[A few details of technic to improve results of operations on the toes and feet].
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90% of the first (hallucal) tarsometatarsal joints are screw-shaped; the axis is directed upwards to the front touching the lateral edge of the joint. Thus the plantar flexion is inevitably accompanied by an adduction and a pronation, and vice versa a dorsiflexion is consequently accompanied by an abduction and a supination, when the articular surfaces exactly slide along each other. 10% of these joints, however, are ellipsoid-shaped; in this case the distal articular surface of the medial cuneiform bone has the form of an ovoid head, and a strong ligament situated next to the lateral edge of the joint effects the same kind of motion described above. The medial cuneonavicular joint is always ellipsoid-shaped, the head of which is made up by the medial facet of the distal articular surface of the navicular bone. Each of the two joints mentioned has a considerable range of mobility.
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Indications and contraindications for tenotomy, tenectomy, and capsulotomy have been cited and surgical procedures outlined. The importance of possible supplemental surgery and biomechanical follow-up have also been stressed.
A brief history and the evolution of the Swanson implant hemi-arthroplasty of the first metatarsophalangeal joint introduces this small series of cases. Preoperative criteria, surgical technique, and results are presented along with the follow-up. Long term follow-up suggests that there are some additional complications to this especially in cases of arthritis associated with systemic diseases.
The authors present a retrospective study of 47 digits, with an average follow-up of 15 months, using the Silastic Hammertoe Implant H.P. The complications inherent with all implants are reviewed and the specific problems noted with this implant, including dislocation, bony regrowth, and lack of a superior cosmetic result, are discussed.
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