Category:
Lesser Toes
Introduction/Purpose:
The correction of lesser toe deformities has been traditionally performed in an open fashion. With minimal-invasive foot surgeries becoming increasingly ...popular, correction of lesser toe deformities via percutaneous soft-tissue procedures and osteotomies is frequently performed. The aim of this study was to evaluate the site of percutaneous proximal phalanx osteotomy of the lesser toes in relation to the metatarsophalangeal joint line when performed without fluoroscopy guidance.
Methods:
In this experimental cadaver study, the metatarsophalangeal joints of the lesser toes of 20 cadaver samples (=80 toes) were palpated. A plantar skin stab incision was made just distal to the joint line without fluoroscopic control. Plantar closing osteotomies of the proximal phalanx were performed with a Shannon burr. Adorsoplantar view was taken with fluoroscopy. The location of the osteotomy and the relative distance from the metatarsophalangeal joint line was evaluated.
Results:
The majority (78/80; 97.5 %) of the osteotomies were localized in the metaphyseal region. No osteotomy violated the metatarsophalangeal joint.
Conclusion:
Percutaneous osteotomy of the proximal phalanx of the lesser toes guided by palpation without using the image intensifier is a safe procedure and does not violate the metatarsophalangeal joint.
Foot and ankle disorders are a common reason for orthopedic surgical intervention. After surgery, specific precautions such as partial weight bearing or complete unloading, and the use of walking ...aids, coupled with a period of rest, are usually implemented to ensure the surgical outcome. However, when these aids are discontinued and the patients resume load increase and normal daily activities, they may enter a transitional phase characterized by inflammation, swelling, and pain. We call this phenomenon the “classic three-month post-operative adaptation phase” (POAP). It is essential to differentiate this physiological transition phase from other conditions, such as from the immediate post-surgical inflammation, complex pain regional syndrome, or an infection. The objective of this expert opinion is to describe and raise medical awareness of this evidence-based phenomenon, which we commonly observe in our daily practice.
Periprosthetic infection after total ankle arthroplasty (TAA) is a serious complication, often requiring revision surgery, including revision arthroplasty, conversion to ankle arthrodesis, or even ...amputation. Risk factors for periprosthetic ankle infection include prior surgery at the site of infection, low functional preoperative score, diabetes, and wound healing problems. The clinical presentation of patients with periprosthetic ankle joint infection can be variable and dependent on infection manifestation: acute versus chronic. The initial evaluation in patients with suspected periprosthetic joint infections should include blood tests: C-reactive protein and erythrocyte sedimentation rate. Joint aspiration and synovial fluid analysis can help confirm suspected periprosthetic ankle infection.
Solid Bolt Fixation of the Medial Column in Charcot Midfoot Arthropathy Wiewiorski, Martin, MD; Yasui, Tetsuro, MD, PhD; Miska, Matthias, MD ...
The Journal of foot and ankle surgery,
2013, January-February 2013, 2013 Jan-Feb, 2013-1-00, 20130101, Letnik:
52, Številka:
1
Journal Article
Recenzirano
Abstract Charcot medial column and midfoot deformities are associated with rocker bottom foot, recurrent plantar ulceration, and consequent infection. The primary goal of surgical intervention is to ...realign and stabilize the plantar arch in a shoe-able, plantigrade alignment. Different fixation devices, including screws, plates, and external fixators, can be used to stabilize the Charcot foot; however, each of these methods has substantial disadvantages. To assess the effectiveness of rigid, minimally invasive fixation of the medial column and midfoot, 8 cases of solid intramedullary bolt fixation for symptomatic Charcot neuroarthropathy were reviewed. The patients included 6 males (75%) and 2 females (25%), with a mean age of 63 (range 46 to 80) years. The Charcot foot deformity was caused by diabetic neuropathy in 7 cases (87.5%) and alcoholic neuropathy in 1 (12.5%). The mean duration of postoperative follow-up period was 27 (range 12 to 44) months. The mean radiographic correction of the lateral talar–first metatarsal angle was 15° (range 3° to 19°), and the mean radiographic correction of the dorsal midfoot dislocation was 9 (range −4 to 23) mm. The mean loss of correction of the lateral talar–first metatarsal angle and midfoot dislocation after surgery was 7° (range 0° to 26°) and 1 (range 0 to 7) mm, respectively. No bolt breakage was observed, and no cases of recurrent or residual ulceration occurred during the observation period. Bolt removal was performed in 3 cases (37.5%), 2 (25%) because of axial migration of the bolt into the ankle joint and 1 (12.5%) because of infection. The results of the present review suggest that a solid intramedullary bolt provides reasonable fixation for realignment of the medial column in cases of Charcot neuroarthropathy.
Ankle deformity is a disabling condition especially if concomitant with osteoarthritis (OA). Varus ankle OA is one of the most common ankle OA deformities. This deformity usually leads to unequal ...load distribution in the ankle joint and decreases joint contact surface area, leading to a progressive degenerative arthritic situation. Varus ankle OA might have multiple causative factors, which might present as a single isolated factor or encompassed together in a single patient. The etiologies can be classified as post-traumatic (e.g., after fractures and lateral ligament instability), degenerative, systemic, neuromuscular, congenital, and others. Treatment options are determined by the degree of the deformity and analyzing the pathology, which range from the conservative treatments up to surgical interventions. Surgical treatment of the varus ankle OA can be classified into two categories, joint-preserving surgery (JPS) and joint-sacrificing surgery (JSS) as total ankle arthroplasty and ankle arthrodesis. JPS is a valuable treatment option in varus ankle OA, which should not be neglected since it has showed a promising result, optimizing biomechanics and improving the survivorship of the ankle joint.
Abstract Several commercially available cartilage repair techniques use a natural or synthetic matrix to aid cartilage regeneration (e.g., autologous matrix–induced chondrogenesis or matrix-induced ...cartilage implantation). However, the use of matrix-aided techniques during conventional knee joint arthroscopy under continuous irrigation is challenging. Insertion and fixation of the matrix can be complicated by the presence of fluid and the confined patellofemoral joint space with limited access to the lesion. To overcome these issues, we developed a novel arthroscopic approach for matrix-aided cartilage repair of patellar lesions. This technical note describes the use of dry arthroscopy assisted by a minimally invasive retraction system. An autologous matrix–induced chondrogenesis procedure is used to illustrate this novel approach.
Abstract Medial column fixation for rocker-bottom deformity in Charcot arthropathy is commonly performed. However, implant failure is commonly encountered because of uncontrolled weight bearing by ...the patient. The aim of this case report is to describe the use of a large solid bolt for fusion of the medial column of the foot in a patient with collapse of the midfoot due to diabetic neuroarthropathy.
Recurrent ankle sprains and other trauma as well as ankle malalignment can lead to chronic osteochondral lesions of the talus. Conservative treatment frequently fails. Several operative treatment ...techniques exist; however, the choice of the right procedure is difficult. This article presents a new surgical technique suitable for treatment osteochondral lesions that combines bone plasty and a collagen matrix.
Purpose
The medial malleolar osteotomy is commonly performed to gain access to the medial talar dome for treatment of osteochondral lesions of the talus. The primary aim of this study was to assess ...osseous healing based on postoperative radiographs to determine consolidation, non-union and malreduction rates.
Methods
Sixty-seven cases were reviewed where an oblique uniplanar medial malleolar osteotomy was performed to gain access to the medial talar dome for addressing an osteochondral lesion. Two, respectively three fully threaded 3.5 mm corticalis screws were used to fixate the osteotomy. Postoperative radiographs were reviewed to assess consolidation, non-union, malreduction and dislocation of the osteotomy.
Results
Out of 67 patients, 66 patients had a consolidation of the osteotomy. 23.9% of the cases showed malreduction of the osteotomy. One patient suffered a non-union, which required a revision surgery. No significant difference was shown between two and three screws used for fixation in terms of malreduction and consolidation of the osteotomy. Eighty-four percent of the patients underwent hardware removal due to pain or medial impingement.
Conclusion
The oblique medial malleolar osteotomy is a safe and relatively simple procedure with a high consolidation rate and low revision providing excellent exposure of the talus. The moderately high malreduction rate and required hardware removal surgery by most of the patients are relevant factors which should be considered before performing this surgery.
Level of evidence
Level III, retrospective cohort study.
Abstract We present a novel fixation plate for primary ankle joint fusion. A single anatomically preshaped angular stable plate was used with an anterior approach. An excellent result with good bone ...consolidation was present at the 1-year follow-up examination.
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