ABSTRACT
OBJECTIVE: We examine the technique and radiographic outcomes obtained with triplanar first tarsometatarsal arthrodesis (3D Lapidus) for the surgical correction of hallux valgus (HV). This procedure, apart from correcting angular deformity 1st-2nd intermetatarsal angle, HV angle, etc., is specifically intended to act on first ray pronation and place the sesamoids in their normal position, to alleviate the metatarsalgia often occurring in HV before and after surgery, possibly caused by their abnormal position. This study aims to examine the radiographic outcomes of the 3D Lapidus procedure. MATERIALS AND METHODS: Retrospective study of 37 feet operated on from April 2019 to December 2019, with a minimum 1-year follow-up (mean 420 days), using the 3D Lapidus procedure. Radiographic outcomes were evaluated. RESULTS: The intermetatarsal angle decreased from a mean value of 16.42° to 5.62° (p < 0.0001). The HV angle decreased from a mean value of 32.12° to 8.05° (p < 0.0001). The preoperative first metatarsocuneiform angle, with a mean value of 21.86°, was null after arthrodesis (p < 0.0001). The tibial sesamoid position, according to the Hardy and Clapham classification, decreased from a mean value of 4.84 to 1.27 after surgery, within normality (p < 0.0001). DISCUSSION: Correction of the deformity in a single plane is generally insufficient. It is necessary to act on the three planes of space to correct the deformity, obtain good outcomes, and avoid recurrence. CONCLUSIONS: Radiographic outcomes of triplanar correction with the 3D Lapidus procedure are excellent, achieving statistically significant differences in all parameters studied.
Subject(s)
Bunion , Hallux Valgus , Metatarsal Bones , Arthrodesis/methods , Hallux Valgus/diagnostic imaging , Hallux Valgus/surgery , Humans , Metatarsal Bones/diagnostic imaging , Metatarsal Bones/surgery , Retrospective Studies , RotationABSTRACT
We present the possible etiopatogenic causes of posterior tibial dysfunction or painful flat foot of the adult and the cause-and-effect relationship that may exist. We also expose the gradation of the lesion and the different therapeutic options for the surgical treatment of the deformity. Since 1939, multiple articles have been published, which have been endorsed by clinical, experimental, electromyographic and biomechanical studies; publications that have been consulted and evaluated for the development of this review. In our opinion: the dysfunction of the posterior tibial is caused in principle by a failure of the plantar navicular calcaneus ligament (spring ligament), the main passive stabilizer of the internal plantar arch. This failure would, in time, mean an increase in work of the posterior tibial tendon, in itself "insufficient", which would go into fatigue, until it reached a partial or total rupture. Published work on soft-part procedures acting on the posterior tibial tendon in stage II has not had the expected result in the natural history of deformity. Arthrodesis, on the other hand, has been effective in other stages, but is associated with a loss of movement dynamics in the back foot and increased pressure on adjacent joints.
Presentamos la posible causa etiopatogénica de la disfunción del tibial posterior o pie plano doloroso del adulto y la relación causa-efecto que puede existir. También exponemos la clasificación de la lesión y las diferentes opciones para el tratamiento quirúrgico de la deformidad. Desde 1939, múltiples artículos han sido publicados, avalados por la clínica, así como por estudios experimentales, electromiográficos y biomecánicos; publicaciones consultadas y evaluadas para el desarrollo de esta revisión, según nuestro criterio: el primum movens de la disfunción del tibial posterior es ocasionado por un fallo del ligamento en hamaca o calcáneo navicular plantar (spring ligament), principal estabilizador pasivo del arco plantar interno. Este fallo supondría en el tiempo un aumento de trabajo del tendón tibial posterior, de por sí "insuficiente", que entraría en fatiga hasta llegar a la rotura parcial o total. Los trabajos publicados en relación con los procedimientos de partes blandas que actúan sobre el tendón tibial posterior en el estadio II no han tenido el resultado esperado en la historia natural de la deformidad. La artrodesis por el contrario, ha sido efectiva en otros estadios, pero está asociada a una pérdida de la dinámica del movimiento en el retropié y a un aumento de la presión en las articulaciones adyacentes.
Subject(s)
Calcaneus , Flatfoot , Flatfoot/diagnostic imaging , Flatfoot/etiology , Flatfoot/surgery , Foot/surgery , Humans , Tendon Transfer , TendonsABSTRACT
The objective of this work is to assess the efficacy of conservative treatment with orthopedic insoles in Müller-Weiss disease (EMW). The plantar support aims to pronounce the hindfoot and immobilize the talo-navicular, and naviculo-cuneiform joints or both at the same time, as an alternative to the valguizing osteotomy of the calcaneus and arthrodesis. The clinical and radiological characteristics of 10 cases of EMW in 8 patients under study are analyzed and the results obtained are evaluated. The manufacturing process of the plantar supports is commented, as well as the materials used. The sample size is not significant, however, preliminary, conservative treatment is possible in certain cases of EMW to relieve pain, improve gait dynamics and limit disease progression in the short-term.
El objetivo de este trabajo es valorar la eficacia del tratamiento conservador con plantillas ortopédicas en la enfermedad de Müller-Weiss (EMW). El soporte plantar tiene como objetivo pronar el retropié e inmovilizar las articulaciones talonavicular y naviculocuneiforme o ambas a la vez como alternativa a la osteotomía valguizante de calcáneo y las artrodesis. Se analizan las características clínicas y radiológicas de 10 casos de EMW en ocho pacientes objeto del estudio y se valoran los resultados obtenidos. Se comenta el proceso de fabricación de los soportes plantares así como los materiales empleados. El tamaño de la muestra no es significativo; sin embargo, de manera preliminar, el tratamiento conservador es posible en determinados casos de la EMW para aliviar el dolor, mejorar la dinámica de la marcha y limitar la progresión de la enfermedad en el corto plazo.
Subject(s)
Calcaneus , Foot Diseases , Tarsal Bones , Arthrodesis , Foot Diseases/surgery , Humans , Osteotomy , Treatment OutcomeABSTRACT
Resumen: El objetivo de este trabajo es valorar la eficacia del tratamiento conservador con plantillas ortopédicas en la enfermedad de Müller-Weiss (EMW). El soporte plantar tiene como objetivo pronar el retropié e inmovilizar las articulaciones talonavicular y naviculocuneiforme o ambas a la vez como alternativa a la osteotomía valguizante de calcáneo y las artrodesis. Se analizan las características clínicas y radiológicas de 10 casos de EMW en ocho pacientes objeto del estudio y se valoran los resultados obtenidos. Se comenta el proceso de fabricación de los soportes plantares así como los materiales empleados. El tamaño de la muestra no es significativo; sin embargo, de manera preliminar, el tratamiento conservador es posible en determinados casos de la EMW para aliviar el dolor, mejorar la dinámica de la marcha y limitar la progresión de la enfermedad en el corto plazo.
Abstract: The objective of this work is to assess the efficacy of conservative treatment with orthopedic insoles in Müller-Weiss disease (EMW). The plantar support aims to pronounce the hindfoot and immobilize the talo-navicular, and naviculo-cuneiform joints or both at the same time, as an alternative to the valguizing osteotomy of the calcaneus and arthrodesis. The clinical and radiological characteristics of 10 cases of EMW in 8 patients under study are analyzed and the results obtained are evaluated. The manufacturing process of the plantar supports is commented, as well as the materials used. The sample size is not significant, however, preliminary, conservative treatment is possible in certain cases of EMW to relieve pain, improve gait dynamics and limit disease progression in the short-term.
Subject(s)
Calcaneus , Tarsal Bones , Foot Diseases/surgery , Osteotomy , Arthrodesis , Treatment OutcomeABSTRACT
The tarsal tunnel is composed of the posterior border of the medial malleoulus, the posterior aspect of the talus and the medial aspect of the calcaneus. The medial calcaneal nerve emerges from the posterior aspect of the posterior tibial nerve in 75% of cases and from the lateral plantar nerve in the remaining 25%. Finally, the medial calcaneal nerve ends as a single terminal branch in 79% of cases and in numerous terminal branches in the remaining 21%. To describe the anatomical variants of the posterior tibial nerve and its terminal branches. To describe the steps for tarsal tunnel release. To describe Baxter nerve release. The anatomical variants of the posterior tibial nerve and its terminal branches within the tarsal tunnel were studied. Then the Lam technique was performed; it consists of: 1) opening of the laciniate ligament, 2) opening of the fascia over the abductor hallucis muscle, 3) exoneurolysis of the posterior tibial nerve and its terminal branches, identifying the emergence and pathway of the medial calcaneal branch, the lateral plantar nerve and its Baxter nerve branch and the medial plantar nerve. Baxter nerve was found in 100% of cases. In 100% of cases in our series the nerve going to the abductor digiti minimi muscle of the foot was found; 87.5% of cases had two terminal branches. The dissections proved that a crucial step was the release of the distal tarsal tunnel.
Subject(s)
Foot/innervation , Tibial Nerve/anatomy & histology , Cadaver , Cross-Sectional Studies , Disease Susceptibility , Fasciitis, Plantar/complications , Foot/blood supply , Genetic Variation , Humans , Tarsal Tunnel Syndrome/etiology , Tarsal Tunnel Syndrome/surgeryABSTRACT
Introducción. Los radios menores también requieren ser intervenidos quirúrgicamente en la cirugía primaria para solucionar metatarsalgias transferenciales o luxaciones metatarsofalángicas, así como la patología del quinto radio.Complicaciones y tratamiento. Las complicaciones puedenpresentarse por mala indicación quirúrgica, incorrecta planificación, errores de técnica o cuidados posoperatorios inadecuados. Las técnicas quirúrgicas correctas serán diferentes según el radio que esté afectado o según el nivel. La rigidez, las recidivas de la deformidad, la hipercorrección y las metatarsalgias por sobrecarga son quizás las más frecuentes.Es este artículo se exponen los diferentes procedimientosutilizados habitualmente para la corrección de estassecuelas
Introduction. The lesser toes sometimes require primarysurgery to address transfer metatarsalgias, metatarsophalangeal dislocations or some specific pathologies affecting the second to the fifth toe.Complications and treatment. Complications can occur because of a poor surgical indication, poor planning, technical errors or inappropriate postoperative care. Surgical techniques will vary depending on which toe is affected and on the level involved. Stiffness, deformity relapses, hypercorrection and overload metatarsalgia are probably the most frequent complications. This paper reviews the different surgical procedures commonly used to correct the above mentioned sequelae
Subject(s)
Humans , Foot Bones/surgery , Metatarsalgia/surgery , Foot Injuries/surgery , Foot Bones/injuries , Joint Dislocations/surgery , Osteotomy/methodsABSTRACT
Introducción. Los radios menores también requieren ser intervenidos quirúrgicamente en la cirugía primaria para solucionar metatarsalgias transferenciales o luxaciones metatarsofalángicas, así como la patología del quinto radio.Complicaciones y tratamiento. Las complicaciones puedenpresentarse por mala indicación quirúrgica, incorrecta planificación, errores de técnica o cuidados posoperatorios inadecuados. Las técnicas quirúrgicas correctas serán diferentes según el radio que esté afectado o según el nivel. La rigidez, las recidivas de la deformidad, la hipercorrección y las metatarsalgias por sobrecarga son quizás las más frecuentes.Es este artículo se exponen los diferentes procedimientosutilizados habitualmente para la corrección de estassecuelas
Introduction. The lesser toes sometimes require primarysurgery to address transfer metatarsalgias, metatarsophalangeal dislocations or some specific pathologies affecting the second to the fifth toe.Complications and treatment. Complications can occur because of a poor surgical indication, poor planning, technical errors or inappropriate postoperative care. Surgical techniques will vary depending on which toe is affected and on the level involved. Stiffness, deformity relapses, hypercorrection and overload metatarsalgia are probably the most frequent complications. This paper reviews the different surgical procedures commonly used to correct the above mentioned sequelae
