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PubMedDate not supplied

Adding stability to the crescentic basilar first metatarsal osteotomy.

Crescentic basilar osteotomies for metatarsus primus varus and hallux valgus allow for substantial correction of the first intermetatarsal angle and the hallux valgus angle. Crescentic osteotomies have two well-documented pitfalls: sagittal plane instability and difficulty in fixation. We describe the addition of a plantar shelf to crescentic basilar osteotomy that allows for easier fixation and less risk of elevation of the first metatarsal postoperatively. This plantar shelf is made in the metaphyseal portion of the first metatarsal, which provides the benefit of better bone healing. In 20 patients, we found an average reduction in the intermetatarsal angle of 9.3 degrees and an average reduction in the hallux valgus angle of 21.8 degrees. Eight weeks postoperatively, only one patient showed elevation of the first metatarsal.

Biomechanical Phenomena↗
PubMed2004

The effect of ankle position on the exam for first ray mobility.

PURPOSE: The clinical assessment of first ray motion in the sagittal plane, as originally described by Morton, is difficult to quantify. Different reports have shown inconsistent values and variability between the manual exam and examination using an external measuring device. The authors hypothesize that when performing a manual examination for evidence of increased first ray motion, the magnitude of first ray mobility varies as the position of ankle dorsiflexion/plantarflexion varies. METHODS: Using an external caliper (a modified Klaue device), the authors quantified first ray motion in reference to variable ankle positions in a group of normal patients, a group of patients with untreated moderate and severe hallux valgus, a group who had undergone a successful metatarsophalangeal joint arthrodesis for hallux valgus, and a small group who had previously undergone a plantar fasciectomy. A total of 119 feet (109 patients) were measured. In addition to first ray motion, radiographic data were compared between groups. RESULTS: With the ankle in the neutral dorsiflexion position, the mean first ray motion was 4.9 mm for the control group, 7.0 mm for the hallux valgus group, 4.4 mm for the metatarsophalangeal fusion group, and 7.7 mm for the plantar fasciectomy group. There was a significant decrease (p < .05) in first ray motion when the ankle was moved to the dorsiflexed position for all four groups. There was a significant increase in first ray motion when the ankle was moved to the plantarflexed position (p < .01) for all groups except the plantar fasciectomy group. No significant difference in first ray motion was observed for the plantar fasciectomy group between the neutral and plantarflexed ankle positions (p < .05). CONCLUSION: The exam for first ray mobility is influenced by the position of the ankle and may explain the discrepancy between the manual exam and measurement with an external device. Recommendations for the manual exam of first ray mobility are given.

Adult↗
PubMedDate not supplied

[Long-term outcome of arthroplasty of the first metatarsophalangeal joint].

INTRODUCTION: Resection arthroplasty of the first metatarsal-phalangeal joint is a wellknown operation for hallux valgus. The follow-up results more than 17 years after arthroplasty are recorded and discussed. MATERIAL AND METHOD: Between 1971 and 1980, 335 arthroplasties were performed on 205 patients. The only indication for arthroplasty of the great toe was hallux valgus. The technique of arthroplasty was according to Keller-Brandes. 102 patients were reexamined clinically and radiographically, after 17.6 years on average. RESULTS: Questionnaire assessment revealed a significantly prolonged walking distance and 70% of the patients were painfree at the time of investigation, whereas 67% suffered from severe pain before operation. Clinical evaluation showed diminished weightbearing of the great toe during walking and a reduced range of motion of the partial-resected first metatarsal-phalangeal joint. Radiographically the shortening of the phalangeal bone of 37% was evident as expected. Hallux-valgus-angle was 23 degrees at the time of investigation and 34 degrees preoperatively in the mean. DISCUSSION: The high rate of hallux valgus relapse, especially due to a high intermetatarsal angle demonstrate unsatisfactory longterm results by the Keller-Brandes operation. We now recommend this operation for older patients and a differentiated approach according to the clinical and radiographical situation for younger patients.

Adolescent↗
PubMedDate not supplied

First metatarsophalangeal fusion in the salvage of failed hallux abducto valgus operations.

The surgical technique of fusing the first metatarsophalangeal joint with multiple Herbert screws has been described. When properly performed, it can achieve a very high fusional rate and a relatively low incidence of complications. It is particularly useful in salvaging failed hallux abducto valgus operations, such as postoperative infection, angular and rotational deformities of the first metatarsophalangeal joint, complications of distal first metatarsal osteotomies, failure of the first metatarsophalangeal joint fusion, and iatrogenic destruction of the first metatarsophalangeal joint.

Adult↗
PubMed1991

Metatarsus primus varus. A statistical study.

A survey of 6000 schoolchildren discovered 36 cases of unilateral and 60 cases of bilateral hallux valgus, defined as a metatarsophalangeal angle of more than 14.5 degrees, measured on standing radiographs. Metatarsus primus varus was found not only in the early stages of hallux valgus but in the unaffected feet of children with unilateral hallux valgus. Adduction of the first metatarsal is not due to differential growth of the cortices of the first metatarsal nor is it a consequence of malalignment of the metatarsocuneiform joint. The intermetatarsal angle did not correlate with the angle of metatarsus adductus nor with the intercuneiform angle.

Anthropometry↗