The plantarward oblique Chevron osteotomy: an optional method to treat hallux valgus with painful plantar callosities.

Hallux valgus (HV) is a foot deformity that can be treated with Chevron osteotomy, and a modified plantarward oblique osteotomy has been proposed in recent years. However, no research has focused on the correctional power of the osteotomy. The aim of this study was to examine the character of this plantarward oblique Chevron osteotomy (POCO) and to determine the rationale of this method.Radiographs and clinical data from 65 HV patients (77 feet) with painful callosities were evaluated. The intermetatarsal angle, hallux valgus angle, and relative height of the second metatarsal were measured, and a valid width of the first metatarsal was proposed. A visual analogue scale (VAS) and the American Orthopaedic Foot and Ankle Society hallux-metatarsophalangeal interphalangeal scale (AOFAS) were used to evaluate the patients' clinical results.There were significant differences in the HVA and IMA. The decline in the height of the second metatarsal was positively related to the decline in the height of the first metatarsal, but the changes were smaller for the first metatarsal. Painful callosities disappeared in 77 feet, 4 (5.1%) patients had no pain but a remaining plantar callosity, and 2 (2.6%) patient had relieved pain with a plantar callosity after follow-up. The VAS scores improved from 8.58 ± 0.50 to 1.96 ± 0.75 points after the operation (p < 0.001). Significant differences were demonstrated in the AOFAS scores (65.81 ± 4.05 vs 87.88 ± 3.41, p < 0.001). The modified POCO prevents the dorsal migration of the metatarsal head, preserves other lesser metatarsals and provides an opportunity for patients who may possibly need additional future deformity correction. Therefore, POCO is a safe and effective method to treat hallux valgus and offers the superior potential benefits of correction and transfer metatarsalgia.

Analysis of corticalization using the pixel value ratio for fixator removal in tibial lengthening.

BACKGROUND: It is important to define callus maturation and corticalization during distraction osteogenesis. Quantitative methods such as ultrasound and Q-computed tomography are sensitive but expensive. The pixel value ratio (PVR) obtained using a PACS (picture archiving and communication system) is a simple and cost-effective investigation tool. Recently, the issue of whether the PVR is correlated with quantitative methods has been studied. We investigated whether serial PVR is a useful technique for predicting corticalization in each callus segment of the regenerate, and can act as a guide for fixator removal in tibial lengthening without intramedullary nailing. METHODS: A retrospective analysis of 30 tibial segments in 18 patients was performed. The mean age of the patients was 18 years (range 5-48 years). There were 6 male patients and 12 female patients, of whom 8 patients were skeletally mature. Indications for limb lengthening were achondroplasia (8 patients), limb length discrepancy (4 patients), and miscellaneous (6 patients). The interobserver variability of the PVR was measured at each callus segment of the regenerate. Serial PVR at each callus segment was classified according to the callus pathway. RESULTS: The mean interobserver correlation coefficient at the regenerate was high in the posterior callus segment (0.92), the lateral callus segment (0.90), and the medial callus segment (0.70). However, there was low mean interobserver variability in the anterior callus segment (0.49) at the regenerate. A PVR of 1 at the regenerate was achieved first at the lateral callus segment, second at the posterior, third at the medial callus segment, and last at the anterior callus segment. There was no fracture at the regenerate or wire breakage in patients who began fixator removal and full weight bearing when the PVR was 1 in the three callus segments at the regenerate. CONCLUSIONS: In tibial lengthening without nailing, serial measurement of the PVR is a reliable and cost-effective technique to assess the maturity of the callus, especially in the lateral and posterior callus segments, and assessment of the cortical pixel value can safely provide guidelines for fixator removal.

Clavus detected incidentally by positron emission tomography with computed tomography.

This is the first report showing that positron emission tomography with computed tomography (PET/CT) can detect clavus. A 37-year-old woman diagnosed with epithelioid sarcoma on her left inguinal region was investigated by whole-body PET/CT. The imaging showed some 18F-fluorodeoxyglucose uptake at the right lateral foot. There had been a clavus in exactly the same region. Every dermatologist, radiologist and oncologist needs to know about this finding for making an accurate diagnosis.

Ultrasound appearance of knuckle pads.

OBJECTIVE: We describe the ultrasound appearance of knuckle pads. DESIGN AND PATIENTS: Retrospective analysis of imaging in a series of five patients initially referred for evaluation of periarticular soft-tissue swelling of the hands involving the dorsum of the PIP and MP joints. Two patients had associated Dupuytren's contractures. Ultrasound and radiographs of the hands in all patients were reviewed and correlated with clinical history and physical exams. RESULTS: Radiographs in four patients demonstrated dorsal soft-tissue thickening. Ultrasound exams showed increased dorsal subcutaneous thickening, with either diffuse or focal hypoechoic areas corresponding to the areas of soft-tissue fullness identified on physical exam. No erosions or synovial proliferation were identified either by radiographs or ultrasound of the underlying joints. CONCLUSIONS: Knuckle pads can sometimes be difficult to distinguish from synovitis on physical examination. Musculoskeletal ultrasound can quickly identify these superficial lesions and exclude underlying synovial proliferation.

Study of straight metatarsal osteotomy for the treatment of plantar callosities.

BACKGROUND AND AIMS: [corrected] To evaluate the outcome of transverse distal metatarsal osteotomies for intractable plantar callosity without hammer toe deformity and associated toe corns. MATERIAL AND METHODS: Twenty-five plantar callosities were treated in 19 feet of 13 patients (mean age 48 years, 5 male, 8 female) with transverse distal metatarsal osteotomy. RESULTS: Twenty-four of the osteotomies united primarily, one after revision. After a 7-year follow-up, 23 of the callosities had healed, two of them after an oblique reosteotomy. Eight hammer toe deformities had developed in the involved rays of four feet. Eight plantar callosities had developed outside the operated rays in five feet. Hallux valgus was a frequent finding in both operated and non-operated feet. CONCLUSION: It seems that transverse distal metatarsal osteotomy is an effective treatment of intractable plantar callosities. Harmful hammer toe deformities and transfer lesions below adjacent metatarsal heads tend to develop over time.

Control ecográfico del callo óseo en pacientes en elongación de miembros / Ultrasound controls of the bone callus in patients in elongation of the limbs

Se realizó seguimiento ecográfico en 10 pacientes en tratamiento de elongación de miembros inferiores. En todos los casos se efectuó corticotomía percutánea bajo control televisado, usando siempre como distractor externo el fijador de Wagner. El ritmo de elongación fue de 1mm por día, hasta alcanzar la longitud deseada. El objetivo fue la evaluación ecográfica del callo óseo para disminuir los controles radiológicos durante la elongación. Los controles se realizaron cada 30 días consistiendo en un examen clínico, radiológico y ecográfico. La ecografía demostró ser de gran utilidad, permitiendo: 1)reconocer la aparición de matriz ósea antes que en las radiográfias; 2)medir exactamente la distracción; 3)determinar el cierre de la cortical y 4)evaluar el callo en múltiples planos. La correlación restrospectiva radiológica y ecográfica fue buena en todos los pacientes examinados, de lo que se deduce que algunas de las placas durante el seguimiento pueden ser reemplazads por la ecografía, disminuyendo así la radiaciones