Complications of the Grice-Green operation.

A case presentation involving complications resulting from errors in surgical technique with the Grice-Green procedure is discussed in this report. The patient was treated 18 years after bilateral tendo achillis lengthenings and Grice-Green extra-articular subtalar arthrodeses with autogenous tibial bone grafts. The complications encountered were severe adductovarus deformity of the feet with multiple painful plantar callosities, in-toed gait with weightbearing on the lateral aspect of the feet, inversion ankle instability, and tripping over the feet. Deformity and symptoms were worse on the right foot. The patient required further surgery, consisting of bilateral calcaneal osteotomy, metatarsal neck osteotomies, excision of callosities and ostectomies for painful plantar metatarsal base lesions, tenotomy of the abductor hallucis and digital fusions. The original surgery was performed for idiopathic flatfeet. Despite the many different causes of flatfoot for which the Grice-Green procedure has been employed, most authors believe it should not be used for idiopathic flatfeet, and restrict its use to the original indication, that of paralytic pes valgus secondary to poliomyelitis. The reader should also realize that there are very long-term consequences to surgery on the pediatric patient.

Biplane cuneiform osteotomy for juvenile metatarsus primus varus.

An operation combining the procedures of Cotton and Fowler on the medial cuneiform has been used for the correction of juvenile metatarsus primus varus and is presented in this manuscript. The procedure consists of a biplanar opening wedge osteotomy of the medial cuneiform with insertion of a bone graft and internal fixation. This surgical approach evolves from the procedures of Cotton (a sagittal plane correction of the depressed distal medial column in pes planus), and Fowler (a transverse plane correction of the medial column for metatarsus adductus). The operation has been utilized at St. Anne's Hospitals and provides excellent reduction of the intermetatarsal angle, with realignment of an oblique metatarsal-cuneiform joint. The operation is done with the Hohmann osteotomy/bunionectomy for realignment of the metatarsophalageal joint to correct hallux valgus that exists with juvenile metatarsus primus varus.

Causalgia: clarifications in terminology and a case presentation.

By way of literature review, clarifications are made in the terminology employed in discussing the atypical post-traumatic pain syndromes, particularly reflex sympathetic dystrophy (RSD). Causalgia is a form of RSD and is the focus of a case report presented from the files at St. Anne's Hospital-West, Northlake, Illinois.

Modification of the Gould operation for cavovarus reconstruction of the foot.

In 1984, Gould described an operation for advanced Charcot-Marie-Tooth disease. A modification of the operation has been applied in cavovarus reconstruction of the foot at St. Anne's Hospitals. The object of the surgery is to convert this type of foot into a plantigrade, more flexible, painless unit. The technique for operation is detailed. An electrodynographic summary is also included. Early clinical results have been excellent to date. Satisfactory elimination of painful metatarsalgia is the chief goal of the surgery. In Gould's study, this was achieved through a 3 to 6-year follow-up. Confirmation of continued excellent results with our own operation must wait, pending a longer-term assessment.

Chevron ankle arthrodesis with bone grafting and internal fixation.

A new technique for ankle arthrodesis was described in 1983 by Marcus et al. in the Journal of Bone and Joint Surgery. It is a chevron ankle arthrodesis with bone grafting and internal fixation. The operation has many features distinguishing it from previously described methods of ankle arthrodesis. The advantages of the technique over other methods of arthrodesis include: bimalleolar approach to the ankle providing excellent exposure; minimal bone resection of the tibiotalar joint, thereby preserving height of the joint and length of the extremity; inherent mechanical stability at the osteotomy sites afforded by the Chevron cuts; several features designed to enhance rapid fusion, including the congruity and stability of the cuts made, onlay bone grafting and rigid internal compression fixation; a normal-looking ankle contour postoperatively, resulting in a superior cosmetic result. The operation has been utilized at St. Anne's Hospitals and can be augmented for use in pantalar arthrodesis.

Considerations for the Lapidus operation.

The Lapidus operation for correction of severe hallux valgus with metatarsus primus varus has never been well accepted by foot surgeons. The main reason for this has been the poor results obtained from its misuse. Lapidus strongly advocated the operation as a virtual panacea for correction of all degrees of severity of these deformities in both young and old patients. The technique, however, is appropriate for severe metatarsus primus varus with hallux valgus, in the foot with marked first ray hypermobility and collapsed distal-medial arch. The purpose and proper indications for the Lapidus operation are discussed, and the technique is illustrated.