ABSTRACT
Iatrogenic metatarsus primus elevatus is an infrequent but devastating complication of first ray surgery. The authors address their clinical and radiographic evaluation of metatarsus primus elevatus, and describe a surgical treatment with emphasis on the sagittal plane Z-osteotomy. This osteotomy provides predictable and versatile correction for the treatment of iatrogenic deformities of the first metatarsal. It allows for plantarflexion and lengthening of the first metatarsal while avoiding an interpositional bone graft. The technical aspects of the procedure are thoroughly discussed.
Subject(s)
Foot Deformities, Acquired/surgery , Osteotomy/methods , Postoperative Complications , Toes/surgery , Foot Deformities, Acquired/diagnostic imaging , Humans , Iatrogenic Disease , Radiography , Toes/diagnostic imagingABSTRACT
Successful management of the Charcot foot is one of the most challenging undertakings faced by physicians. However, many times such patients undergo prolonged and attentive care only to develop further deformity, and in many cases succumb to amputation. Research in the past few years has yielded a new understanding of the Charcot process that should serve as the basis for improved therapeutic measures. The authors discuss these more recent developments and how this knowledge may be applied to better serve the patient. In addition, surgical reconstruction of the diabetic Charcot foot is introduced and discussed.
Subject(s)
Arthropathy, Neurogenic/therapy , Diabetic Neuropathies/therapy , Foot Deformities, Acquired/therapy , Acute Disease , Chronic Disease , Diabetes Mellitus, Type 1/complications , Humans , Postoperative CareABSTRACT
The authors describe their experience with the "Z" incision, when extensive surgery is performed on the plantar aspect of the foot.
Subject(s)
Foot/surgery , Humans , Methods , Postoperative ComplicationsABSTRACT
This procedure was quite successful, particularly in patients with a transverse plane dominant flexible pes valgus deformity. The modifications that have proved to be successful include the use of the oblique skin incision following the relaxed skin tension lines, the use of allogeneic bone graft, and the use of ancillary procedures, including the gastrocnemius recession and medial arch tendosuspension. The procedure is less predictable in those patients whose deformity is primarily in the frontal or sagittal plane. It is most critical that preoperative analysis be used to discover the presence of the masked metatarsus adductus prior to performing this procedure.
