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Foot and Ankle Surgery : Official... Jun 2020The Chevron osteotomy is a reliable and popular osteotomy for treating hallux valgus worldwide. Many modifications have been described, but none of them address the...
INTRODUCTION
The Chevron osteotomy is a reliable and popular osteotomy for treating hallux valgus worldwide. Many modifications have been described, but none of them address the rotational deformity of the first metatarsal. The objective of this study is to describe a variation of biplanar Chevron osteotomy which can address first metatarsal rotation when necessary.
METHODS
The indications for the Rotational Biplanar Chevron Osteotomy (RBCO) are mild to moderate hallux valgus deformity associated with hallux pronation related to internal rotation of the first metatarsal bone. We describe a technique that uses a medial based wedge parallel to the plantar limb of the osteotomy in order to make the distal fragment free to correct rotation.
RESULTS
The more recent concern about hallux valgus surgery is the very interesting concept that this deformity really occurs in three different planes, and we may have mistreated the rotation component with our current techniques. Many authors have revisited many common techniques in order to adapt them to correct metatarsal pronation. To our best knowledge, this is the first paper to describe a modification of the Chevron osteotomy to address the rotation of the first metatarsal.
CONCLUSION
We can conclude that the rotational biplanar Chevron osteotomy can be an useful tool in the treatment of mild hallux valgus associated with metatarsal pronation.
Topics: Hallux Valgus; Humans; Metatarsal Bones; Osteotomy; Treatment Outcome
PubMed: 31155287
DOI: 10.1016/j.fas.2019.05.011 -
Foot and Ankle Clinics Dec 2020Fractures of the proximal fifth metatarsal are common injuries with a unique history. Treatment of these fractures is controversial partly because of confusion regarding... (Review)
Review
Fractures of the proximal fifth metatarsal are common injuries with a unique history. Treatment of these fractures is controversial partly because of confusion regarding fracture subtype nomenclature. Today "Jones fracture" refers to proximal fifth metatarsal fracture in zones 2 or 3. Zone 2 fractures are acute injuries, and their optimal treatment is unclear. Zone 3 fractures commonly occur in the presence of a chronic stress reaction. Because of poor healing potential, zone 3 fractures typically require operative treatment. Zone 1 fractures have excellent healing potential and may be treated nonoperatively with a weightbearing as tolerated protocol.
Topics: Foot; Foot Injuries; Fracture Fixation, Internal; Fractures, Bone; Humans; Metatarsal Bones; Weight-Bearing
PubMed: 33543727
DOI: 10.1016/j.fcl.2020.08.012 -
The Journal of Foot and Ankle Surgery :... 2021
Topics: Bone Screws; Humans; Metatarsal Bones
PubMed: 33551232
DOI: 10.1053/j.jfas.2020.04.009 -
Journal of Pediatric Orthopedics Jan 2023The operative management of the juvenile bunion has not enjoyed the same level of success as its adult counterpart leading to the concern that we do not fully understand...
BACKGROUND
The operative management of the juvenile bunion has not enjoyed the same level of success as its adult counterpart leading to the concern that we do not fully understand what differentiates these 2 deformities. This study aims to (1) characterize the radiographic and pedobarographic features commonly encountered in the juvenile bunion and (2) determine which of these radiographic or pedobarographic parameters correlate with patient-reported outcome (PRO) scores at the time of presentation.
METHODS
An IRB-approved retrospective analysis of prospectively enrolled patients between 10 and 18 years of age with bunion deformities was performed at a single pediatric institution over a 4-year period. Standardized weight-bearing radiographs were used to determine hallux valgus angle (HVA), intermetatarsal angle, sesamoid position (SP), distal metatarsal articular angle (DMAA), and other radiographic parameters. Pedobarographic analysis was used to determine peak pressure, contact area, contact time, and pressure-time integral within 11 plantar regions. Foot-specific PRO measures were administered at the initial presentation.
RESULTS
Thirty-two patients (57 feet) met the inclusion criteria of which56/57 feet (98.2%) had an elevated DMAA (average 21.4degrees±8.9 degrees), and 51/57 (89.4%) had a congruent joint. The DMAA correlated positively with the HVA (r=0.734 P <0.001), intermetatarsal angle (r=0.439 P =0.001), and SP (r=0.627 P <0.001). Pedobarographic analysis (available in 15/32 patients) demonstrated that the HVA correlated with increased second metatarsal head peak pressure (r=0.667 P =0.011) and pressure-time integral (r=0.604 P =0.002), which in turn was strongly correlated with worse PROs. Conversely, increased first metatarsal head contact area correlated with improved PROs. Analysis of radiographic measurements demonstrated that HVA and lateralized SP correlated significantly with worse PRO scores.
CONCLUSIONS
Nearly all juvenile bunions have an elevated DMAA and a congruent joint. There is a clear correlation between the severity of radiographic and pedobarographic deformity and worse PRO scores at the time of presentation. We believe that the presence of elevated DMAA is the defining factor that differentiates the juvenile bunion from the deformity typically seen in adults.
LEVEL OF EVIDENCE
III.
Topics: Adult; Humans; Child; Retrospective Studies; Hallux Valgus; Metatarsal Bones; Metatarsophalangeal Joint; Radiography; Treatment Outcome
PubMed: 36224093
DOI: 10.1097/BPO.0000000000002277 -
Journal of the American Academy of... Jun 2020Hallux valgus deformity is a multiplanar deformity, where the rotational component has been recognized over the past 5 to 10 years and given considerable importance.... (Review)
Review
Hallux valgus deformity is a multiplanar deformity, where the rotational component has been recognized over the past 5 to 10 years and given considerable importance. Years ago, a rounded shape of the lateral edge of the first metatarsal head was identified as an important factor to detect after surgery because a less rounded metatarsal head was associated to less recurrence. More recently, pronation of the metatarsal bone was identified as the cause for the rounded appearance of the metatarsal head, and therefore, supination stress was found to be useful to achieve a better correction of the deformity. Using CT scans, up to 87% of hallux valgus cases have been shown to present with a pronated metatarsal bone, which highlights the multiplanar nature of the deformity. This pronation explained the perceived shape of the metatarsal bone and the malposition of the medial sesamoid bone in radiological studies, which has been associated as one of the most important factors for recurrence after treatment. Treatment options are discussed briefly, including metatarsal osteotomies and tarsometatarsal arthrodesis.
Topics: Bunion; Hallux; Hallux Valgus; Humans; Metatarsal Bones; Pronation
PubMed: 32656482
DOI: 10.5435/JAAOSGlobal-D-20-00091 -
PM & R : the Journal of Injury,... Nov 2021Metatarsal bone stress injuries (BSIs) are common in athletic populations. BSIs are overuse injuries that result from an accumulation of microdamage that exceeds bone... (Review)
Review
Metatarsal bone stress injuries (BSIs) are common in athletic populations. BSIs are overuse injuries that result from an accumulation of microdamage that exceeds bone remodeling. Risk for metatarsal BSI is multifactorial and includes factors related to anatomy, biology, and biomechanics. In this article, anatomic factors including foot type, metatarsal length, bone density, bone geometry, and intrinsic muscle strength, which each influence how the foot responds to load, are discussed. Biologic factors such as low energy availability and impaired bone metabolism influence the quality of the bone. Finally, the influence of biomechanical loads to bone such as peak forces, load rates, and loading cycles are reviewed. General management of metatarsal BSI is discussed, including acute care, rehabilitation, treatment of refractory metatarsal BSI, and evaluation of healing/return to sport. Finally, we identify future research priorities and emerging treatments for metatarsal BSI.
Topics: Athletic Injuries; Biomechanical Phenomena; Foot; Fractures, Stress; Humans; Metatarsal Bones; Sports
PubMed: 33155355
DOI: 10.1002/pmrj.12518 -
Foot & Ankle International Apr 2021Rotation of the first metatarsal (M1) as a potential etiological factor of hallux valgus (HV) deformity was described relatively early in the description of HV... (Review)
Review
Rotation of the first metatarsal (M1) as a potential etiological factor of hallux valgus (HV) deformity was described relatively early in the description of HV pathoanatomy. However, because biplanar radiographs have been the standard method for imaging HV, clinicians primarily developed measurement methods and corrective operations confined to 2 dimensions, medial-lateral and inferior-superior. Recently, as our understanding of HV pathoanatomy has further developed, aided in part by advanced imaging technology, M1 rotation about its axis ("axial rotation") and its implications for HV deformity and treatment has reemerged. The goal of this review is to summarize M1 rotation in HV from a historical perspective, to present the current understanding of its potential role in the etiology/pathogenesis of HV, and to summarize relevant imaging and operative considerations with respect to M1 rotation. Level III, systematic review.
Topics: Bunion; Hallux; Hallux Valgus; Humans; Metatarsal Bones; Rotation
PubMed: 33764800
DOI: 10.1177/1071100721997149 -
Foot and Ankle Surgery : Official... Jul 2021The only classification of Müller-Weiss disease (MWD) is based primarily on Méary's talo-first metatarsal angle. It describes increasing sag of the medial longitudinal...
BACKGROUND
The only classification of Müller-Weiss disease (MWD) is based primarily on Méary's talo-first metatarsal angle. It describes increasing sag of the medial longitudinal arch with greater degrees of compression and fragmentation of the navicular. Purportedly, the talar head pushes the subtalar joint into varus and drives the medial pole of the navicular medially, as it protrudes inferiorly and laterally. Its authors stipulated heel varus as a pre-requisite, coining the term 'paradoxical pes planus varus' to define heel varus and flatfoot as hallmark deformities of the condition.
METHODS
We measured Méary's and Kite's talocalcaneal angles, heel offset, anteroposterior thickness of the navicular at each naviculocuneiform (NC) joint, medial extrusion of the navicular and calculated percentage compression at each NC joint in 68 consecutive feet presenting with MWD. Morphology and activity at the various peri-navicular joints were studied using SPECT-CT in 45 feet.
RESULTS
Inverse relationships between Méary's angle and degree of navicular compression reach statistical significance at NC2 but not at NC3. Strong correlation exists between medial extrusion and percentage compression at NC2 and NC3. Medial extrusion is significantly greater on the affected side in unilateral cases and on the more compressed side in bilateral cases. Significant inverse relationships exist between Kite's angle and percentage compression at both NC2 and NC3 and degree of medial extrusion of the navicular. No correlation was detected between Kite's angle and either heel offset or Méary's angle. Varus heel offset was present in only 33% of cases. The combination of heel varus and negative Méary's angle was present in just 26% of cases, the commonest combination being heel valgus with sagging at 56%.
CONCLUSION
Our findings confirm part of Maceira's hypothesized pathomechanism of MWD. Reductions in Kite's talocalcaneal angle confirm that lateral and inferior protrusion of the talar head causes increasing compression and medial extrusion of the navicular. However, such shift of the talar head does not always lead to heel varus. As such, we caution against universal advocacy of lateral displacement calcaneal osteotomy, as the heel is not always in varus in MWD.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Bone Diseases; Female; Flatfoot; Follow-Up Studies; Foot; Foot Diseases; Humans; Male; Metatarsal Bones; Middle Aged; Osteotomy; Retrospective Studies; Single Photon Emission Computed Tomography Computed Tomography; Subtalar Joint; Tarsal Bones; Treatment Outcome; Young Adult
PubMed: 32600969
DOI: 10.1016/j.fas.2020.06.009 -
Annals of Biomedical Engineering Apr 2021Bone lengthening and bone transport are regeneration processes that commonly rely on distraction osteogenesis, a widely accepted surgical procedure to deal with numerous...
Bone lengthening and bone transport are regeneration processes that commonly rely on distraction osteogenesis, a widely accepted surgical procedure to deal with numerous bony pathologies. Despite the extensive study in the literature of the influence of biomechanical factors, a lack of knowledge about their mechanobiological differences prevents a clinical particularization. Bone lengthening treatments were performed on sheep metatarsus by reproducing the surgical and biomechanical protocol of previous bone transport experiments. Several in vivo monitoring techniques were employed to build an exhaustive comparison: gait analysis, radiographic and CT assessment, force measures through the fixation, or mechanical characterization of the new tissue. A significant initial loss of the bearing capacity, quantified by the ground reaction forces and the limb contact time with the ground, is suffered by the bone lengthening specimens. The potential effects of this anomaly on the musculoskeletal force distribution and the evolution of the bone callus elastic modulus over time are also analyzed. Imaging techniques also seem to reveal lower bone volume in the bone lengthening callus than in the bone transport one, but an equivalent mineralization rate. The simultaneous quantification of biological and mechanical parameters provides valuable information for the daily clinical routine and numerical tools development.
Topics: Animals; Biomechanical Phenomena; Bone Regeneration; Bony Callus; Elastic Modulus; Female; Gait; Metatarsal Bones; Osteogenesis, Distraction; Sheep; Tomography, X-Ray Computed
PubMed: 33111968
DOI: 10.1007/s10439-020-02665-z -
Foot and Ankle Clinics Dec 2019The use of a Shannon burr facilitates an osteotomy of the lesser metatarsals without requiring an open approach to the metatarsal. The end result that is aimed for is... (Review)
Review
The use of a Shannon burr facilitates an osteotomy of the lesser metatarsals without requiring an open approach to the metatarsal. The end result that is aimed for is the same as for open surgery and therefore care needs to be taken to perform the bone cut in the appropriate manner. A description is provided of the surgical technique for distal minimally invasive osteotomy and its newer modifications-the distal intracapsular minimally invasive osteotomy and the distal oblique metatarsal osteotomy.
Topics: Humans; Metatarsal Bones; Metatarsalgia; Minimally Invasive Surgical Procedures; Osteotomy
PubMed: 31653366
DOI: 10.1016/j.fcl.2019.08.011