A Short-Term Retrospective of First Metatarsophalangeal Joint Arthrodesis Using a Plate With PocketLock Fixation.

BACKGROUND: Various techniques have been described for arthrodesis of the first metatarsophalangeal (MTP) joint. The purpose of this study was to retrospectively review the results of fixation for the first MTP arthrodesis of patients treated using dome-shaped reamers to prepare the joint surfaces and a novel MTP Plate with PocketLock fixation. METHODS: Between July 2012 and November 2013, 16 feet in 16 patients were treated with a first MTP arthrodesis with a MTP Plate with PocketLock fixation. The mean patient age was 58.8 years (range, 46-82 years). Physical and radiographic examinations were performed at follow-up visits. The average follow-up period was 17.3 months. The radiographs were examined for union (3 bridging cortices), time to union, hardware failure, or other radiographic complications. The charts were reviewed to assess AOFAS-MTP-IP (American Orthopaedic Foot & Ankle Society metatarsophalangeal-interphalangeal) scores and postoperative complications. RESULTS: Fusion was seen in 11 of 16 feet (68.8%) and partial union in 1 patient (6.3%). Five nonunions (31.2%) were noted in the sample group: All were symptomatic and required revision surgery. No malunions were identified in our sample. One hardware failure was documented in a nonunion patient. The mean time to osseous union was 81.7 ± 15.9 days. The preoperative AOFAS MTP-IP score was 55.6 and the postoperative score was 64.7. CONCLUSION: The high nonunion and revision surgery rates demonstrate that this particular plate should be used with caution for a first MTP joint arthrodesis. LEVEL OF EVIDENCE: Therapeutic, Level IV: Case series.

Extensile decompression of the proximal and distal tarsal tunnel combined with partial plantar fascia release in the treatment of chronic plantar heel pain.

BACKGROUND: Chronic heel pain that is recalcitrant to nonoperative measures is a rare but disabling condition. There are no reports in the literature of extensile proximal and distal tarsal tunnel release combined with partial plantar fasciotomy in the treatment of chronic heel pain. We present our results. METHODS: A retrospective chart review was conducted, and charts were assessed for details of their presenting complaints, physical exam, diagnostic studies, medical history, Visual Analog Scale (VAS) scores for pain, American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scores, and complications. RESULTS: The mean AOFAS ankle-hindfoot score was 86 ± 12.9 (range = 69-100). Of 15 heels, 10 (67%) had an excellent or good rating at the time of the last follow-up visit. One of 15 (7%) reported a poor outcome. The mean VAS pain score changed from 6.3 ± 3.1 to 1.4 ± 1.8 (P = .001). There were no wound complications or infections. CONCLUSION: This technique offers another operative option for chronic heel pain that is associated with satisfactory outcomes and rest pain relief. Despite reducing pain at rest in all patients, the majority of patients may be left with mild to moderate residual symptoms with activity that is similar to the outcomes of previously reported procedures.