Cryptococcal Osteomyelitis of the First Metatarsal Head in an Immunocompetent Patient

2017 ◽  
Vol 107 (3) ◽  
pp. 248-252
Author(s):  
Jae Hoon Ahn ◽  
ChanJoo Park ◽  
Choong Woo Lee ◽  
Yoon-Chung Kim
Keyword(s):  
Fungal Infections ◽  
Full Range ◽  
Metatarsophalangeal Joint ◽  
Metatarsal Head ◽  
Immunocompetent Patient ◽  
First Metatarsophalangeal Joint ◽  
Osteolytic Lesions ◽  
First Metatarsal ◽  
Fungal Osteomyelitis

Most fungal infections primarily occur in immunocompromised patients. We describe a case of osteomyelitis involving the first metatarsal head due to Cryptococcus neoformans in a previously healthy immunocompetent patient. She was treated with surgical debridement combined with antifungal drug therapy for 6 months. At 5-year follow-up, she remained symptom free with full range of motion of the first metatarsophalangeal joint. Fungal osteomyelitis should be considered as a possible cause in osteolytic lesions in the metatarsal bone.

scholarly journals Total Joint Replacement of the First Metatarsophalangeal Joint with Roto-Glide as Alternative to Arthrodesis

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0035
Author(s):  
Martinus Richter ◽  
Stefan Zech ◽  
Stefan Meissner ◽  
Issam Naef
Keyword(s):  
Joint Replacement ◽  
Total Joint Replacement ◽  
Weight Bearing ◽  
Treatment Options ◽  
Metatarsophalangeal Joint ◽  
Metatarsal Head ◽  
Degenerative Changes ◽  
First Metatarsophalangeal Joint ◽  
First Metatarsal

Category: Midfoot/Forefoot Introduction/Purpose: Total joint replacement (TJR) and arthrodesis (A) are treatment options for severe osteoarthritis of the first metatarsophalangeal joint (MTP1). The aim of this study was to compare outcome (clinical and pedographic) of TJR (Roto- Glide) and A of MTP1. Methods: All patients that completed follow-up of at least 24 months after TJR and A of MTP1 before November 5, 2018 were included in the study. Preoperatively and at follow-up, radiographs and/or weight-bearing computed tomographies (WBCT) were obtained. Degenerative changes were classified in four degrees. Standard dynamic pedography was performed (percentage force at first metatarsal head/first toe from force of entire foot). Visual-Analogue-Scale Foot and Ankle (VAS FA) and MTP1 range of motion for dorsi-/plantarflexion (ROM) were registered and compared pre-operatively and follow-up. From November 24, 2011 until October 31, 2016, 25 TJR and 49 A were performed that completed follow-up. Results: Parameters (average values if not stated otherwise) for TJR/A were preoperatively: age 59/60 years; 7(28%)/14(29%) male; height 168/169 cm; weight 71/72 kg; degree degenerative changes 3.3/3.1; ROM 19.4/0/9.8°//20.3/0/9.2°; percentage force first metatarsal/first toe 7.9/14.6//8.5/15.3; VAS FA 45.9/46.2. Six wound healing delays were registered (TJR 2, A 4) as only complications. Follow-up time on average 45.7/46.2 and range 25.0-80.3/24.1-81.1 months. VAS FA at follow-up was 73.4/70.2.; percentage force first metatarsal/first toe 15.8/5.8//12.3/10.8; ROM 35.6/0/10.5°//10.5/0/0. Parameters did not differ between TJR and A (each p>.05) except higher force percentage first toe and lower ROM for A at follow-up (each p<.05). VAS FA and pedography parameters improved for TJR and A between preoperatively and follow-up, ROM increased for TJR and decreased for A (each p<.05). Conclusion: TJR and A were performed in similar patient cohorts regarding demographic parameter, degree of degenerative changes, ROM, pathological pedographic pattern, and VAS FA. TJR and A improved pathological pedographic pattern and VAS FA at minimum follow-up of 24 months. TJR additionally improved ROM and showed better pedographic pattern (and not different to physiological pattern) than A. Survival rate of TJR was 100% up to 6 years. In this study, TJR was a valuable alternative to A for treatment of severe MTP1 osteoarthritis.

Plantar Pressure and Joint Motion After the Youngswick Procedure for Hallux Limitus

2004 ◽  
Vol 94 (1) ◽  
pp. 22-30 ◽  
Author(s):  
Alan R. Bryant ◽  
Paul Tinley ◽  
Joan H. Cole
Keyword(s):  
Pressure Distribution ◽  
Peak Pressure ◽  
Metatarsophalangeal Joint ◽  
Metatarsal Head ◽  
Joint Motion ◽  
First Metatarsophalangeal Joint ◽  
Hallux Limitus ◽  
First Metatarsal ◽  
Second Metatarsal

The effects of the Youngswick osteotomy on plantar peak pressure distribution in the forefoot are presented for 17 patients (23 feet) with mild-to-moderate hallux limitus deformity and 23 control subjects (23 feet). During 2 years of follow-up, the operation produced a significant increase in the range of dorsiflexion of the first metatarsophalangeal joint in these patients, reaching near-normal values. Preoperative and postoperative measurements, using a pressure-distribution measurement system, show that peak pressure beneath the hallux and the first metatarsal head remained unchanged. However, peak pressure was significantly increased beneath the second metatarsal head and decreased beneath the fifth metatarsal head. These findings suggest that the foot functioned in a less inverted manner postoperatively. Compared with normal feet, hallux limitus feet demonstrated significantly higher peak pressure beneath the fourth metatarsal head preoperatively and postoperatively. (J Am Podiatr Med Assoc 94(1): 22-30, 2004)

Bilateral osteochondritis dissecans of the first metatarsophalangeal joint

1994 ◽  
Vol 84 (6) ◽  
pp. 297-310 ◽  
Author(s):  
CA Camasta ◽  
TE Pitts ◽  
SV Corey
Keyword(s):  
Osteochondritis Dissecans ◽  
Convex Surface ◽  
Metatarsophalangeal Joint ◽  
Metatarsal Head ◽  
Hallux Rigidus ◽  
Osteochondral Defects ◽  
First Metatarsophalangeal Joint ◽  
First Metatarsal ◽  
Articular Damage

The authors present a review of the literature concerning the pathogenesis, diagnosis, and treatment of osteochondral defects of the lower extremity. A case of bilateral osteochondritis dissecans of the first metatarsophalangeal joint in a 43-year-old female is presented, including surgical treatment with 1- and 3-year follow-up examinations. The correlation between articular damage to the first metatarsal head and concomitant hallux limitus and hallux rigidus is discussed. The authors also propose that osteochondritis dissecans lesions almost always occur on the convex surface of a joint because of a convergence of impaction forces.

Modified Austin Procedure for Correction of Hallux Valgus

1997 ◽  
Vol 18 (3) ◽  
pp. 119-127 ◽  
Author(s):  
Hans-Jörg Trnka ◽  
Alexander Zembsch ◽  
Hermann Wiesauer ◽  
Marc Hungerford ◽  
Martin Salzer ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Hallux Valgus ◽  
Metatarsophalangeal Joint ◽  
Metatarsal Head ◽  
Hallux Valgus Angle ◽  
First Metatarsophalangeal Joint ◽  
Intermetatarsal Angle ◽  
Soft Tissue Procedure ◽  
Valgus Angle

The Austin osteotomy is a widely accepted method for correction of mild and moderate hallux valgus. In view of publications by Kitaoka et al. in 1991 and by Mann and colleagues, a more radical lateral soft tissue procedure was added to the originally described procedure. From September 1992 to January 1994, 85 patients underwent an Austin osteotomy combined with a lateral soft tissue procedure to correct their hallux valgus deformities. Seventy-nine patients (94 feet) were available for follow-up. The average patient age at the time of the operation was 47.1 years, and the average follow-up was 16.2 months. The average preoperative intermetatarsal angle was 13.9°, and the average hallux valgus angle was 29.7°. After surgery, the feet were corrected to an average intermetatarsal angle of 5.8° and an average hallux valgus angle of 11.9°. Sesamoid position was corrected from 2.1 before surgery to 0.5 after surgery. The results were also graded according to the Hallux Metatarsophalangeal Interphalangeal Score, and the functional and cosmetic outcomes were graded by the patient. Dissection of the plantar transverse ligament and release of the lateral capsule repositioned the tibial sesamoid and restored the biomechanics around the first metatarsophalangeal joint. There was no increased incidence of avascular necrosis of the first metatarsal head compared with the original technique.

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.

Evaluation of Metatarsal Head Resurfacing Hemiarthroplasty in the Surgical Treatment of Hallux Rigidus: A Retrospective Study and Mid- to Long-Term Follow-up

2017 ◽  
Vol 11 (1) ◽  
pp. 22-31 ◽  
Author(s):  
Musa Uğur Mermerkaya ◽  
Erkan Alkan ◽  
Mehmet Ayvaz
Keyword(s):  
Surgical Treatment ◽  
Case Series ◽  
Metatarsophalangeal Joint ◽  
Metatarsal Head ◽  
Treatment Method ◽  
Hallux Rigidus ◽  
Retrospective Case ◽  
First Metatarsophalangeal Joint

Background. The aim of this study was to evaluate the mid- to long-term outcomes of metatarsal head resurfacing hemiarthroplasty in the surgical treatment of advanced-stage hallux rigidus. Methods. We performed a retrospective review of 57 consecutive patients (25 [43.9%] males, 32 [56.1%] females; mean age, 61.0 ± 6.4 years) who underwent first metatarsal head resurfacing hemiarthroplasty (HemiCAP) for hallux rigidus between August 2007 and September 2010. Sixty-five implantations were performed in 57 patients; 8 patients underwent bilateral procedures. All patients were clinically rated prior to surgery and at the final follow-up visit using the American Orthopaedic Foot and Ankle Society (AOFAS) hallux metatarsophalangeal-interphalangeal scale and first metatarsophalangeal joint range of motion (MTPJ ROM). Results. The median follow-up duration was 81 (range = 8-98) months. The median preoperative AOFAS score was 34 (range = 22-59) points, which had increased to 83 (range = 26-97) points at the final follow-up visit (P < .001). The median preoperative first MTPJ ROM was 25° (range = 15° to 40°), which had increased to 75° (range = 30° to 85°) at the final follow-up visit (P < .001). Conclusions. First MTPJ hemiarthroplasty is an effective treatment method that recovers toe function and first MTPJ ROM, and provides good mid- to long-term functional outcomes. Levels of Evidence: Level IV: Retrospective case series

Clinical, Quantitative Assessment of First Tarsometatarsal Mobility in the Sagittal Plane and Its Relation to Hallux Valgus Deformity

1994 ◽  
Vol 15 (1) ◽  
pp. 9-13 ◽  
Author(s):  
Kaj Klaue ◽  
Sigvard T. Hansen ◽  
Alain C. Masquelet
Keyword(s):  
Hallux Valgus ◽  
Sagittal Plane ◽  
Metatarsophalangeal Joint ◽  
Metatarsal Head ◽  
Valgus Deformity ◽  
Main Concern ◽  
First Metatarsophalangeal Joint ◽  
First Metatarsal ◽  
Hallux Valgus Deformity ◽  
First Ray

Today, bunion surgery is still controversial. Considering that a bunion deformity in fact may be a result of multiple causes, the rationale of the currently applied techniques of surgical treatment has not been conclusively demonstrated. In view of the known hypermobility syndrome of the first ray that results in insufficient weightbearing beneath the first metatarsal head, the relationship between this syndrome and hallux valgus deformity has been investigated. The results suggest a direct relationship between painful hallux valgus deformity and hypermobility in extension of the first tarsometatarsal joint. A pathological mechanism of symptomatic hallux valgus is proposed that relates this pathology with primary weightbearing disturbances in the forefoot where angulation of the first metatarsophalangeal joint is one of the consequences. The alignment of the metatarsal heads within the sagittal plane seems to be a main concern in many hallux valgus deformities. As a consequence, treatment includes reestablishing stable sagittal alignment in addition to the horizontal reposition of the metatarsal over the sesamoid complex. As an example, first tarsometatarsal reorientation arthrodesis regulates the elasticity of the multiarticular first ray within the sagittal plane and may be the treatment of choice in many hallux valgus deformities.

scholarly journals Mid-term (4-7 years) Results of Matrix-Associated Stem Cell Transplantation (MAST) in Chondral Defects of the First Metatarsophalangeal Joint

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0035
Author(s):  
Martinus Richter ◽  
Stefan Zech ◽  
Stefan Meissner ◽  
Issam Naef
Keyword(s):  
Bone Marrow ◽  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Metatarsophalangeal Joint ◽  
Metatarsal Head ◽  
Pelvic Bone ◽  
First Metatarsophalangeal Joint ◽  
Chondral Defects

Category: Midfoot/Forefoot Introduction/Purpose: Matrix-associated stem cell transplantation (MAST) has shown good short-term results for treatment of chondral defects at first metatarsophalangeal joint (MTP1). The aim of the study was to assess mid-term results (=4-year-follow- up). Methods: In a prospective consecutive non-controlled clinical follow-up study, 61 patients with 81 chondral defects at MTP1 that were treated with MAST from October 1, 2011 to October 31, 2014 were analysed. Degree of osteoarthritis, range of motion (ROM), size and location of the chondral defects, pedographic parameters, and the Visual Analogue Scale Foot and Ankle (VAS FA) before treatment and at follow-up were registered and analysed. Bone marrow aspirate was harvested from the ipsilateral pelvic bone marrow and centrifuged (10 minutes, 1,500 RPM). The supernatant was used to impregnate a collagen I/III matrix (Chondro-Guide). The matrix was fixed into the chondral defect with fibrin glue. Results: Following mean (range) values were registered at time of surgery: age 44 (35-72) years, VAS FA 49.4 (12.3-82.3), ROM 20.4/0/8.4° (dorsiflexion/plantarflexion), degree of osteoarthritis 1.9 (1-3). The 81 chondral defects were located as follows, dorsal metatarsal head, n=28 (35%), plantar metatarsal head, n=12 (15%); dorsal & plantar, n=21 (26%); medial sesamoid, n=14 (17%); lateral sesamoid, n=6 (7%)(two defects, n=14, three defects, n=3). The defect size was 0.9 (.5 - 3.0) cm2. Fifty-six patients (92%) completed follow-up at 62 (48-84) months. VAS FA increased to 82.5 (45.6-100; t-test, p<.01). ROM increased to 30.2/0/15.4 (p=.05). Degree of osteoarthritis decreased to 1.1 (0-3, p=.04) Conclusion: The surgical treatment of chondral defects at MTP1 including MAST led to improved clinical scores, ROM and degree of osteoarthritis after 4-7 years. No adverse effects of MAST were registered. Even though a control group is missing, we conclude that MAST is an effective method for the treatment of chondral defects at MTP1.

scholarly journals Effectiveness of the Plantar Aponeurosis Release for Limitation of the First Metatarsophalangeal Joint Extension after Hallux Valgus Surgery

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0001
Author(s):  
Hongjoon Choi ◽  
Daewook Kim ◽  
Yeong Hun Kang ◽  
Jong Ho Park
Keyword(s):  
Hallux Valgus ◽  
Metatarsophalangeal Joint ◽  
Metatarsal Head ◽  
Knee Extension ◽  
First Metatarsophalangeal Joint ◽  
Plantar Aponeurosis ◽  
First Metatarsal ◽  
Metatarsal Angle ◽  
Additional Procedure ◽  
The Mean

Category: Midfoot/Forefoot Introduction/Purpose: Even though stiffness of the first metatarsophalangeal joint (1MTP) is not a common complication, reduced dorsiflexion range of motion at the 1MTP after surgery for hallux valgus was reported as a complication. However, few clinical studies have investigated this issue and no clinical resolution has been reached thus far. We hypothesized that tightness of the gastrocnemius-plantar aponeurosis complex is one of the factors that limits the extension of 1MTP after hallux valgus surgery. Thus, an additional procedure of the plantar aponeurosis release during hallux valgus surgery may improve the range of extension at 1MTP. The purpose of this study was to test the efficacy of plantar aponeurosis release in improving the range of extension when a limitation is detected after hallux valgus surgery. Methods: Thirteen patients (17 feet) with limited 1MTP extension after hallux valgus surgery, underwent an additional procedure of plantar aponeurosis release. The inclusion criterion was limitation of 1MTP extension showed more than 15 degrees difference between knee extension and flexion position, measured after completing all procedures of the hallux valgus surgery. The passive range of 1MTP extension was evaluated by a goniometer while the first metatarsal head was supported with a palm, assuming a weightbearing position with knee extension and flexion, after completing all procedures of the hallux valgus surgery (Barouk test). A silfverskiold test was performed in all cases preoperatively. The weightbearing dorsoplantar and lateral radiographs of the foot were performed to measure the hallux valgus angle, intermetatarsal angle, distal metatarsal articular angle, and the talo-first metatarsal angle. Results: The mean range of 1MTP extension significantly improved from 2.53 degrees to 40.88 degrees in the knee extension position (p<0.0000). The mean range of the 1MTP extension also improved from 18.24 degrees to 43.24 degrees in the knee flexion position. The silfverskiold test was positive in 12 cases. In all patients, congruence of 1MTP was corrected. There were no surgery-related complications such as plantar aponeurosis rupture or nerve injury. Conclusion: Our study supports tightness of the gastrocnemius-plantar aponeurosis complex is one of the factors that limit the extension of 1MTP after hallux valgus surgery. Hence, plantar aponeurosis release can be considered as an effective additional procedure to improve the range of 1MTP extension when a limitation is presented after hallux valgus surgery.

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