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Hallux varus is a deformity, either congenital or acquired, of the first metatarsophalangeal joint. It presents as a medical deviation of the hallux in relation to the longitudinal axis of the first metatarsal shaft. The authors discuss the case history of a patient and the surgical technique--a split width tenodesis--which they used to correct the deformity.
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In this paper the authors discuss transverse plane deformities at the lesser metatarsophalangeal joints and propose a new surgical procedure for correcting these deformities. The results have been encouraging because the procedure does not interfere with function and there have been no recurrences.
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Although designed for finger joint replacement, the Calnan-Nicolle prosthesis and the Swanson prosthesis have been successfully adapted for use in the foot. The author discusses the advantages and disadvantages of a new joint prosthesis developed by Nicolle which, with slight modification, is also being used in the lesser metatarsophalangeal joints.
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A technique for stabilization of the metatarsophalangeal joint maintaining propulsive power of the hallux and prevention of transfer lesions has been described. It utilizes the flexor hallucis longus tendon to maintain the integrity of the biomechanics of the first metatarsophalangeal joint while obviating the need for an interphalangeal joint fusion to prevent hallux flexus. The procedure is an adjunct to the medial and dorsal exostectomy, corrects for proximal and distal articular set angles, and provides for a rapid recovery of function of the metatarsophalangeal joint.
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A case of avulsion fracture of the lateral sesamoid is reported in association with dislocation of themetatarsophalangeal joint of the hallux. The radiographic criteria to establish the diagnosis of fracture in sesamoid bones are outlined. Review of the literature reveals only one other reported case associated with a hallux dislocation, and in that case, the radiographic diagnosis was not clearly established.
Cadaveric and fresh amputation dissection studies revealed that condylar anomalies, metatarsal axial rotation, and bowstrung flexor tendos will commonly produce subluxation and degenerative changes at the metatarsophalangeal-sesamoid joint. The average arc of motion of the sesamoids from maximum plantar- and dorsiflexion was measured at 71.9 +/- 11 degrees. The anatomic variations presented are correlated with the incidence of chronic sesamoiditis, painful bipartite sesamoids, and chronic nonunions.
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A composite retrospective radiographic analysis of 71 patients who had undergone the Keller arthroplasty and 76 who had undergone the Keller with hemi-implant was performed. The combined mean preoperative intermetatarsal angle was 11.4 degrees, the mean postoperative intermetatarsal angle was 9.4 degrees, and the mean change in intermetatarsal angle was 2.0 degrees. Although the reduction of the metatarsus primus adductus deformity obtained was less than previous studies, the amount of correction was directly proportional to the magnitude of deformity. The authors conclude that through reverse buckling at the first metatarsophalangeal joint, adequate reduction in the positional component of metatarsus primus adductus can be obtained with the Keller arthroplasty alone or with a hemi-implant. These procedures are preferred over metatarsal osteotomies in the physiologically older patient, especially when a severe metatarsus primus adductus deformity exists.
Fibular sesamoidectomy is necessary in certain instances to achieve permanent correction of hallux abducto valgus deformities. The decision to remove the fibular sesamoid is usually based on the position of the tibial sesamoid (which is determined by clinical and radiographic examination). If the fibular sesamoid is in positions 4 to 7, it is difficult, if not impossible, to maintain the correction of the hallux abducto valgus; if the position is 1 through 3, the sesamoids can be moved medially and maintained by the crista which is still intact.
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This report describes the use of a double-stemmed flexible hinge silicone elastomer implant for use as a total joint replacement for the metatarsophalangeal joint of the great toe. Experience with this prosthesis has been since 1971 with 103 prostheses implanted in 71 patients with a minimum follow-up of 12 months and an average follow-up of 7.4 years. Of the 71 patients, 40 had osteoarthritis with 64 joints replaced, 22 had rheumatoid arthritis with 29 joints replaced, four patients were revised from a failed excisional hemiarthroplasty, three patients with four joints involved were revised from a failed silicone implant hemiarthroplasty, and two patients had a surgically arthrodesed metatarsophalangeal joint taken down and revised to a total joint arthroplasty. Of the total number of patients involved, eight were men, 63 were women, and the average age per joint was 56 years. The results were graded as excellent, good, fair, and poor on two bases: relief of pain and the cosmetic result. Overall results were good. On the basis of these results over a 12-year period, it was concluded that there is a place for total joint prosthetic replacement in the surgical reconstruction of the painful, destroyed metatarsophalangeal joint of the great toe.