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Congenital metatarsus adductus: clinical evaluation and treatment.

Congenital metatarsus adductus, a deformity at the tarsometatarsal joints in which the metatarsals are deviated internally in relation to transverse plane, predisposes to "pigeon-toed" gait. Treatment is aimed at achieving normally balanced foot by overcorrection at the deformity sites. The most common problem after treatment is pronation deformity, which can be avoided by carefully positioning the heel at the time of casting. The sooner conservative measures are instituted, the more easily and rapidly the deformity will be corrected. If conservative casting does not result in improvement, then soft tissue surgery is indicated.

Adult↗

Surgical management of hallux limitus and rigidus in the young patient.

As demonstrated in a recent survey, hallux limitus and rigidus are often the presenting complaints of our young population. Normal first metatarsophalangeal joint function depends not only on an intact articulation but also sesamoidal mobility and the capacity for the first metatarsal to plantarflex. Whereas acute or chronic microtrauma can impair articular surfaces, first metatarsal plantarflexion can be limited in cases of hypermobility, excessive metatarsal length, immobility of the first metatarsocuneiform joint, or metatarsus primus elevatus. Conservative therapy can be more effective in relieving the symptoms of hallux limitus or rigidus in young patients; however, surgical intervention is often necessary or desirable. The choice of surgical procedure should be based on the etiology of the deformity, as well as the degree of articular degeneration. It is the senior author's opinion that young patients with hallux limitus or rigidus are best served by the performance of cheilectomy with osteotomies designed to create an internal rocker bar mechanism. Procedures designed to shorten or plantarflex the first metatarsal should be reserved for obvious cases of excessive metatarsal length or elevation.

Adult↗

Motion of the first metatarsophalangeal joint.

The analysis of motion of the first metatarsophalangeal joint in this study demonstrates the character of motion about this joint. Four instantaneous centers of rotation were calculated in the first metatarsal head that formed an arc encircling an area of increased stress patterns. The joint motion is made up of rolling, sliding, and compression. The fact that there is more than one center of motion contradicts the theory of a simple hinge joint. The joint is a dynamic acetabulum or "hammock," as described by Kelikian. That is, the first metatarsal head moves within a stable support comprised of the base of the proximal phalanx, the sesamoids, soft tissue, and muscle tendons. The nature of first metatarsophalangeal joint motion must be considered when contemplating surgical procedures of the first metatarsophalangeal joint.

Adult↗

Variation in practitioner-measured x-ray angles in hallux abducto valgus evaluation.

Angular measurements taken on preoperative hallux abducto valgus x-rays have been relied upon heavily by surgeons in helping to determine the nature and extent of the deformity, as well as a guide for selecting the most appropriate surgical procedure for correction. The reliability of measuring these angles among different physicians has never been tested, to these authors' knowledge. Therefore, this study is designed to measure the variation in values for the five basic angles among a group of podiatrists with varying capabilities, training, and experiences, and demonstrates that preoperative radiographic measurements may not be an accurate reflection of the general degree of pathology about the first metatarsophalangeal joint.

Calibration↗

Joint surgery for rheumatoid arthritis.

The state of the art in the surgery of rheumatoid joint disease is discussed with emphasis on guidelines for choosing the patients and the types of procedures available. Strong-willed, strong-boned, strong-muscled, and well-informed patients are the best candidates. Synovectomy is particularly useful in the minimally erosive stages of the disease when the active synovitis is not suppressed by one or more steroid injections or other modalities of therapy. Arthrodeses and arthroplasties are midstage procedures that are now being supplanted by total joint replacement. This is especially true of the knee, but new prostheses for elbows, shoulders, wrists, and ankles are on the horizon.

Ankle Joint↗