First Metatarsal Dorsal Close Wedge Osteotomy Combined with Medial Cuneiform Plantar Open Wedge Osteotomy for the Treatment of a Cavus Foot / 대한정형외과학회잡지

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.

Mid to Long Term Follow-up Results of Reconstruction in Rheumatoid Arthritic Forefoot Deformities / 대한족부족관절학회지

PURPOSE: We assess the mid to long term follow up results of arthrodesis of the first metatarso-phalangeal (MTP) joint and resection arthroplasty of the lesser toes in rheumatoid arthritic forefoot deformity. MATERIALS AND METHODS: Between 1998 to 2001 year, 25 cases (18 patients) rheumatoid forefoot deformities were surgically corrected. Follow up period was 83 months (range, 63 to 90 months). The clinical outcome was evaluated using subjective satisfaction and AOFAS score. The radiological measurements were hallux valgus angle, first and second intermetatarsal angle, second metatarso-phalangeal angle (MTP-2nd angle). RESULTS: Subjective satisfaction was 76%. AOFAS score improved from 37 to 73. The hallux valgus angle improved from preoperative 39 degrees (27~64 degrees) to 14 degrees (4~34) at the last follow up. The intermetatarsal angle were preoperative 13 degrees (6~22 degrees) to 11 degrees (3~13 degrees) at the last follow up, The MTP-2nd angle were preoperative 24 degrees (9~47) to last follow up 15 degrees (2~39 degrees) respectively (p>0.05). Complication was intractable callus 10 cases, Interphalangeal arthritis 5 cases. CONCLUSION: Mid to long term outcomes rheumatoid forefoot reconstruction by first MTP arthrodesis and resection arthroplasty of lesser toes results a satisfaction and pain relief.

Reconstruction of Rheumatoid Forefoot Deformity / 대한류마티스학회지

OBJECTIVE: The purpose of the present study was to assess the short term result of the reconstruction of forefoot deformity, commonly seen in rheumatoid patients. METHODS: 15 patients (20 feet) were evaluated and the average follow up period was 18.4 months. The reconstructive procedure included the arthrodesis of the first metatarsophalangeal joint of hallux, the lesser metatarsophalangeal resection arthroplasty, and extensor tenotomy of lesser toes. The subjective and the objective findings were studied, using the rating scale of The American Orthopaedic Foot and Ankle society, and the radiological measurement. RESULTS: Subjective assessment with respect to pain, function, alignment was excellent in ten feet (50%), good in ten feet (50%), and no fair and poor. The hallux valgus angle (HVA) and 1st intermetatarsal angle were improved from 48.4+/-4.23 and 16.5+/-2.08 to 13.5+/-1.96 and 11.0+/-1.28 degrees respectively. The average dorsiflexion angle was 18.95+/-2.20 degrees. All arthrodesis site were fused within average 8 weeks after operation. The overall complication of the procedure was few and reoperation was none. CONCLUSION: The reconstructive procedure, including the arthrodesis of the first metatarsophalangeal joint and the lesser metatarsophalangeal resection arthroplasty with extensor tenotomy was regarded as a good option for treating a rheumatoid forefoot deformity surgically.