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Foot and Ankle Surgery : Official... Oct 2019Weil's osteotomy (WO) is the most applied surgical treatment for metatarsalgia, a persistent pain in the lesser metatarsals' heads. We aim to review its effectiveness...
BACKGROUND
Weil's osteotomy (WO) is the most applied surgical treatment for metatarsalgia, a persistent pain in the lesser metatarsals' heads. We aim to review its effectiveness and safety compared to the percutaneous technique known as distal metatarsal mini-invasive osteotomy (DMMO).
METHODS
Systematic review in Medline, Pubmed, Embase, Cinahl and Cochrane Library. We included studies that directly compared WO and DMMO for the treatment of primary metatarsalgia. Data on pain, function, complications and patients' satisfaction were extracted and narratively synthesized.
RESULTS
Four retrospective studies were identified. There were no significant differences in clinical effectiveness or patients' satisfaction. Time to bone healing was significantly longer for DMMO, whereas WO showed more wound problems and metatarsophalangeal stiffness. Other complications were infrequent in the two procedures.
CONCLUSION
Evidence on the direct comparison of WO and DMMO is scarce and of low quality. Randomized studies are needed in order to control for potential confounders.
Topics: Arthrodesis; Humans; Metatarsal Bones; Metatarsalgia; Metatarsophalangeal Joint; Minimally Invasive Surgical Procedures; Osteotomy; Patient Satisfaction; Plastic Surgery Procedures; Treatment Outcome
PubMed: 30321939
DOI: 10.1016/j.fas.2018.06.004 -
BMC Musculoskeletal Disorders Nov 2023To evaluate the radiographic diagnostic criteria and propose standardised radiographic criteria for Lisfranc injuries.
PURPOSE
To evaluate the radiographic diagnostic criteria and propose standardised radiographic criteria for Lisfranc injuries.
METHODS
A systematic review of the PubMed and Embase databases was performed according to the PRISMA guidelines. The various radiographic criteria for the diagnosis of Lisfranc injuries were extracted. Descriptive statistics were presented for all continuous (as mean ± standard deviation) and categorical variables (as frequencies by percentages).
RESULTS
The literature search included 29 studies that totalled 1115 Lisfranc injuries. The risk of bias ranged from "Low" to "Moderate" risk according to the ROBINS-I tool. The overall recommendations according to the GRADE assessment ranged from "Very Low" to "High". 1 metatarsal to 2 metatarsal diastasis was the most common of the 12 various radiographic diagnostic criteria observed, as was employed in 18 studies. This was followed by 2 cuneiform to 2 metatarsal subluxation, as was employed in 11 studies.
CONCLUSION
The radiographic diagnostic criteria of Lisfranc injuries were heterogeneous. The proposition for homogenous radiographic diagnostic criteria is that the following features must be observed for the diagnosis of Lisfranc injuries: 1 metatarsal to 2 metatarsal diastasis of ≥ 2 mm on anteroposterior view or 2 cuneiform to 2 metatarsal subluxation on anteroposterior or oblique views. Further advanced imaging by CT or MRI may be required in patients with normal radiographs but with continued suspicion for Lisfranc injuries.
LEVEL OF EVIDENCE
4, systematic review.
Topics: Humans; Joint Dislocations; Magnetic Resonance Imaging; Radiography; Metatarsal Bones; Foot Injuries
PubMed: 38012651
DOI: 10.1186/s12891-023-07043-z -
The Journal of Foot and Ankle Surgery :... 2016Acute compartment syndrome of the lower leg and foot is a not widely reported, but serious, potential complication that can develop after fractures, crush injuries, or... (Review)
Review
Acute compartment syndrome of the lower leg and foot is a not widely reported, but serious, potential complication that can develop after fractures, crush injuries, or high-velocity trauma of the lower extremity. Early recognition and treatment are critical in preventing morbidity and permanent complications. Although compartment syndrome of the lower leg and foot has been well-studied and documented in adults, its occurrence in the pediatric population is rare. We performed a systematic review of the published data and present the case of the youngest patient with isolated ACS of the foot. A high index of suspicion is warranted in pediatric patients with a traumatic injury to the lower extremity for compartment syndrome. Inconclusive radiographic findings owing to skeletal immaturity and the inability to verbalize symptoms place young children at high risk of undiagnosed compartment syndrome. Clinicians should have a very low threshold for fasciotomy to prevent long-term sequelae associated with undiagnosed compartment syndrome.
Topics: Acute Disease; Child, Preschool; Compartment Syndromes; Crush Injuries; Fasciotomy; Follow-Up Studies; Foot Injuries; Humans; Injury Severity Score; Male; Metatarsal Bones; Radiography; Treatment Outcome; Wound Healing
PubMed: 27067201
DOI: 10.1053/j.jfas.2016.02.010 -
Injury Feb 2022The fifth metatarsal base avulsion fracture (i.e., Pseudo-Jones fracture) is one of the most common foot fractures. The management of pseudo-Jones fractures could be... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The fifth metatarsal base avulsion fracture (i.e., Pseudo-Jones fracture) is one of the most common foot fractures. The management of pseudo-Jones fractures could be carried out surgically or conservatively. This systematic review and meta-analysis aimed to provide an update about the efficacy of orthotic removable support compared to short-leg casting for individuals with pseudo-Jones fracture.
METHODS
We searched Embase, Medline, and Cochrane Central register of Controlled Trials (CENTRAL) for randomized controlled trials (RCTs) that compared the clinical outcomes of orthotic removable support and short-leg cast for adult individuals with a fifth metatarsal base avulsion fracture. We used 95% as a confidence level and P <0.05 as a threshold. The standardized mean difference (SMD) was used for the continuous outcomes, and the risk ratio (RR) was used for the dichotomous outcomes.
RESULTS
A total of 6 RCTs incorporating 403 individuals out were deemed eligible. There was no significant difference between orthotic removable support and short-leg casting regarding AOFAS score (standardized mean difference (SMD)= 0.31, 95% CI -0.17 to 0.8), pain on VAS score (SMD= -0.08, 95% CI -0.39 to 0.22), VAS-FA score (SMD= 0.22, 95% CI -0.19 to 0.62) EQ-5D VAS score, and non-union rate (RR=0.37, 95% CI 0.05 to 2.74).
CONCLUSION
The current meta-analysis reveals that there is no difference between orthotic removable support and short-leg casting for the conservative management of individuals sustaining pseudo-Jones fracture.
Topics: Adult; Ankle Injuries; Fractures, Avulsion; Fractures, Bone; Humans; Leg; Metatarsal Bones
PubMed: 34838261
DOI: 10.1016/j.injury.2021.11.032 -
Foot and Ankle Clinics Mar 2020Minimally invasive (MIS) or percutaneous surgery has evolved rapidly through the development of novel techniques with precise description, correct indications, and the...
Minimally invasive (MIS) or percutaneous surgery has evolved rapidly through the development of novel techniques with precise description, correct indications, and the incorporation of modifications of safe and effective techniques described in open surgery. The correct term to describe these procedures should be percutaneous and MIS should be reserved for procedures between percutaneous and open surgery (eg, osteosynthesis). According to results, third-generation techniques are useful, effective, and easier than open procedures. It seems that MIS surgery has an extensive learning curve, and therefore it may be difficult to duplicate the results shown on already-published data.
Topics: Hallux Valgus; Humans; Learning Curve; Metatarsal Bones; Minimally Invasive Surgical Procedures; Osteotomy
PubMed: 31997749
DOI: 10.1016/j.fcl.2019.10.010 -
International Orthopaedics May 2019This systematic review aimed to compare radiographic correction, clinical outcomes, complications, and re-operations between lateral column lengthening (LCL) and... (Comparative Study)
Comparative Study
PURPOSE
This systematic review aimed to compare radiographic correction, clinical outcomes, complications, and re-operations between lateral column lengthening (LCL) and arthroereisis (AR) for treating symptomatic flatfoot in children.
METHODS
We conducted a comprehensive search on MEDLINE, EMBASE, and Cochrane Library databases. Literature search, data extraction, and quality assessment were conducted by two independent reviewers. The outcomes analyzed included radiographic parameters, clinical scores, satisfaction, complications, and re-operations.
RESULTS
Twenty-one and 13 studies were included in the LCL and AR groups, respectively. The change in anteroposterior talo-first metatarsal angle was greater in the LCL (9.5° to 21.7°) than in the AR group (10.6° to 12.8°). The change in calcaneal pitch was greater in the LCL (2.1° to 26.53°) than in the AR group (- 1.3° to 3.23°). Improvements in the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score were greater in the LCL (27.7 to 39.1) than in the AR group (17 to 22). The percentage of satisfaction was similar between the LCL (68% to 89%) and AR (78.5% to 96.4%) groups. The complication rate was higher in the LCL (0% to 86.9%) than in the AR group (3.5% to 45%). The most common complications were calcaneocuboid subluxation and persistent pain in the LCL and AR groups, respectively. The re-operation rate was similar between the LCL (0% to 27.3%) and AR (0% to 36.4%) groups.
CONCLUSIONS
The LCL group has achieved more radiographic corrections and more improvements in the AOFAS score than the AR group. Complications were more common in the LCL group than in the AR group, and the re-operation rates were similar between the two groups.
Topics: Bone Transplantation; Child; Flatfoot; Foot Bones; Humans; Retrospective Studies; Subtalar Joint
PubMed: 30701302
DOI: 10.1007/s00264-019-04303-3 -
Zhongguo Gu Shang = China Journal of... Aug 2019To evaluate efficacy of radiographic and clinical of Chevron osteotomy versus Scarf osteotomy for hallux valgus at moderate and severe degree. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To evaluate efficacy of radiographic and clinical of Chevron osteotomy versus Scarf osteotomy for hallux valgus at moderate and severe degree.
METHODS
Randomized controlled trial (RCT) about Chevron and Scarf osteotomy for hallux valgus, in PubMed, Embase, Cochrane Library, CBM, CNKI, Wanfang Data were searched by computer from establishing database to June 2018. According to inclusion and exclusion criteria, two researchers independently screened the literatures, evaluated risk of bias and extracted related observation index, RevMan 5.3.5 software was used to perform Meta-analysis. Postoperative hallux valgus angle (HVA), intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA), AOFAS score, complications and patients' satisfaction degree between Chevron and Scarf osteotomy.
RESULTS
Six RCT literatures were included, involving 507 patients, 92.5% patients were at moderate and severe degree, and 261 patients were performed by Chevron osteotomy and 246 patients were performed by Scarf osteotomy. Meta analysis results showed that Chevron osteotomy was better than Scarf osteotomy in correcting HVA [MD=-1.95, 95%CI(-2.64, -1.27), <0.000 01]. While there were no statistical differences in IMA [MD=-0.42, 95%CI(-1.04, 0.21), =0.19], DMAA[MD=0.78, 95%CI(-0.72, 2.29), =0.31], AOFAS score [MD=2.47, 95%CI(-2.38, 7.33), =0.32], complications [RR=1.09, 95%CI(0.54, 2.20), =0.82], and patients' satisfaction degree [RR=1.00, 95%CI(0.96, 1.05), =0.92].
CONCLUSIONS
Chevron osteotomy, which has advantages in simple operation, shorten metatarsal bone, less trauma, was better in correcting HVA of hallux valgus at moderate and severe degree, and had similar effects in IMA, DMAA, AOFAS score, complications and patients' satisfactory degree.
Topics: Hallux Valgus; Humans; Metatarsal Bones; Metatarsophalangeal Joint; Osteotomy; Treatment Outcome
PubMed: 31533392
DOI: 10.3969/j.issn.1003-0034.2019.08.018 -
Foot and Ankle Surgery : Official... Oct 2019Information regarding return rates (RR) and mean return times (RT) to sport following Lisfranc injuries remains limited. (Meta-Analysis)
Meta-Analysis
BACKGROUND
Information regarding return rates (RR) and mean return times (RT) to sport following Lisfranc injuries remains limited.
METHODS
A systematic search of nine major databases was performed to identify all studies which recorded RR or RT to sport following lisfranc injuries.
RESULTS
Seventeen studies were included (n=366). For undisplaced (Stage 1) injuries managed nonoperatively (n=35), RR was 100% and RT was 4.0 (0-15) wks. For stable minimally-displaced (Stage 2) injuries managed nonoperatively (n=16), RR was 100% and RT was 9.1 (4-14) wks. For the operatively-managed injuries, Percutaneous Reduction Internal Fixation (PRIF) (n=42), showed significantly better RR and RT compared to both: Open Reduction Internal Fixation (ORIF) (n=139) (RR - 98% vs 78%, p<0.019; RT - 11.6 wks vs 19.6 wks, p<0.001); and Primary Partial Arthrodesis (PPA) (n=85) (RR - 98% vs 85%, p<0.047; RT - 11.6 wks vs 22.0 wks, p<0.002).
CONCLUSIONS
Stage 1 and stable Stage 2 Lisfranc injuries show good results with nonoperative management. PRIF offers the best RR and RT from the operative methods, though this may not be possible with high-energy injuries.
LEVEL OF EVIDENCE
IV. Systematic Review of Level I to Level IV Studies.
Topics: Foot Injuries; Foot Joints; Fracture Dislocation; Fractures, Bone; Humans; Ligaments, Articular; Metatarsal Bones; Return to Sport
PubMed: 30321929
DOI: 10.1016/j.fas.2018.07.008 -
Foot and Ankle Surgery : Official... Jun 2022Children with cerebral palsy are highly likely to develop foot deformities, some of which may require surgical intervention. Hallux valgus is a common forefoot deformity...
BACKGROUND
Children with cerebral palsy are highly likely to develop foot deformities, some of which may require surgical intervention. Hallux valgus is a common forefoot deformity which can cause issues with pain, footwear, orthotic splints and soft tissues. It remains unclear what the optimal surgical treatment is for children with cerebral palsy and hallux valgus deformity.
OBJECTIVE
To systematically review studies reporting the clinical and radiological outcomes of surgical correction of hallux valgus deformity in children with cerebral palsy.
METHODS
A systematic review of studies published in electronic databases (Medline, Embase, Pubmed and Cochrane library) from inception until January 2021. Keywords related to hallux valgus and cerebral palsy were included.
RESULTS
58 studies were identified of which 7 met the criteria for inclusion. 200 feet in 134 patients with a mean age of 13.5 years were included, with a mean follow up period of 43 months. A range of clinical and radiographic outcomes were assessed. A treatment framework for the assessment and management of hallux valgus in children with cerebral palsy based on the published evidence is presented.
CONCLUSION
Non-ambulant children with cerebral palsy with symptomatic hallux valgus should primarily undergo first MTPJ arthrodesis whilst those who are ambulant should undergo first metatarsal osteotomy± soft tissue correction.
Topics: Adolescent; Bunion; Cerebral Palsy; Child; Hallux Valgus; Humans; Metatarsal Bones; Retrospective Studies; Treatment Outcome
PubMed: 35012870
DOI: 10.1016/j.fas.2021.12.009 -
Foot and Ankle Surgery : Official... Dec 2020Valente Valenti proposed in 1976 a "V" resection of the first metatarsophalangeal joint (MPT1) on the sagittal plane for advanced stages of hallux limitus/rigidus,...
BACKGROUND
Valente Valenti proposed in 1976 a "V" resection of the first metatarsophalangeal joint (MPT1) on the sagittal plane for advanced stages of hallux limitus/rigidus, preserving length of the first ray, flexor hallux brevis and sesamoid function. The available literature concerning correct indications, management and clinical outcomes of the Valenti procedure (VP) and its modifications in patients affected by hallux limitus/rigidus was systematically analyzed.
METHODS
Titles and abstracts of all selected articles were independently screened by two authors to assess their suitability to the research focus.
RESULTS
Selection produced 8 articles as full-text, for a total of 347 patients, with a mean follow-up of 6±7.1 (range 0.2-17.5) years. Most common complication was transient sesamoiditis in 21 (7.4%) patients. No substantial differences in clinical outcomes were found between the original and modified techniques.
CONCLUSIONS
VP appears to allow an early recovery with few complications, if compared to fusion, interposition arthroplasties or osteotomies. The wide joint resection does not prevent, if necessary, further procedures such as fusion or implants.
LEVEL OF EVIDENCE
Level I, systematic review.
Topics: Arthroplasty; Hallux Rigidus; Humans; Metatarsal Bones; Osteotomy; Toe Phalanges
PubMed: 31839478
DOI: 10.1016/j.fas.2019.11.009