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Objective: To explore the effectiveness of the first-stage debridement and Ilizarov metatarsal bone lengthening in treatment of diabetic foot ulcer complicated with chronic osteomyelitis of metatarsal head. Methods: Between January 2015 and October 2018, 8 cases (9 feet, 11 sites) of diabetic foot ulcer complicated with chronic osteomyelitis of metatarsal head were treated by first-stage debridement and Ilizarov metatarsal bone lengthening. There were 3 males (4 feet, 5 sites) and 5 females (5 feet, 6 sites), with an average age of 57.5 years (range, 44-65 years). According to diabetic foot Wagner grade, 6 cases (7 feet) were grade 3 and 2 cases (2 feet) were grade 4. The chronic osteomyelitis located at left foot in 4 cases, right foot in 3 cases, and bilateral feet in 1 case. The duration of chronic osteomyelitis was 1-5 years (mean, 3.1 years). The chronic osteomyelitis site was the 1st metatarsal head in 3 feet, the 3rd metatarsal head in 1 foot, the 4th metatarsal head in 1 foot, and the 5th metatarsal head in 6 feet. Two patients had chronic osteomyelitis at 2 sites on 1 foot. The length of lengthened metatarsal bone, lengthening time, and the time of wearing external fixation frame were recorded, and the external fixation frame index was calculated. The healing conditions of foot ulcer and lengthening bone segment were observed, the healing time was recorded, and the healing index of lengthening bone was calculated. The ankle function was evaluated according to the American Orthopedic Foot and Ankle Society (AOFAS) score criteria. Results: All patients were followed up 9-26 months with an average of 15.0 months. Except pin tract infection during the bone lengthening period, there was no complications such as skin necrosis and vascular or nerve injury occurred during treatment. The length of lengthened metatarsal bone was 12-35 mm with an average of 20.5 mm; the metatarsal bone lengthening time were 21-84 days with an average of 57.8 days. The average time of wearing external fixation frame was 14.6 weeks (range, 10.4-21.1 weeks) and the external fixation frame index was 54.3 days/cm (range, 42.9-59.2 days/cm). The ulcer wound healed with an average healing time of 30.5 days (range, 19-70 days) and no ulcer recurrence was observed during follow-up. Bone healing was obtained in all bone lengthening segments, and the average healing index was 42.5 days/cm (range, 37-51 days/cm). The average AOFAS score was 91.7 (range, 87-95); 5 feet were excellent and 4 feet were good. The excellent and good rate was 100%. Conclusion: The metatarsal bone lengthening under Ilizarov law of tension-stress after debridement can promote diabetic foot ulcers healing and reconstructing the length of metatarsal to retain the function of metatarsal load and avoid amputation. This is an effective method for the treatment of diabetic foot ulcer complicated with chronic osteomyelitis of metatarsal head.
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Objective To explore the surgical technique and treatment outcomes of the big toe wrap-around flap combination of the second phalange with the metatarsal to reconstruct the thumb. Methods From June,2014 to December, 2016, 6 patients of the thumb defects onⅤdegree, we took the big toe wrap-around flap with the second toe and the metatarsal to reconstruct the thumb. The metatarsal head was truncated nearby the metatarsophalangeal joint,and the metatarsal head was turned 70°-80° from the dorsal side to the plantar side, then recombinated the metatarsal after dealed with the fracture, so it can rebuild the metacarpophalangeal joints and the metacarpal. 6 cases were followed up. Results All cases survived,and they were followed up duing 4 to 24 months after operation. The shape was similar with uninjured sides and the two-point discrimination was 1.0-2.0 cm.The function recovered satis-factorily and the maximum flexion of the metacarpophalangeal joints can reach 50 degrees,at the same time,it has the function of dorsiflexion. They were got bone healing and there was no bone absorption and joint degeneration. The donor foot has no ulceration,and walking without the pain and lameness. According to the Upper Extremity Functional functional Evaluation Standard set up by Hand Surgery Branch of Chinese Medical Association,there were excellent in 3 cases and good in 3 cases. Conclusion Combined the big toe wrap-around flap with the second toe and the metatarsal to reconstruct the thumb, it can rebuild the metacarpophalangeal joints and metacarpal, we can get the thumb which have the physiological curvature and the suitable length,the configuration and the function were satisfac-tory.It is an effective method for reconstruction of the thumb defect onⅤdegree.
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Objective To compare the therapeutic effects of locking compression plate distal ulna hook plate (LCP-DUHP) and cannulated screws in the internal fixation for fractures of the fifth metatarsal base at zones Ⅰ and Ⅱ.Methods This retrospective study included 67 patients who had been treated for fractures of the fifth metatarsal base at zones Ⅰ and Ⅱ from July 2013 through December 2015.Of them,29 were treated by internal fixation with cannulated screws,including 17 men and 12 women with an average age of 46.6 years.There were 13 zone Ⅰ fractures and 16 zone Ⅱ fractures according to the Lawrence-Botte partition.The other 38 patients were treated by internal fixation with LCP-DUHP,including 20 men and 18 women with an average age of 33.7 years.There were 20 zone Ⅰ fractures and 18 zone Ⅱ fractures according to the Lawrence-Botte partition.The therapeutic effects were evaluated at the final follow-ups using visual analogue scale (VAS) for the affected feet,American Orthopaedic Foot and Ankle Society (AOFAS) midfoot scoring system,and incidence of postoperative complications.Results All this series were followed up for 51 to 87 weeks (average,57weeks).There were no significant differences between the cannulated screws group and the LCP-DUHP group in terms of fracture healing time (13.9 ± 1.6 weeks versus 14.2 ± 1.8 weeks),VAS scores (4.9 ± 1.3 versus 4.8 ± 1.O) or AOFAS midfoot scores (87.9 ± 3.4 versus 88.6 ± 2.5) (P ＞ 0.05).Bony union was achieved in all.No implant failure was observed in this series.Conclusion Both LCP-DUHP and cannulated screws can lead to satisfactory therapeutic effects in the treatment of fractures of the fifth metatarsal base at zones Ⅰ and Ⅱ.
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Objective To investigate the clinical effect of the free fibula composite tissue flap transplantation to repair the first metatarsal bone with soft tissue defect on foot.Methods From August, 2008 to August, 2013, 6 patients with the first metatarsal bone and soft tissue defect on foot were treated with transplantation of free fibula composite tissue flap.The causes: 2 cases in traffic accident injury, 4 cases in machine injury;3 cases with traumatic defect, and septic defect in 3 patients.Of the 6 cases, the fibular length with transplantation was 6 cm to 12 cm, and the flap area was 8 cm × 5 cm-18 cm × 16 cm;All the cases were followed-up in 3, 6, 12 months postoperatively to observe the fracture healing, and to assess injured limb function in 1 year postoperatively.Results All cases were followed up 12-24 months, and average of 14 months;All the flaps survived, and the metatarsal bone and fibula healing was good visibly in half a year, The surgery function were assessed according to Maryland's scale, and the excellent were 2 and the good were 4.Conclusion The transplantation of free fibula composite tissue flap to repair the first metatarsal bone with soft tissue defect on foot is a safe and effective strategy, and it has the advantages such as covering the wound at foot approvingly, one-time rebuild repair foot weight bearing area and the surrounding soft tissue defect, shorten the treatment cycle, for small area damage in donor area, and the function postoperative is good, etc.
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Objective To study the effects of fluoride on longitudinal growth and pathological changes of cultured rat metatarsal bone rudiments.Methods Twenty-four neonatal SD rats were divided into four groups according to the random number table,then the second,third and fourth metatarsal bone rudiments were surgically isolated.The left metatarsal bone rudiments were cultured in α-MEM without F-as control group and the right metatarsal bone rudiments from the same rat were cultured in α-MEM with 1 × 10-7,1 × 10-6,1 × 10-5 and 1 × 10-4 mol/L F-.The length and width of the mineralized area of metatarsal were measured on day 0,day 1,day 4 and day 7,respectively,and the pathological changes of metatarsal bone rudiments were observed by the routinely paraffin-embedded sections method on day 7.Results On day 7,the length of the mineralized area was significantly lower of right metatarsal bone [(240.5 ± 139.3)μm] than the left metatarsal bone [(394.1 ± 173.9)μm,t =4.37,P ＜ 0.01] in the 1 × 10-4 mol/L F-group,but the width of the mineralized area [(239.9 ± 119.4)μm] was not different significantly compared to the left metatarsal bone [(223.3 ± 99.9)μm,t =0.44,P ＞ 0.05].The relative vertical growth rate of the mineralized area on day 4 was significantly lower of right metatarsal bone [(2.43 ± 1.44)％] than left metatarsal bone [(8.34 ± 1.74)％,t =3.21,P ＜ 0.01] in 1 × 10-4 mol/L F-group,and the difference was also significant on day 7 [(16.16 ± 2.87)％ vs.(26.52 ± 4.46)％,t =3.13,P ＜ 0.01].Toluidine blue staining results showed that the thickness of cartilage cells of proliferation and hypertrophic layers was significantly lower of right metatarsal bone [(111.33 ± 27.29),(125.33 ± 30.08)μm] than left metatarsal bone [(127.33 ± 38.36),(160.50 ± 42.73)μm,t =4.82,5.81,all P ＜ 0.01] in 1 × 104 mol/L F-group.The ratio of proliferative and hypertrophic layers was significantly higher of right metatarsal bone (0.93 ± 0.36) than left metatarsal bone (0.83 ± 0.32,t =4.42,P ＜ 0.01) in 1 × 10-4 mol/L F-group.Conclusions Our findings indicate that excessive fluoride could cause longitudinal bone growth inhibition.Such growth inhibition is mediated by decreased chondrocyte proliferation and differentiation and the disproportion of proliferation and differentiation.
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Bizarre parosteal osteochondromatous proliferation (Nora's lesion) is a rare benign tumor and known to be primarily occur in the small tubular bone of the hands and feet. However, it is very unusual to be reported that it occurs in metatarsal bone in Korea. Thus, we report this tumor of metatarsal bone including the literature review because we have experienced this example.
Subject(s)
Foot , Hand , Korea , Metatarsal BonesABSTRACT
Objective To evaluate the clinical effects of free fibula and flap grafts on the repair of all the first metatarsal bone at one stage.Methods There were 9 cases with the first metatarsal bone defect from Janurary 2003 to December 2009 that treated with free vascularized fibular bone and free vascularized flap at one stage.In which 6 cases reconstructed at the primary stage and 3 cases reconstructed at the second stage.Seven cases reconstructed by free vascularized fibular combined with ALTPF,two cases reconstructed by free vascularized fibular combined with TAPF.The free vascularized fibular and flap restored the first metatarsal bone and the soft tissue defects respectively.Vascular anastomosis was the artery of flap anastomosis with anterior tibial artery and the vein of the flap anastomosis with great saphenous vein,the peroneal artery and accompany vein anastomosis with artery and vein of the flap.Results The grafted tissues survived smoothly in 8 cases,vein crisis happened in I case and the ALTPF necrosis after blood vessels expedition.So the TAPF was changed to cover the soft defect and survived smoothly.Followiy-up were done from 6 to 36 months in 9 cases.There were no ulcer on flaps and no fracture again,the fibulas had been bone healing.Evaluated by Maryland standards,six cases were excellent,two cases were fine,one case was good.Conclusion The fibula combined flap grafts provide a relatively better alternative to repair the first metatarsal bone compound tissue defects at one stage.In addition,the procedure decreased frequency of operations and short the course of treatment.Sensory function reconstruction of fibula flaps should be given full attention.As fine function of the reconstructed foot,it is a effective method for reconstruction the burdened area of the foot.
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Fractures located at the metaphyseal/diaphyseal junction at the base of the fifth metatarsal were first described by Sir Robert Jones in 1902. However, ever since, there has been disagreement and debate regarding the diagnosis, classification, pathomechanics, the incidences, and potential causes of delayed unions and nonunions, and the optimal method of treatment. It appears to be widely agreed that proximal fractures of the metaphyseal/diaphyseal region of the fifth metatarsal are prone to delayed union or even nonunion. Several classifications of proximal fifth metatarsal stress fractures have been devised. Torg et al. classified fractures involving the proximal part of the diaphysis of the fifth metatarsal into three types. The Torg classification is a good grading system that can be used to determine the type of surgery needed as well as for the prediction of prognosis. The "plantar gap" might add to the decision-making process for surgery and improve the prediction of patient prognosis. In addition, the new classification using 'plantar gap' might be used for classification of fifth metatarsal stress fracture. Fifth metatarsal stress fractures can be treated conservatively or surgically, and excellent results have been reported for surgery with rapid recovery in athletes. Intramedullary screw fixation has become a popular form of fixation for fifth metatarsal stress fractures. Bone grafting presents the problems of a longer recovery time and additional skin incision for harvesting. The modified tension band wiring is an useful and simple option for surgical treatment of challenging fifth metatarsal stress fractures.
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Humans , Athletes , Athletic Injuries , Bone Transplantation , Diaphyses , Fractures, Stress , Incidence , Metatarsal Bones , Prognosis , SkinABSTRACT
PURPOSE: We wanted to analyze the results of the 1st metatarsal dorsal close wedge osteotomy (MTDW) combined with medical cuneiform plantar open wedge (MCPOW) for treating forefoot deformity of a cavus foot. MATERIALS AND METHODS: We retrospectively analyzed 30 patients. Their mean age was 21.5 years (SD 10.6 years) and the average follow-up period was 2.3 years. Thirty-four cases of thirty patients were classified as group A, as classified by the 1st MTDW combined with the MCPOW, 16 feet (14 patients) were group B by the 1st MTDW or MCPOW, 12 feet (10 patients), and group C by triple arthrodesis, 6 feet (6 patients). We evaluated the ankle dorsiflexion, plantarflexion, heel alignment, and the Maryland foot score (MFS) preoperatively and the last follow-up, and we analyzed the radiologic Hibb, Meary, calcaneal pitch and tibiotalar angles. RESULTS: The ankle dorsiflexion (p=0.01), plantar flexion (p=0.03) and heel alignment (p=0.02) of group A were significantly improved more than that of groups B and C. The MFS of group A revealed better than group B and C (p=0.01). The Meary (p=0.01), Hibb (p=0.02) and calcaneal pitch angle (p=0.02) of group A were significantly improved more than that of groups B and C. CONCLUSION: 1st MTDW combined with MCPOW osteotomy that focuses at the apex of the deformity for correction of a cavus foot can obtain better clinical and radiological results than other surgical procedures.
Subject(s)
Animals , Humans , Ankle , Arthrodesis , Congenital Abnormalities , Follow-Up Studies , Foot , Heel , Maryland , Metatarsal Bones , Osteotomy , Retrospective StudiesABSTRACT
@#ObjectiveTo evaluate the strain of the weight-bearing metatarsal bone. Methods6 fresh-frozen cadaveric lower extremities were dissected to expose the dorsal aspect of metatarsal. Bone segments were clarified for adherence of strain-gauges while feet kept intact. Then vertical downward axial load was exerted to distal tibia at a 2 mm/min velocity, from 0 N to 1200 N with one minute interval of 200 N leveled loading augment each for sampling. Superficial strain of the metatarsal was measured by resistance strainmeter methods. ResultsThe strain increased gradually with axial loading, and compress force was always found at every marked bone. The strain of every marked bone was significantly different at the same loading (P<0.05). As to the strain of the middle of the metatarsal, the sequence was the second metatarsal＞the third metatarsal＞the fourth metatarsal＞the first metatarsal＞the fifth metatarsal. As to the strain of the second metatarsal, the sequence was the middle＞the neck＞the base. ConclusionThe peak strain was found at the middle of the second and third metatarsal with axial loading, which prompts the stress fractures of the second and third metatarsal are most common, especially the middle of the second metatarsal.
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As the interest in health is increasing and the population enjoyed the leisure sports is steadily increasing, the stress fracture, fracture or variant of metatarsal bone of foot has been shown frequently. The mistaken estimation about the length and rank of metatarsal bones during the osteotomy of the metatarsal bones of foot can be complicated. It is essential to have detailed knowledges about the anatomical structure of surgical region. This study aimed to investigate the metatarsal bones of foot and to develop a regression equation that can predict the length of metatarsal bones during the osteotomy. The subject of this study is fifty four feet (30M/224F). We measured the whole length and the article length of metatarsal bone. Also, we measured the whole width and the article width in the head, body, base of the metatarsal bone. The data was analyzed using SPSS win 13.0. The regression equation models of length of the metatarsal bones were developed by multiple regression analysis. The regression equation predicted first metatarsal length was second metatarsal articular length x0.770+7.780, second metatarsal length was third metatarsal length x0.976+6.050, third metatarsal length was fourth metatarsal length x1.000+0.922, fourth metatarsal length was third metatarsal length x0.917+4.167, fifth metatarsal length was fourth metatarsal length x0.901+7.972. The results of this study would be useful to clarify the characteristics of the metatarsal bone of the foot, to develop a regression equation for prediction of the length of the metatarsal bone.
Subject(s)
Foot , Fractures, Stress , Head , Leisure Activities , Metatarsal Bones , Osteotomy , SportsABSTRACT
PURPOSE: Zone I fractures of the fifth metatarsal bone can generally be treated by conservative methods while both surgical and conservative methods are used for zone II fractures. However, the clinical results of conservative treatment have been rarely reported. The purpose of this study is to report the clinical results of conservative treatment for zone I and II nondisplaced fractures. MATERIALS AND METHODS: Between July 2007 and August 2008, consecutive thirty seven patients (38 fractures) with zone I and II fractures of the fifth metatarsal bone were treated with tolerable weight bearing and minimum duration of immobilization based on pain on weight bearing. We evaluated the duration of immobilization, time to clinical and radiographic union, and time to pre-injury activity level. RESULTS: Clinical and radiological union were achieved in all patients without any complications including malunion or nonunion. The mean duration of immobilization was 28.7 days. The mean 33.1 days and 48.9 days were required for clinical union and radiographic union respectively, after the initial injury. The mean time to pre-injury activity level was 4.8 months. CONCLUSION: Our study shows that the acute nondisplaced zone I, II fracture of fifth metatarsal bone can be treated effectively using tolerable weight bearing and minimum duration of immobilization, which is based on the pain on weight bearing.
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Humans , Immobilization , Metatarsal Bones , Weight-BearingABSTRACT
O tumor de células gigantes é uma neoplasia rara e representa 5% dos tumores ósseos primários. Acomete com maior freqüência joelho e punho, sendo raro em pequenos ossos do pé. Os autores apresentam um paciente do sexo masculino, 32 anos de idade, há quatro meses com dor no pé direito. A radiografia simples demonstrou lesão osteolítica e insuflante acometendo o primeiro metatarso do pé direito. A tomografia computadorizada revelou lesão radiolucente com bordas bem definidas. Foi realizada biópsia da lesão, cujo estudo histológico definiu o diagnóstico de tumor de células gigantes. Os autores enfatizam a correlação entre os achados de imagem e a histologia.
Giant cell tumor of bone is a rare neoplasm and account for 5% of all primary bone tumors. It is common in the knee and wrist, but rare in the small bones of the foot. The authors report a 32-yearold male patient presented with a four-month history of right foot pain. Plain radiographs showed an expansive lytic lesion involving the first right metatarsal bone. Computed tomography scan demonstrated a radiolucent lesion with well-defined borders. Biopsy was performed and the histological diagnostic was giant cell tumor. The authors emphasize the correlation between the imaging and histological findings.
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Humans , Male , Adult , Metatarsus/surgery , Metatarsus/pathology , Tomography, X-Ray Computed , Giant Cell Tumor of Bone/surgery , Giant Cell Tumor of Bone/diagnosisABSTRACT
[Objective]To evaluate the effects of Austin surgery for mild and moderate juvenile hallux valgus. [Method]From November 2005 to Januuary 2007,16 juvenile hallux valgus patients(28 feet)with average of 17.8 years(range,17 to 19 years)were treated with Austin surgery.The X-ray films of all patients were obtained before operation,and twelve months,fifteen months after operation.The hallus valgus angle,intermetatarsal angle,proximal articular set angle,and distal articular set angle were measured and analyzed on radiographs.The surgical outcome was evaluated combined with the Gu Xiang-jie's score.All pamameters were statistically analyzed. [Result]All the patients were completely followed up.Hallax valgus angle reduced from 26.3?1.19 to 11.7?0.40,intermetatarsal angle reduced from 14.1?0.82 to 7.2?0.85,proximal articular set angle from 12.7?0.28 to 6.4?0.54(all P
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PURPOSE: To evaluate the clinical results of lengthening in first brachymetatarsia using a distraction osteogensis with an external fixator. MATERIALS AND METHODS: Fifteen cases in nine patients, who had received firstmetatarsal distraction osteogenesis from January 1996 to December 2002, were enrolled in this study. At the final follow-up, the application time of the external fixator was measured and the percentage of lengthening, healing index, complication rate, and the patients satisfaction was analyzed. The patients satisfaction was evaluated using the American Orthopedic Foot and Ankle Society (AOFAS) scores, which were scored according to the level of stiffness, pain, function, and alignment. RESULTS: The score according to the AOFAS-Hallux Metatarsophalangeal joint and Inter-Phalangeal joint scale was excellent in 13 patients and good in 2. All patients were satisfied with the procedure. The average percentage of lengthening was 48.7%. The average healing index was 72.8 days/cm. The major complication was a cavus foot, which was noticed in four feet. All the first toes showed some decrease in motion at the metatarsophalangeal joint. The other complications were hallux valgus, angulation of the metatarsals, and a pin tract infection each in two feet. CONCLUSION: Distraction osteogenesis is an effective method for first brachymetatarsia. However, excessive lengthening can cause potential complications.
Subject(s)
Humans , Ankle , External Fixators , Follow-Up Studies , Foot , Hallux Valgus , Joints , Metatarsal Bones , Metatarsophalangeal Joint , Orthopedics , Osteogenesis, Distraction , ToesABSTRACT
PURPOSE: To present our experience of distal chevron osteotomy utilizing one BOLD screw(R) as an alternative fixation method which has advantages over the Kirschner (K)-wire fixation. MATERIALS AND METHODS: Between January 2001 and June 2003, 19 patients with a symptomatic hallux valgus deformity underwent 20 distal metatarsal chevron osteotomies with one BOLD screw(R) fixation. The mean age was 55.6 years with a minimum follow up period 12 months. For radiographical evaluation, hallux valgus angle (HVA) and intermetatarsal angle (IMA) were used. For clinical evaluation, we used AOFAS hallux metatarsophalangeal interphalangeal scale and overall satisfaction of the patients. RESULTS: The AOFAS scores improved from mean 47.5 points to mean 68.1 points at postoperative 3 months and mean 86.0 points at last follow-up. The average HVA corrected from 25.3 degrees to 12.7 degrees. The IMA was corrected from 11.6 degrees to 7.6 degrees. The overall satisfaction of the patients was 85%. There was no major complication. CONCLUSION: We demonstrated that distal chevron osteotomy with one BOLD screw(R) fixation has advantages such as no additional procedure, no loss of correction, early rehabilitation, no prominent hardware and skin irritation. This method also showed excellent bone union, correction and patient satisfaction.
Subject(s)
Humans , Congenital Abnormalities , Follow-Up Studies , Hallux Valgus , Hallux , Metatarsal Bones , Osteotomy , Patient Satisfaction , Rehabilitation , SkinABSTRACT
PURPOSE: To present our experience of distal chevron osteotomy utilizing one BOLD screw(R) as an alternative fixation method which has advantages over the Kirschner (K)-wire fixation. MATERIALS AND METHODS: Between January 2001 and June 2003, 19 patients with a symptomatic hallux valgus deformity underwent 20 distal metatarsal chevron osteotomies with one BOLD screw(R) fixation. The mean age was 55.6 years with a minimum follow up period 12 months. For radiographical evaluation, hallux valgus angle (HVA) and intermetatarsal angle (IMA) were used. For clinical evaluation, we used AOFAS hallux metatarsophalangeal interphalangeal scale and overall satisfaction of the patients. RESULTS: The AOFAS scores improved from mean 47.5 points to mean 68.1 points at postoperative 3 months and mean 86.0 points at last follow-up. The average HVA corrected from 25.3 degrees to 12.7 degrees. The IMA was corrected from 11.6 degrees to 7.6 degrees. The overall satisfaction of the patients was 85%. There was no major complication. CONCLUSION: We demonstrated that distal chevron osteotomy with one BOLD screw(R) fixation has advantages such as no additional procedure, no loss of correction, early rehabilitation, no prominent hardware and skin irritation. This method also showed excellent bone union, correction and patient satisfaction.
Subject(s)
Humans , Congenital Abnormalities , Follow-Up Studies , Hallux Valgus , Hallux , Metatarsal Bones , Osteotomy , Patient Satisfaction , Rehabilitation , SkinABSTRACT
PURPOSE: To report on a new operative technique of distraction osteogenesis and it's results in brachymetatarsia. MATERIALS AND METHODS: 17 patients (39 metatarsal bones) formed the basis of this study (male: female-2: 15). To prevent varus deformity of the hindfoot after lengthening, all screws were inserted at the same level from the medial aspect of the first metatarsal bone for horizontal distraction in the anterior direction, rather than distraction in the direction of the anatomical axis. Also, care was taken to ensure that the screw for the fourth metatarsal bone did not interpose with the fifth extensor tendon. RESULTS: All cases achieved satisfactory lengthening and bony union, except 1 case. The healing index increased with patient's age. Plantar capsular release was performed in seven cases, six of which had been previously operated on bilaterally. There was no hindfoot varus deformity or entrapment of the fifth extensor tendon on final follow up. CONCLUSION: Varus deformity of the hindfoot can be prevented by horizontal distraction of the first metatarsal bone. Also, entrapment of the fifth extensor tendon can be prevented by careful handling of the fifth extensor tendon during operation on the 4th metatarsal bone. Complications of stiffness or of an increase in treatment period were mainly found in bilaterally operated or relatively old (over 20 year-old) patients.
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Humans , Axis, Cervical Vertebra , Congenital Abnormalities , Follow-Up Studies , Joint Capsule Release , Metatarsal Bones , Osteogenesis, Distraction , TendonsABSTRACT
Polydactyly is a most common congenital anomaly of the foot. As is in the hand, it's classification systems and operative methods are various and complicated, but not much attention is given. We reviewed 129 foot polydactylies of 96 patients since the last 10 years(1993- 2003). Cases were classified morphologically and radiologically by previous classification systems(Wassel's classification, Hirase's classification) and then operative methods, complications, residual deformities were reviewed. Cases from the complications related to surgery including residual deformities were the major concern and 20 cases of unfavorable results were mainly due to varus deformity and metatarsal bone status. Based on our study, cases were reclassified by metatarsal bone status and varus deformity, and in conclusion we found that the new classification system is more helpful in deciding surgical method, predicting complications and residual deformities. Therefore, we suggested a new simple classification system based on the status of metatarsal bone and varus deformity, which is a more suitable system to planning operative method and predicting complication and residual deformity than the previous classification system.
Subject(s)
Humans , Classification , Congenital Abnormalities , Foot , Hand , Metatarsal Bones , PolydactylyABSTRACT
Objective To study the spatial change of transverse arch in the metatarsal head during a normal walking cycle, demonstrate the significance of transverse arch in normal walking and the relationship with hallux valgus. Methods A modeling gait cycle was obtained under the C- armed machine, the coronal spatial change of the transverse arch of the metatarsal head were recorded using video tape. On computer work station, the images from video tape were transformed to mpeg files. A model of the transverse arch was created for the analysis of the relationship between the transverse arch index Q and sinking time; between Q and I andⅡ intermetatarsal angle;Ⅰ andⅣ intermetatarsal angle; sinking time and body mass. Results There was a transverse arch formed by the 5 metatarsal heads. In normal walking, during standing phase to toe- off phase, the 2 and 3 metatarsal heads approach the ground resulting in sinking of the transverse arch. The transverse arch index had an adverse relationship with the hallux valgus angle. The time of the transverse arch sinking decrease accompanying with the transverse index Q. Conclusion The transverse arch of metatarsals played an important role during normal gait cycle. During normal walking, when the center of pressure moved forward, the force acting on the 2 and 3 metatarsal was increasing. So, the metatarsal heads drop down resulting in sinking of the transverse arch of the metatarsal head. In hallux valgus patients, the time of transverse arch sinking was earlier than normal and duration was longer. The total force acting on the 2 and (or) 3 metatarsal increased, which may caused disorder of forefoot.