowering the patient’s morbidity and mortality. (J Am Podiatr Med Assoc 102(5): 412–416, 2012)

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