Metatarsal Shaft Osteotomies Research Articles

Return to Run Rates Following Hallux Valgus Correction: A Retrospective Comparison of Metatarsal Shaft Osteotomies vs the Modified Lapidus Procedure

Category:Bunion; OtherIntroduction/Purpose:Hallux valgus affects 23 -36% in general populations. The purpose of this study was to evaluate return to run following either a modified Lapidus procedure or a metatarsal osteotomy. We hypothesized that there would be no difference in the ability to return to running.Methods:A Retrospective review of a consecutive series of patients at a single institution with surgical correction was performed. 51 patients were identified. 35 were treated with a metatarsal shaft osteotomy and 16 with a modified Lapidus.Results:No difference was found between the cohorts in terms of age, sex, or pre- operative hallux valgus angle (HVA). 27/35 (77%) with metatarsal shaft osteotomy were able to return to running versus 13/16 (81%) with modified Lapidus. There was no significant difference in the ability to return to running between cohorts (p=1.00).Conclusion:Our study showed no statistical difference for the modified Lapidus versus metatarsal osteotomies relative to return to running.

Fifth metatarsal scarf osteotomy without implant fixation

Fifth metatarsal shaft osteotomy has demonstrated efficacy for bunionette. We adapted screwless 1st metatarsal scarf osteotomy to the 5th ray. The technique consists in short osteotomy, translation and diaphyseal bone-suture. We report the first 25 operated feet, with mean AOFAS score 58.4 preoperatively and 94.9 postoperatively at a mean 25 months’ follow-up. These results were comparable to reported data, whatever the deformity.

Return to run rates following hallux valgus correction: A retrospective comparison of metatarsal shaft osteotomies versus the modified lapidus procedure

BackgroundHallux valgus affects 23–36% in general populations. The purpose of this study was to evaluate return to run following either a modified Lapidus procedure or a metatarsal osteotomy. We hypothesized that there would be no difference in the ability to return to running. MethodsA Retrospective review of a consecutive series of patients at a single institution with surgical correction was performed. 51 patients were identified. 35 were treated with a metatarsal shaft osteotomy and 16 with a modified Lapidus. ResultsNo difference was found between the cohorts in terms of age, sex, or preoperative hallux valgus angle (HVA). 27/35 (77%) with metatarsal shaft osteotomy were able to return to running versus 13/16 (81%) with modified Lapidus. There was no significant difference in the ability to return to running between cohorts (p =1.00). ConclusionOur study showed no statistical difference for the modified Lapidus versus metatarsal osteotomies relative to return to running.

Treatment of hallux valgus deformity.

Hallux valgus deformity is a very common pathological condition which commonly produces painful disability. It is characterised as a combined deformity with a malpositioning of the first metatarsophalangeal joint caused by a lateral deviation of the great toe and a medial deviation of the first metatarsal bone.Taking the patient’s history and a thorough physical examination are important steps. Anteroposterior and lateral weight-bearing radiographs of the entire foot are crucial for adequate assessment in the treatment of hallux valgus.Non-operative treatment of the hallux valgus cannot correct the deformity. However, insoles and physiotherapy in combination with good footwear can help to control the symptoms.There are many operative techniques for hallux valgus correction. The decision on which surgical technique is used depends on the degree of deformity, the extent of degenerative changes of the first metatarsophalangeal joint and the shape and size of the metatarsal bone and phalangeal deviation. The role of stability of the first tarsometatarsal joint is controversial.Surgical techniques include the modified McBride procedure, distal metatarsal osteotomies, metatarsal shaft osteotomies, the Akin osteotomy, proximal metatarsal osteotomies, the modified Lapidus fusion and the hallux joint fusion. Recently, minimally invasive percutaneous techniques have gained importance and are currently being evaluated more scientifically.Hallux valgus correction is followed by corrective dressings of the great toe post-operatively. Depending on the procedure, partial or full weight-bearing in a post-operative shoe or cast immobilisation is advised. Post-operative radiographs are taken in regular intervals until osseous healing is achieved.Cite this article: Fraissler L, Konrads C, Hoberg M, Rudert M, Walcher M. Treatment of hallux valgus deformity. EFORT Open Rev 2016;1:295-302. DOI: 10.1302/2058-5241.1.000005.

First Metatarsal Shaft Osteotomies: A Wide Range of Correction for Hallux Valgus Deformity

The main objective of metatarsal osteotomies is to decrease the intermetatarsal angle. Distal, shaft and proximal osteotomies have been defined based on the osteotomy site. Distal osteotomies mainly used for mild deformities and proximal osteotomies are suitable for severe deformities. Metatarsal shaft osteotomies may be used for all mild, moderate and severe cases. There is still no ideal osteotomy type for hallux valgus correction. Metatarsal shaft osteotomies have greater capacity for the correction of mild, moderate and severe hallux valgus deformity. All metatarsal shaft osteotomies and their modifications have good clinical results. Their high osteotomy contact area and practical fixation are the other advantages. All metatarsal osteotomies as so the shaft osteotomies have also some disadvantages. Appropriate technical applications and new improvements may provide higher success to metatarsal shaft osteotomies. Newer modifications may decrease the complications and improve union of the osteotomy.

Comparison of screw-fixation stabilities of metatarsal shaft osteotomies: a biomechanical study

Although metatarsal shaft osteotomies have become popular in the surgical treatment of moderate or advanced hallux valgus owing to better reduction and stability, they present fixation problems as the angular correction increases. The purpose of this biomechanical study was to evaluate the effects of widely used metatarsal shaft osteotomies and a newly defined osteotomy modification on the stability of screw fixation at greater angular corrections. Upon evaluation of known problems of shaft osteotomies, a new osteotomy type was designed that might provide an adequate contact area while allowing a greater angular correction, increased stability, and safer osteosynthesis. In our new modification of the Mau osteotomy, the proximal plantar notch that was defined for the Sammarco's modification to increase the contact area was created more proximally making an angle of about 50 degrees with the osteotomy, and the osteotomy was extended until 5 mm to the distal joint surface, aiming to increase the contact area and intrinsic stability. For biomechanical analysis, 30 standard metatarsal bone models (Sawbones) were divided into five groups equal in number for the following osteotomy methods: Myerson's modification of the Ludloff osteotomy, Mau osteotomy, scarf osteotomy, offset V osteotomy, and the new modification of the Mau osteotomy. Osteotomies were performed with a standard correction of 10 degrees in the intermetatarsal angle, followed by appropriate osteosynthesis with fixation by two Acutrak compression screws. The relationship between osteotomies and osteosynthesis in terms of stability was assessed by the three-point bending test. The mean stiffness of the Ludloff osteotomy was significantly lower than all the other osteotomy groups (p<0.05). Stiffness of the Mau group was significantly greater than three groups (p<0.05), but the difference from the offset V group did not reach significance. Stiffness of the new Mau modification was significantly greater than the scarf group (p=0.016), but did not differ significantly from the offset V group. Osteotomy groups with and without notching had similar stiffness values (p=0.582), whereas single notching was associated with a significantly greater stiffness compared to double notching (p=0.031). Our findings suggest that the new modification to the proximal shaft osteotomies moves the center of rotation of angulation more proximally and provides sufficient stability of screw fixation.

A New Technique for Lesser Metatarsal Osteotomy in the Treatment of Metatarsalgia

Metatarsalgia is a commonly presenting complaint to foot and ankle surgeons and can be a very debilitating condition. It is heralded by the presence of diffuse pain in the area around the metatarsal heads, often times accompanied by intractable plantar keratosis. Causes may include (1) bony (long second metatarsal, posttraumatic deformity, prominent condyle); (2) metatarsophalangeal joint instability with resultant displacement of the plantar fat pad; (3) hypermobility of the first ray leading to lesser metatarsal overload (hallux valgus, generalized ligamentous laxity); (4) iatrogenic (hallux valgus correction, with a shortening of the first metatarsal leading to transfer metatarsalgia); or (5) systemic disease (eg, rheumatoid arthritis, seronegative arthritides). With numerous etiologies, the management of this condition has varied considerably over the years. Nonoperative management is the first line of treatment. This can be accomplished with rest, footwear modification, an orthotic with a metatarsal pad, immobilization in a cast, medication (nonsteroidal anti-inflammatory drugs), or through an intra-articular steroid injection. Only when nonsurgical measures have been exhausted should surgery be contemplated. It is important to determine the cause of pain so that operative treatment can be tailored appropriately. In this study, we will be proposing a new, less technically demanding technique for the shortening of metatarsals in the treatment of metatarsalgia. This technique can be used in isolation or in combination with other procedures depending on the cause of pain and deformity. When a metatarsal requires shortening we recommend an extra-articular metatarsal shaft osteotomy with rigid plate fixation.

Indikation und Technik der modifizierten Ludloff Osteotomie

Summary The Ludloff metatarsal shaft osteotomy is a highly efficient technique in the correction of hallux valgus and varus angle of the first ray. It minimizes shortening, whilst allowing for depression of the first ray. Optimal results can be obtained by performing the osteotomy angled 10° plantarly with a correction of 8° to 16°. A correction of the PASA is not possible. The Ludloff technique, stabilized with 2.7 mm titanium screws, is indicated in a varus angle of more than 16° and a concomitant lateral subluxation in the first MTP joint. The bony correction is combined with a lateral soft tissue release and repair of medial capsule. The technique should be avoided in osteopenia.

Combined Second and Third Toe Transfer

Historically, restoration of hand function following multiple digital amputation has been unsatisfactory. The evolution of digital reconstruction with toe transfer has enabled surgeons to reestablish prehension in these severely injured hands. A 4-year experience with 26 consecutive combined second and third toe transfers to replace missing adjacent fingers was reviewed in order to delineate the indications and technical considerations and to emphasize prevention of donor-site complications. Combined second and third toe transfer is reserved for adjacent finger amputations proximal to the digital web space with remaining fingers no longer than the small finger. Radial amputations are replaced with contralateral combined toe units, while ipsilateral toes are more ideal for ulnar amputations. Limited dorsal and plantar skin flaps extending only to the midpoint of the first and third digital web spaces allow for direct donor-site closure and uncomplicated healing. Maintenance of the plantar metatarsal arch by avoiding metatarsal shaft osteotomies or bone grafting-shortened metatarsals eliminates potential gait disturbances. When properly applied in selected patients, this single-stage microsurgical procedure can restore prehensile function, improve the appearance of the hand with multiple digital amputations, and preserve near-normal donor-foot function.

Surgery for Adolescent Hallux Valgus

Attention is directed to the large number of operations for the correction of hallux valgus in the adolescent and important variations among the most popular surgical procedures, as well as the factors influencing the outcome of these operations. A consistently reliable operation is the modified Wilson procedure, a metatarsal shaft osteotomy. Its merits are its technical simplicity, minimal damage to soft tissue, and pleasing correction of deformity. The operation narrows the forefoot, relaxes soft tissues, and maintains excellent mobility of the first metatarsophalangeal joint.