Biomechanical Evaluation of Hemiarthroplasty in the First Proximal Phalanx. A Finite Element Study

ABSTRACT Hallux rigidus produces a decrease in the dorsiflexion of the first metatarsophalangeal joint and is usually associated with the appearance of osteophytes. Hemiarthroplasty in the first proximal phalanx is a recommended surgical procedure in patients with advanced grade of hallux rigidus. Finite element analysis allows us to understand the biomechanical behavior of the foot. The objective of this work is to evaluate the biomechanical effects of an hemi implant placed in first proximal phalanx. Two models of finite elements are going to be compared, one free of pathologies and the other with a hemiarthroplasty in the first ray of the foot. We detected after inserting the prosthesis in the model that passive windlass mechanism is lost, and the lesser toes become overloaded, which leads to a loss of efficiency in gait as well as being able to cause postsurgical medical complications.

Lesion clearance combined with Ilizarov technique for treatment of tophi in first metatarsophalangeal joint with bone defect / 中国修复重建外科杂志

Objective: To evaluate the effectiveness of lesion clearance combined with Ilizarov technique for the treatment of tophi in first metatarsophalangeal (MTP) joint with bone defect. Methods: Between July 2016 and June 2018, 14 cases of tophi in the first MTP joint with bone defect were treated by lesion clearance combined with Ilizarov technique. There were 12 males and 2 females. The average age was 39.3 years (range, 22-60 years). The disease duration ranged from 5 to 15 years, with an average of 11.2 years. The tophi volume ranged from 2.5 cm×2.7 cm×2.2 cm to 5.2 cm×2.9 cm×2.4 cm. The X-ray films showed that the length of the bone defect ranged from 2.0 to 4.6 cm, with an average of 3.4 cm. Preoperative visual analogue scale (VAS) score was 7.6±0.9; American Orthopaedic Foot and Ankle Society (AOFAS) score was 47.5±4.3; short-form 36 health survey scale (SF-36) score was 79.7±4.7. Results: The incision primarily healed in 13 patients after operation. The skin necrosis at the edge of the incision occurred in 1 patient and recovered after symptomatic treatment. All 14 patients were followed up 12-16 months, with an average of 13.6 months. X-ray films showed that the first metatarsal column defects were repaired. The time of bone extension ranged from 2 to 6 weeks, with an average of 3.6 weeks. The time of bone healing ranged from 9 to 16 weeks, with an average of 11.2 weeks. During follow-up, no complication such as nerve, blood vessel, or tendon injury, needle tract infection, or stress fracture occurred. At last follow-up, VAS score was 1.4±0.5, AOFAS score was 86.6±4.8, and SF-36 score was 89.1±3.3, all of which were superior to preoperative scores, with significant differences ( t=22.532, P=0.000; t=22.702, P=0.000; t=6.124, P=0.000). Conclusion: Lesion clearance combined with Ilizarov technique is a safe and effective method for the treatment of tophi in the first MTP joint with bone defect.

Shortening Scarf Osteotomy for Treatment of Hallux Rigidus Deformity / 대한족부족관절학회지

PURPOSE: To evaluate the effect of shortening scarf osteotomy on pain relief and range of motion (ROM) of the first metatarsophalangeal joint in hallux rigidus patients. MATERIALS AND METHODS: Twenty-three cases of 19 patients who had been treated with shortening scarf osteotomy for the hallux rigidus between January 2007 and December 2013 were reviewed. The mean follow-up period was 21.4 months, and the mean age was 59.2 years. The first metatarsal bone was shortened until the ROM of the first metatarsophalangeal joint was greater than 80° or 40° of dorsiflexion. The length shortened by scarf osteotomy was measured. The authors also measured and compared the joint interval difference of the standing foot using an anteroposterior radiography. Moreover, the difference of ROM of the first metatarsophalangeal joint between the preoperative and final follow-up periods was also compared. The clinical results were evaluated and compared using the American Orthopaedic Foot and Ankle Society (AOFAS) scoring system and visual analogue scale (VAS) score. RESULTS: The mean shortening length was about 6.5 mm (range, 4∼9 mm). The joint space has been increased to 1.8 mm, and the ROM of the first metatarsophalangeal joint has also been increased to 18.4° after the operation. In three cases, the postoperative ROM has been decreased to less 10°. The AOFAS score has been improved from 41.7 (range, 32∼55) to 86.2 (range, 65∼95), and the VAS score was also decreased from 3.7 (range, 3∼5) to 1.3 (range, 0∼3). Two cases have shown no decrease in pain even after the operation. CONCLUSION: Shortening scarf osteotomy was found to decrease joint pain by decompressing the pressure of the first metatarsophalangeal joint. This osteotomy also helped improve the ROM of the first metatarsophalangeal joint. Shortening scarf osteotomy can be considered one of the effective methods for joint preservation.

Overuse Capsuloligamentous Injury of the First Metatarsophalangeal Joint: A Case Report / 대한족부족관절학회지

Capsuloligamentous injury at the first metatarsophalangeal (MTP) joint is a common traumatic injury during physical activity, particularly on artificial turf. Mechanism of injury include excessive flexion, extension, or valgus stress. We report a non-operatively treated capsuloligamentous injury at the first MTP joint, which did not occur traumatically but developed by a stress-related mechanism in a collegiate rower.

Lateral Dislocation of the First Metatarsophalangeal Joint: A Case Report

Dislocation of the metatarsophalangeal joint is rare due to the stability of the ligaments and soft tissue surrounding the joint. The authors have experienced lateral dislocation of the first metatarsophalangeal joint, which required surgery, accompanied by complete injuries of medial collateral ligament and capsule, contributing to medial stability, differing from posterior dislocation with intersesamoid complex rupture, with a review of the relevant literature and previous reported cases.