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PubMed1999

Role of metatarsus primus elevatus in the pathogenesis of hallux rigidus.

Metatarsus primus elevatus has been suggested as a primary causative factor in the pathogenesis of hallux rigidus. The purpose of this investigation was to define the role of elevation of the first ray in the pathogenesis of hallux rigidus by comparing patients with known hallux rigidus with a control population. We reviewed 264 lateral weightbearing radiographs from 81 patients with hallux rigidus, 50 asymptomatic volunteers, and 64 patients diagnosed with isolated Morton's neuroma. Results revealed that the mean values for elevation of the first ray in patients with mild or moderate hallux rigidus were nearly identical to those in the control group. Patients with advanced radiographic hallux rigidus had a slightly higher mean value for metatarsus primus elevatus. An average of nearly 8 mm of metatarsus primus elevatus is a normal finding in patients with hallux rigidus as well as in normal subjects. This investigation did not address the clinical outcome or biomechanical effects of a plantarflexion osteotomy of the first ray. However, on the basis of the finding that first ray elevation is normal, it seems unlikely that a plantarflexion osteotomy would have a role in the treatment of hallux rigidus.

Adult↗
PubMed1999

[Hallux valgus treated by Scarf osteotomy of the first metatarsus and the first phalanx associated with an adductor plasty. Apropos of 50 cases with a 2-year follow up].

PURPOSE OF THE STUDY: Fifty hallux-valgus were treated with Scarf Osteotomy of the first metatarsal, associated to a phalangeal varisation or shortening osteotomy and an adductor plasty. Patients were evaluated with a minimum follow-up of two years. MATERIAL AND METHODS: Forty five females and two males were operated with an average age of fifty years. The pre operative metatarsus varus was of 15 degrees 8. Mean alignment of metatarsal bar was 31 degrees 4. The cuneo-metatarsal joint was twenty two times spheric and twenty eight times plane. The average metatarso-phalangeal great toe valgus was 39 degrees 8. RESULTS: They were appreciated with a minimal follow-up of two years, according to the 3 Groulier's criteria: correction of deformation, statics troubles, functional activity. The metatarsus varus improved with an average of 10 degrees 4, as well as the alignment of the metatarsal bar (25 degrees). The post operative average phalangeal valgus was 22 degrees 7. These results were statistically significant. Cuneo-metatarsal joint type did not influenced final result. Articular joint line was normal in 64% of cases. Global result was excellent or good in 70%, passable in 22%, and bad in 8% of cases. DISCUSSION: Scarf Osteotomy of the first metatarsal allows complete correction of metatarsus varus. The surgical approach can be proposed at every age. There are no vascular trouble or arthrosis worsening. It must be completed with a phalangeal varisation or shortening osteotomy and adductor plasty.

Adolescent↗
PubMed1989

Hallux valgus and metatarsus adductus: the surgical dilemma.

Hallux varus in the presence of metatarsus adductus is a complex clinical entity that requires careful evaluation and preoperative planning. The metatarsus adductus complicates the picture by accentuating the effect of the intermetatarsal angle and also creates compensatory pronation. Transpositional osteotomies of the first metatarsal are difficult to perform in patients with an adducted forefoot and mild increase in intermetatarsal angle. Surgical therapy generally requires aggressive osteotomies of the first ray to decrease its medial prominence. Total metatarsus adductus correction should be considered in patients with severe deformity.

Child↗
PubMed1993

[Metatarsus primus double osteotomy, a logical and non-disabling surgical technique for treatment of hallux valgus].

The procedure known as the Metatarsus Primus Double Osteotomy ("L'ostéotomie métatarsienne bipolaire" of Schnepp-Carret) for the treatment of the hallux valgus is a logical, efficient and non-mutilating procedure. The technique consists in reducing the hallux valgus deformity by a subcapital bone wedge resection of the metatarsus primus. The bone wedge is then pinched into a second proximal osteotomy of the metatarsus primus, correcting the varus deformity in a valgus direction. This procedure is little known and is not even mentioned in the classic orthopedic literature of German and English language.

Bone Wires↗
PubMed1980

Abductor hallucis release in congenital metatarsus varus.

Adduction of the forefoot diagnosed in the young child generally corrects spontaneously. Resistant forefoot adduction is usually combined with a degree of supination of the forefoot and described as congenital metatarsus varus. In true congenital metatarsus varus there is a contraction or shortening of the abductor hallucis muscle and tendon which is considered to be the primary deforming factor. In the early severe or resistant deformity correction can be achieved by either division of the tendon with release of its capsular attachment, or, in the more severe deformity, by complete release of the abductor hallucis muscle from its extensive attachment to bone and soft tissues.

Child↗
PubMed1988

Neonatal metatarsus adductus, joint mobility, axis and rotation of the lower extremity in preterm and term children 0-5 years of age.

A total of 484 premature children and a control group of 114 healthy term children underwent orthopaedic follow-up from birth to 5 years of age. At birth, metatarsus adductus was found to be more frequent in twins than in single infants (41% vs 16%; P less than 0.01), but occurred with equal frequency in single preterm and term infants (16% vs 12%). By 5 years of age, metatarsus adductus had resolved in all the term but only in 81% of the preterm children (P less than 0.05). In the preterm and term groups, knee axis (mean intermalleolar distance 22.0 mm vs 20.1 mm), tibial torsion (mean angle -1.2 degrees vs + 0.6 degrees) and angle of gait (mean angle + 1.5 degrees vs + 0.7 degrees) at 5 years were statistically insignificant. Hip function at 5 years was similar in normal preterm and term children but significantly decreased in preterm children with cerebral palsy, more so with regard to abduction (56 degrees vs 39 degrees, P less than 0.05) and extension (22 degrees vs 8 degrees, P less than 0.01). The difference between the sexes was insignificant in both the preterm and term groups.

Child, Preschool↗
PubMedDate not supplied

Abductory midfoot osteotomy procedure for metatarsus adductus.

The authors describe a new surgical technique for the correction of metatarsus adductus using an abductory osteotomy performed in the lesser tarsal region that enables transverse plane correction of an adducted forefoot. This procedure is based on the premise that matatarsus adductus deformity is actually a deformity of the midtarsus rather than the metatarsus segment of the foot. The osteotomy technique involves shortening of the lateral column using closing wedge technique and lengthening of the medial column using opening wedge technique. The correction is entirely in the transverse plane; however, modifications may be performed when other planal deformities are present. Historical review, principles, technique, and case studies are discussed.

Bone Transplantation↗
PubMedDate not supplied

[Intermediate results following subcapital metatarsal osteotomy in the therapy of hallux valgus with metatarsus primus varus].

71 feet were investigated after subcapital modified osteotomy of the metatarsus according to Kramer for an average follow-up period of 19 months. Mean improvement of the Hallux valgus angle was 10 degrees whereas the intermetatarsal angle was improved by 4 degrees on average. The high degree of satisfaction of patients (83%) with the outcome of this surgical method suggest its application in cases of medium metatarsus primus varus within hallux valgus deformations when the metatarso-phalangeal joint is not affected. In patients aged 50 years and older as well as in cases of MT I varus exceeding 18-20 degrees this operation should strictly be limited to the cases indicated above.

Adolescent↗
PubMedDate not supplied

Scintigraphic appearance of the dorsal cortex of the third metacarpus and third metatarsus in the horse.

The lack of "standard uptake pattern" to refer to when interpreting scintigraphic images poses a problem to anyone working with skeletal scintigraphy. An article written by Koblik et al. stated that in the normal scintigraphic image of older horses, the dorsal cortex of the metacarpus and metatarsus is not identifiable, whereas it can be identified in younger horses. In this retrospective study we evaluated the association between the age of a horse and visibility of the dorsal cortex of the metacarpus and metatarsus. We found that dorsal cortical uptake can be seen in the normal adult horse. The population in the study consisted of 139 horses scanned under general anesthesia in lateral recumbency. Scintigraphic images of 202 limbs were examined visually and by using a profile image tool. In almost all limbs the dorsal cortex was identifiable (82%); only 7% of the dorsal cortices were not identifiable; and 11% of the scintigraphic images were not interpretable.

Aging↗
PubMed1982

Aetiology and interrelationship of some common skeletal deformities. (Talipes equinovarus and calcaneovalgus, metatarsus varus, congenital dislocation of the hip, and infantile idiopathic scoliosis).

The Edinburgh Register of the Newborn 1964-1968 and the Edinburgh Scoliosis Clinic 1964-1971 have been used to establish the population frequency in the city of the idiopathic forms of talipes equinovarus and calcaneovalgus, metatarsus varus, congenital dislocation of the hip, and infantile scoliosis. A survey of 165 patients now aged 7 to 11 years showed an aetiological relationship, but with differing environmental factors. These factors were established by comparison with the Edinburgh Register control group of 692 normal infants born over the same period, giving a unique opportunity to obtain more accurate antenatal data than has previously been possible. The principal associations were: talipes equinovarus with antepartum haemorrhage and maternal hypertension; metatarsus varus with twin pregnancies; congenital dislocation of the hip with first born children, older than average fathers, breech presentation, a significant lack of menstrual problems in the mother, and maternal upper respiratory infection during pregnancy; infantile idiopathic scoliosis with breech presentation, prematurity, and the onset of the curve in the winter months. No significant association with raised intrauterine pressure (hydramnios or oligohydramnios) was found among these simple idiopathic deformities. It is concluded that the multifactorial genetic background in likely to be similar in all, but that the additional environmental element is variable.

Adult↗
PubMed2004

A technique for creating critical-size defects in the metatarsus of sheep for use in investigation of healing of long-bone defects.

OBJECTIVE: To develop a technique for use in investigation of healing of long-bone defects by creation of a critical-size defect in the left metarsal III and IV bone (metatarsus) of sheep. ANIMALS: 18 healthy adult sheep. PROCEDURE: Sheep were allocated to 4 groups (3, 3, 5, and 7 sheep in groups 1 to 4, respectively). An ostectomy with various segmental length-to-diaphyseal diameter ratios (0.5, 1.0, 2.0, and 2.0 for groups 1 to 4, respectively) was performed on the left metatarsus of each sheep. The defect was left empty in sheep of groups 1, 2, and 3, whereas the defect was filled with a massive corticocancellous bone autograft in sheep of group 4. RESULTS: All sheep tolerated the surgical procedure well and were able to use the affected limb the day after surgery. Radiographic and histologic examinations conducted 16 weeks after surgery revealed nonunion in all sheep of groups 1, 2, and 3, whereas consistent bone healing with abundant bone formation was observed in all sheep of group 4. CONCLUSIONS AND CLINICAL RELEVANCE: Analysis of these findings suggests that the sheep metatarsal model is a critical-size defect model with low morbidity. It should allow the assessment of new technologies for bone regeneration in conditions closely mimicking the clinical setting. IMPACT FOR HUMAN MEDICINE: Use of this technique in sheep should be of benefit for the preclinical study of osteoconductive, osteoinductive, or osteogenic biomaterials for use in humans.

Animals↗
PubMed1983

The pathology of congenital metatarsus varus. A post-mortem study of a newborn infant.

A case of congenital metatarsus varus from an autopsy of a newborn infant was explored. Contracture of the anterior tibialis muscle was present as well as alterations in size and shape of the first cuneiform bone. Furthermore, subluxations in the fore- and midfoot were observed, especially round the first cuneiform bone. It is concluded that congenital metatarsus varus may be classified as a subluxation followed by secondary bone changes and contractures in the soft tissues.

Foot Deformities, Congenital↗
PubMed1993

Metatarsus proximus and digital divergence. Association with intermetatarsal neuromas.

A retrospective radiologic study was performed to determine whether there is an increased finding of metatarsus proximus and digital divergence in patients with a confirmed diagnosis of intermetatarsal neuroma when compared with an asymptomatic group. The study included 48 patients with pathologic confirmation of neuroma and 100 asymptomatic patients. Results of the study revealed no statistical relationship between the radiologic findings of metatarsus proximus and digital divergence and the physical occurrence of neuromas. An unexpected finding was an increased intermetatarsal angle of the affected interspace in the neuroma group.

Adult↗
PubMed1994

Juvenile hallux abducto valgus association with metatarsus adductus.

The authors evaluated the radiographs of 40 patients (72 feet) under 21 years of age who underwent surgery for symptomatic hallux abducto valgus deformity at Northlake Regional Medical Center. Forty-eight of 72 feet had metatarsus adductus angles greater than 15 degrees. A statistically significant correlation was found between an increasing metatarsus adductus angle and an increasing hallux abductus angle.

Adolescent↗
PubMed2003

[Bone lengthening of congenitally short metacarpus and metatarsus by the callus distraction technique].

OBJECTIVES: We evaluated the results of lengthening of congenitally short metacarpus and metatarsus by the callus distraction technique. METHODS: We treated congenitally short metacarpus (n=7) and metatarsus (n=4) of five patients (4 females, 1 male; mean age 15 years; range 10 to 21 years) by callotasis. Callus distraction was performed with the use of mini-Orthofix or Ilizarov type semicircular external fixators. The distraction rate was 0.25x2 mm/day for both types. The mean follow-up period was 23 months (range 12 to 33 months). RESULTS: The mean metacarpal and metatarsal lengthenings were 20 mm (range 15 to 25 mm) and 25 mm (range 20 to 30 mm), respectively. The mean healing index was 1.4 months/cm for metacarpal lengthening, and 1.8 months/cm for metatarsal lengthening. No neurovascular complications were encountered. One patient required autogenous fibular grafting for union. Pin tract infections were found in three patients. The overall complication rate was 36%. CONCLUSION: Callotasis is an effective and reliable method for lengthening of short metacarpal and metatarsal bones. In addition, it preserves the periosteal bone tissues, which has a favorable effect on the duration of treatment.

Adolescent↗
PubMed1991

[Initial experience with the closed method of subcapital osteotomy of the 1st metatarsus in hallux valgus].

The authors summarize initial findings with Bösh's modification of Hohmann's subcapital osteotomy made by means of a cutter from a short dermal incision under X-ray control. The valgosity and rotation of the hallux are corrected by a lateral and possibly plantar shift and by derotation of the head of the metatarsus. The position of the head is ensured by supporting the medial exostosis by a wire inserted by the intramedullary route into the Ist metatarsus. The operation was performed in five female patients aged 37-60 years on nine feet. The results were evaluated after 10-13 months. For osteotomy conic cutters were used (diameter of base 2.1 mm and 5 mm) and a drill (3000 rotations per minute) from the small instrumentarium of SYNTHES Co. The Kirschner wire was removed after four weeks and fixation a with a plaster spica of the toe took, depending on healing, 7-12 weeks after operation. In all instances marked correction of the position of the toe occurred (reduction of the valgosity angle by 8-19 degrees). As to subjective evaluation, four patients evaluated the result as excellent, three as satisfactory, i.e. disappearance or marked reduction of complains and once as unsatisfactory with persisting pain and difficulties as regards footwear. After analysis of the first early results the authors recommend to indicate the operation in valgosity of the toe up to 35 degrees and minimal arthrosis, to perform the osteotomy in a strictly subcapital and extracapsular position and to reduce the period of fixation. The advantage of the method is that the metatarsophalangeal joint is not damaged, the operation is sparing, marked correction of the position of the toes is achieved, the time of operation is short and the scar is not visible.

Adult↗
PubMed1987

Surgical management of metatarsus adductus deformity.

This article is intended to provide the podiatric physician with a comprehensive overview of the surgical management of metatarsus adductus deformity. Both soft tissue and osseous procedures are reviewed including a practical discussion of the preferred incisional approaches, surgical techniques, and postoperative care. Current indication and concepts for each procedure are discussed. A comprehensive history and physical exam, with emphasis on the clinical evaluation and radiographic findings, are critical aspects in the management of the patient with metatarsus adductus. Selection of procedures will be based upon this information as well as chronological age and osseous maturity. When significant deformities in the rearfoot complex are present (that is, pes valgo planus, equinus), consideration should be given to surgical correction simultaneously with correction of the forefoot deformity or at a later stage.

Cartilage, Articular↗
PubMed1986

A reappraisal of metatarsus adductus and skewfoot.

The hypothesis that the treatment of adduction of the fore part of the foot in the child is altered by an associated deformity of the middle or the hind part, or both, was tested in a prospective study of eighty-four patients (124 feet). Radiographic classification delineated four configurations of adduction of the foot, based on varying relationships of the fore, middle, and hind parts of the foot. Twenty-two (43 per cent) of the feet with adduction of the fore part alone (simple metatarsus adductus) required no treatment, as compared with eighteen feet (24 per cent) with the other types of adduction (p less than 0.03). The patients with a complex skew-foot deformity required twice as long a period of cast treatment as those with simple metatarsus adductus (p = 0.0001). On evaluation at a minimum follow-up of two years, only one of the 124 feet had residual adduction of the fore part of the foot, as determined radiographically. It was also found that the use of the Denis-Browne bar was accompanied by an increased incidence of flat-foot deformity at follow-up.

Child, Preschool↗