scholarly journals Cavus Foot Correction Using a Full Percutaneous Procedure: A Case Series

2021 ◽  
Vol 18 (19) ◽  
pp. 10089
Author(s):  
Rodrigo Schroll Astolfi ◽  
José Victor de Vasconcelos Coelho ◽  
Henrique César Temóteo Ribeiro ◽  
Alexandre Leme Godoy dos Santos ◽  
José A. Dias Leite
Keyword(s):  
Minimally Invasive ◽  
Bone Healing ◽  
Weight Bearing ◽  
Wound Complications ◽  
Invasive Technique ◽  
Wedge Osteotomy ◽  
Closing Wedge Osteotomy ◽  
First Metatarsal ◽  
Closing Wedge ◽  
Cavus Foot

Cavus foot is a tri-planar deformity that requires correction in several bones and soft tissue. Minimally invasive surgeries are less aggressive, faster and easier to recover from. Here, we describe the initial results of a technique for percutaneous cavus foot correction. The procedure consists of calcaneal dorsal/lateral closing wedge osteotomy (with fixation), cuboid, medial cuneiform and first metatarsal closing wedge osteotomy (without fixation), and plantar fascia and tibialis posterior tenotomy with the patient in the prone position. Immediate weight bearing is permitted. Twenty patients were selected to undergo the procedure. The mean follow-up was 4.2 months and mean age 42.3 years. Eight of the 20 patients were submitted to cuboid and first metatarsal osteotomy, and 12 (60%) only calcaneal osteotomy. The median time for complete bone healing was 2.2 months. No wound complications were observed. No cases of non-consolidation of the cuboid or first metatarsal osteotomies were detected. The most common complication was sural nerve paresthesia. This is the first description of cavus foot correction using a minimally invasive technique. Complete bone healing is obtained even with immediate weight bearing and without cuboid and first metatarsal fixation.

scholarly journals Correction of Valgus Lesser Toes by Percutaneous Closing Wedge Osteotomy of the Proximal Phalanx

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0039
Author(s):  
Robbie Ray ◽  
Peter W. Robinson ◽  
Paul M. Dearden ◽  
Thomas A. Goff ◽  
Peter Lam ◽  
...  
Keyword(s):  
Sagittal Plane ◽  
Weight Bearing ◽  
Proximal Phalanx ◽  
Valgus Deformity ◽  
Coronal Plane ◽  
Wound Complications ◽  
Wedge Osteotomy ◽  
Continuous Variables ◽  
Closing Wedge Osteotomy ◽  
Closing Wedge

Category: Lesser Toes; Bunion Introduction/Purpose: Deformities of the lesser toes are usually described in the sagittal plane. Coronal plane deviation is also common, yet there is a paucity of literature on the management of these challenging deformities. Traditional soft tissue procedures and translational Weil osteotomies are unpredictable and can lead to post-operative stiffness. We present the results of a novel percutaneous osteotomy of the proximal phalanx to treat valgus deformity of the 2nd toe. Methods: 29 patients underwent 38 osteotomies at a mean age of 59+/-9 years. Through a 2mm dorsomedial incision, a percutaneous proximal metaphyseal medial closing wedge osteotomy is performed using a low speed, high torque 2x8mm burr. The toe is then taped for 2 weeks. Mean follow up was 29+/-18 months. Post-operative weight bearing radiographs were performed at a mean of 27+/-18 months. Dichotomous variables were assessed using a Chi square test. After confirming normality using a Kolomgrov-Smirnov test, continuous variables were measured using paired and independent t-tests. Results: 90% (n=26) patients responded. 88% (n=23) patients were satisfied or extremely satisfied with the procedure. 24% reported a partial (n=4) or complete recurrence (n=2) of deformity. Patients who perceived recurrence were significantly more likely to be dissatisfied (p=0.001). Radiographs were available for 27/38 osteotomies. Mean valgus angle decreased from 21+/-10° to 9+/-8° (p=0.001). All osteotomies united with no delayed union. There were no wound complications or infections. 2 patients reported long term numbness in the toe and 1 patient complained of a floating toe. Conclusion: Percutaneous closing wedge osteotomies to correct (valgus)coronal plane deformity is technically straight forward with a low complication rate and high patient satisfaction. Future studies should assess the role of this technique to correct medial crossover deformities and compare outcomes with other techniques.

Radiographic Impact of Lapidus, Proximal Lateral Closing Wedge Osteotomy, and Suture Button Procedures on First Ray Length and Dorsiflexion for Hallux Valgus

2020 ◽  
Vol 41 (8) ◽  
pp. 964-971 ◽  
Author(s):  
Ian M. Foran ◽  
Nasima Mehraban ◽  
Stephen K. Jacobsen ◽  
Daniel D. Bohl ◽  
Johnny Lin ◽  
...  
Keyword(s):  
Hallux Valgus ◽  
Wedge Osteotomy ◽  
Level Of Evidence ◽  
Closing Wedge Osteotomy ◽  
First Metatarsal ◽  
Suture Button ◽  
Closing Wedge ◽  
Radiographic Measurements ◽  
Valgus Angle ◽  
First Ray

Background: Shortening and dorsiflexion of the first metatarsal are known potential side effects of metatarsal osteotomies for hallux valgus (HV) with the potential to cause transfer metatarsalgia. We compared the effect of the first tarsometatarsal joint arthrodesis (Lapidus procedure), proximal lateral closing wedge osteotomy (PLCWO), and intermetatarsal suture button fixation procedures on the length and dorsiflexion of the first ray. Methods: We retrospectively evaluated 105 feet in 99 patients with 30 weeks of follow-up. The average age was 54 years. Seventy-four feet had a Lapidus procedure, 12 had a PLCWO, and 19 had intermetatarsal suture button fixation. Digital radiographic measurements were made for the pre- and postoperative hallux valgus angle (HVA) and intermetatarsal angle (IMA), absolute and relative shortening of the first ray, and dorsiflexion. Results: Preoperative HVA and IMA did not differ between treatment groups ( P > .05 for each). Similar corrections of HVA (30.5-13.5 degrees) were achieved between all groups ( P > .05). The IMA was improved more in the Lapidus group (14.3-6.5 degrees) compared with the suture button fixation group (14.2-8.1 degrees) ( P = .045). There were significant differences in the change in absolute first cuneiform–metatarsal length (FCML) between the Lapidus (–1.6 mm), PLCWO (–2.3 mm), and intermetatarsal suture button fixation (+1.9 mm) procedure ( P = .004). There were also significant differences in relative first metatarsal shortening between the Lapidus (0.1 mm relative shortening), PLCWO (1.1 mm relative shortening), and intermetatarsal suture button fixation (1.3 mm lengthening) procedure ( P < .001). The average dorsiflexion differed between the Lapidus (1.8 degrees) and suture button fixation (0.4 degrees) groups ( P = .004). Conclusion: Intermetatarsal suture button fixation relatively lengthened the first ray, the Lapidus procedure maintained length, and the PLCWO relatively and absolutely shortened it. Dorsiflexion may be higher with the Lapidus and osteotomy procedures. Level of Evidence: Level III, retrospective comparative series.

scholarly journals Percutaneous Basal Closing Wedge Osteotomy of the First Metatarsal in the Treatment of Moderate to Severe Hallux Valgus and Its Short-Term Clinical Outcomes

2018 ◽  
Vol 3 (1) ◽  
pp. 247301141774889
Author(s):  
K. B. Chan ◽  
Raymond Yeung
Keyword(s):  
Clinical Outcomes ◽  
Hallux Valgus ◽  
Delayed Union ◽  
Wedge Osteotomy ◽  
Short Term ◽  
Closing Wedge Osteotomy ◽  
First Metatarsal ◽  
Closing Wedge ◽  
Severe Hallux Valgus ◽  
Mini Open

Background: Although percutaneous surgery for the treatment of hallux valgus is popular in Europe, there is sparse English written literature documenting its efficacy. This study described the operative techniques using percutaneous basal closing wedge osteotomy of the first metatarsal in correction of moderate to severe hallux valgus (HV) and its short-term clinical outcomes. We postulated that satisfactory correction of hallux valgus (HV) angle, intermetatarsal (IM) angle, and patients’ clinical outcomes could be achieved with this technique. Methods: We conducted a retrospective review of 25 feet in 23 patients who underwent a percutaneous basal closing wedge osteotomy of the first metatarsal (MT1) combined with a mini-open modified McBride procedure and mini-open resection of medial eminence. Follow-up averaged 21.5 months. Radiographic outcomes included pre- and postoperative HV angle, IM angle, absolute and relative shortening of MT1, and time to union. American Orthopaedic Foot & Ankle Society (AOFAS) scores were compared between pre- and postoperatively. Results: The average HV angle improved from 39.4 (range, 29-58.3) degrees preoperatively to 14.7 (range, 0.1-23.2) degrees postoperatively ( P < .05). IM angle improved from 14.9 (range, 6.7-22.4) degrees to 6.6 (range, 0.9-14.8) degrees ( P < .05). The average absolute shortening was 3.8 (range, 0.27-12.91) mm and the relative shortening was 0.8 (range, 0.05-1.91) mm. There was no delayed union or malunion at the osteotomy site. The average AOFAS score improved from 39 (range, 12-50) to 81 (range, 70-93) ( P < .05). Conclusions: Satisfactory hallux valgus deformity correction and patients’ outcomes were achieved with this technique. Our results are similar to results reported in other studies using open techniques. There was no malunion or delayed union of the osteotomy. Level of Evidence: Level IV, case series study.

Effectiveness of Percutaneous Proximal Closing Wedge Osteotomy With Akin Osteotomy to Correct Severe Hallux Valgus Determined by Radiographic Parameters

2016 ◽  
Vol 10 (2) ◽  
pp. 170-179 ◽  
Author(s):  
Toshinori Kurashige ◽  
Seiichi Suzuki
Keyword(s):  
Hallux Valgus ◽  
Wedge Osteotomy ◽  
Metatarsal Osteotomy ◽  
Closing Wedge Osteotomy ◽  
First Metatarsal ◽  
Closing Wedge ◽  
Valgus Angle ◽  
Akin Osteotomy ◽  
Severe Hallux Valgus

Some authors reported the results from percutaneous distal metatarsal osteotomy for hallux valgus recently. On the other hand, there are few reports of percutaneous proximal metatarsal osteotomy. The purpose of the present study was to evaluate the radiographic results of percutaneous proximal closing wedge osteotomy with Akin osteotomy for correction of severe hallux valgus and increasing longitudinal arch height. Consecutive 17 feet (mean age = 70.8 years) were investigated. The mean follow-up was 22 months. Excision of medial eminence, distal soft tissue release, and Akin osteotomy were all performed percutaneously and concurrently. Weight-bearing anteroposterior and lateral radiographs of the feet were acquired preoperatively and at final follow-up. On the anteroposterior radiographs, hallux valgus angle, intermetatarsal angle, and first metatarsal shortening were measured. On the lateral radiographs, talometatarsal angle, calcaneal pitch angle, and first metatarsal dorsiflexion were measured. The average improvements in hallux valgus angle and intermetatarsal angle were 27.6° and 9.9°, respectively. The average first metatarsal shortening was 2.7 mm. The first metatarsal dorsiflexion improved by 2.2°; however, other parameters did not improve significantly. In conclusion, percutaneous proximal closing wedge osteotomy with Akin osteotomy corrects severe hallux valgus; however, the procedure does not increase the medial longitudinal arch. Levels of Evidence: Therapeutic, Level IV: Case series

Cavus Foot Correction in Adults by Dorsal Closing Wedge Osteotomy

2002 ◽  
Vol 23 (4) ◽  
pp. 344-347 ◽  
Author(s):  
Nikolaus Wülker ◽  
Christof Hurschler
Keyword(s):  
Wedge Osteotomy ◽  
Closing Wedge Osteotomy ◽  
Closing Wedge ◽  
Cavus Foot

First Metatarsal Length Change after Basilar Closing Wedge Osteotomy for Hallux Valgus

2011 ◽  
Vol 32 (5) ◽  
pp. 513-518 ◽  
Author(s):  
Thomas Day ◽  
Timothy P. Charlton ◽  
David B. Thordarson
Keyword(s):  
Hallux Valgus ◽  
Length Change ◽  
Wedge Osteotomy ◽  
Closing Wedge Osteotomy ◽  
First Metatarsal ◽  
Closing Wedge

Proximal Closing Wedge Osteotomy and Adductor Tenotomy for Treatment of Hallux Valgus

Foot & Ankle ◽  
1989 ◽  
Vol 9 (6) ◽  
pp. 272-280 ◽  
Author(s):  
Sylvia Resch ◽  
Anders Stenström ◽  
Niels Egund
Keyword(s):  
Recovery Period ◽  
Large Change ◽  
Metatarsal Head ◽  
Wedge Osteotomy ◽  
Intermetatarsal Angle ◽  
Closing Wedge Osteotomy ◽  
First Metatarsal ◽  
Closing Wedge ◽  
Radiographic Measurements ◽  
Adductor Tenotomy

After 2 to 4 years, 25 patients (27 feet) who had a proximal closing wedge osteotomy of the first metatarsal and an adductor tenotomy were reviewed. A total of 20 patients (22 of 27 feet) were completely satisfied; 5 patients not completely satisfied had metatarsalgia because of dorsal displacement of the first metatarsal head. Radiographic measurements showed a narrowing of the forefoot rather than a large change in the intermetatarsal angle. The recovery period was long, an average of 11 weeks. Pin inflammation occurred in 5 patients and incisional neuromas in 2 patients. The risk of these complications must be taken into consideration when using this operation.

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