Percutaneous Fifth Metatarsal Osteotomy for Bunionette Deformity Without Fixation or Strapping: A Retrospective Study.

BACKGROUND: Bunionette deformity (BD) is a painful condition of the fifth metatarsal characterized by an osseous prominence and fifth toe varus deformity. The purpose of this study is to assess the clinical, functional, and radiographic outcomes of percutaneous distal metatarsal metaphyseal osteotomy (DMMO) without fixation or postoperative strapping of the foot. METHODS: A retrospective case series was performed on 111 patients (132 feet) with symptomatic BD who underwent percutaneous DMMO of the fifth metatarsal from September 2020 to January 2022 by an experienced minimally invasive surgeon. According to the Shimobayashi classification, we treated 1 type I deformity, 37 type II deformities, 52 type III deformities, 42 feet with type IV deformity, and no patient with a type V deformity. Ninety patients (81%) underwent unilateral osteotomy, and 21 (19%) had bilateral osteotomies. Most cases included other procedures including treatment of 114 associated deformities of the same feet: 68 bunions, 12 lesser metatarsal osteotomies (2-3-4 metatarsals), and 34 hammertoes (20 second hammertoes, 10 third hammertoes, 1 fourth hammertoes, 2 fifth hammertoes). Patient-reported clinical outcome measures, including the Foot Function Index (FFI) questionnaire, the visual analog score (VAS), and overall satisfaction were collected. Fourth-to-fifth intermetatarsal angle (IMA) correction, time to bone union, and complication rates were assessed in all patients. RESULTS: Mean follow-up was 24.1 months (range, 14-39 months). Both radiographic parameters and patient-reported outcome measures significantly improved after DMMO procedure. The average fourth-to-fifth IMA improved from 12.2 degrees, preoperatively, to 4.4 degrees, postoperatively (P < .001). Patient outcomes reflect the overall outcomes of the combined surgeries on a per-patient basis. Preoperatively, patients had a mean VAS score of 7.6, which improved to 0.6 at the last follow-up (P < .001). Furthermore, the average FFI significantly decreased from pre- to postoperation from 19.2 to 4.4, respectively (P < .001). Overall, 108 of 111 patients reported being satisfied with the outcomes of the procedure. Average bone union was achieved at 12.6 weeks postoperation, with a minimum of 12 and a maximum of 25 weeks. The complication rate was 1.5%, including 1 case of an asymptomatic cock-up deformity and 1 case of lateral fifth metatarsal shaft bone overhang pain, which resolved with an exostectomy. CONCLUSION: The results of this study of patients who had minimally invasive surgery from an experienced surgeon suggest that percutaneous DMMO of the fifth metatarsal without internal fixation or postoperative immobilization or strapping can be effective at improving radiographic alignment, pain, function, and overall satisfaction with minimal rates of complication. LEVEL OF EVIDENCE: Level IV, case series.

Midterm Outcomes of Sliding Distal Metatarsal Minimally Invasive Osteotomy to Treat Bunionette Deformity.

BACKGROUND: Bunionette deformity is described as a painful bony prominence on the lateral aspect of the fifth metatarsal head. The present study prospectively assessed the clinical, functional, and radiographic outcomes of sliding distal metatarsal minimally invasive osteotomy (S-DMMO) used in a large series of patients with a midterm follow-up period. METHODS: From December 2015 to December 2018, we evaluated 74 feet (57 patients). Radiologic (4-to-5 intermetatarsal angle, fifth metatarsophalangeal angle, the fifth metatarsal head width, lateral deviation angle, fifth metatarsal length, medial displacement, and elevation), clinician-reported scores (AOFAS score, visual analog scale [VAS]) and patient-reported outcomes measure (Foot and Ankle Ability Measure [FAAM] activities of daily living [ADL], FAAM sports, Manchester-Oxford Foot Questionnaire [MOXFQ], and patient satisfaction survey) were included in the analysis. The time to bone union was also assessed. RESULTS: The average 4-to-5 intermetatarsal angle improved from 11.1 degrees preoperatively to 4.5 degrees postoperatively (P < .001), whereas the average fifth metatarsophalangeal angle improved from 15.7 degrees preoperatively to 4.8 degrees postoperatively (P < .001). The lateral deviation angle was found to be 2.2 degrees. The fifth metatarsal length decreased from 66.6 to 64.3 mm postoperatively. The average initial medial displacement was 4.67 mm preoperatively and 4.54 mm at final follow-up. The elevation of the fifth metatarsal head was 1.08 mm. The American Orthopaedic Foot & Ankle Society score improved from 54.3 ± 20.86 points preoperatively to 93.4 ± 17.3 (P < .001). VAS score decreased from 7.9 to 0.7 (P < .001). Also, FAAM ALD, FAAM Sport, and MOXFQ showed statistically significant differences (P < .001) between preoperative and postoperative periods. Patients found the procedure excellent in 89.1% of cases, very good in 5.4%, and good in 5.4%. Bone union was obtained at 8.1 weeks. CONCLUSION: The most important finding of the present study is that S-DMMO showed improvement in function and pain associated with a high satisfaction rate. Also, we found substantial capacity to correct deformities and a low incidence of complications. LEVEL OF EVIDENCE: Level IV, case series.

Percutaneous Bunionette Correction: Retrospective Case Series.

Introduction. Bunionette is a deformity of the fifth metatarsal in which there is a painful lateral bony prominence of the distal region of this bone caused by various anatomical and biomechanical changes. The aim of this study is to report on a minimally invasive technique without the use of hardware to treat these deformities. Methods. This is a case series of 18 patients, 25 feet, who underwent bunionette percutaneous surgical treatment. All patients answered the American Orthopaedic Foot and Ankle Society (AOFAS) scale and the visual analogue pain scale (VAS) preoperatively and at the last follow-up. Standard radiological evaluation included measurement of intermetatarsal (4-5 IMA) and fifth toe metatarsophalangeal (5-MTTP) angles. Time to radiographic consolidation, complications, and satisfaction rate were also documented. Results. The average follow-up was 15.9 months, the AOFAS increased from 49.6 to 92.4 and the VAS decreased from 7.7 to 1.2. It was observed that average 5-MTTP decreased from 15° to 2.7° and that 4-5-IMA decreased from 9.1° to 3.3°. These outcomes showed a statistically significant difference (P < .001). The most common observed complication was the formation of a hypertrophic bone callus in the third postoperative month in three operated feet (12%). One patient had algodystrophy, which improved after conservative treatment. There were no cases of infection, neuropraxis, or recurrences. Fifteen patients rated the result as excellent, 2 as good, and 2 as regular. Conclusion. Percutaneous osteotomy of the fifth metatarsal without the use of hardware is a safe, reproducible technique and presents good clinical and radiographic results for the treatment of bunionette.Levels of Evidence: Therapeutic studies, Level IV: Case series.

Percutaneous Oblique Distal Osteotomy of the Fifth Metatarsal for Bunionette Correction.

BACKGROUND: Bunionette is a common foot disorder, and several types of corrective surgery have been described. With the popularization of minimally invasive surgeries, the forefoot region has become a suitable area for this type of technique. The aim of this study was to evaluate the results of oblique distal osteotomy of the fifth metatarsal adapted for a percutaneous approach. METHODS: We prospectively evaluated 31 consecutive tailor's bunion patients who underwent operative correction on a total of 42 feet between 2017 and 2019 after failure of conservative treatment. Clinical outcomes such as pain (visual analog scale [VAS]), function (American Orthopaedic Foot & Ankle Society [AOFAS] Lesser Toe Metatarsophalangeal-Interphalangeal Scale scoring system), personal satisfaction, and complications were evaluated. Radiographic aspects were also examined. Shapiro and Mann-Whitney statistical tests were conducted. The average age of the patients was 69.5 years, and the average follow-up was 13.1 months. RESULTS: After the operative procedure, there was a decrease of 6.6 points on the VAS for pain (P < .001) and an increase of 34.9 in the AOFAS score (P < .001). Radiographic correction was achieved for both the fifth metatarsophalangeal angle (P < .001) and the intermetatarsal angle (P < .001), which showed decreased values. There was 1 case of superficial infection and 2 cases of nonunion (asymptomatic). A large majority of patients regarded the procedure outcome as satisfactory. CONCLUSION: This percutaneous oblique distal osteotomy of the fifth metatarsal for bunionette deformity produced improvements in pain and function and a high rate of satisfaction, with a low incidence of complications and a high capacity for correcting the deformity. LEVEL OF EVIDENCE: Level II, prospective cohort study.

Reproducibility and Reliability of the Radiographic Angles Used to Assess Tailor's Bunions.

BACKGROUND: Tailor's bunion, or bunionette, deformity is a common condition of the lateral forefoot. To aid in assessing the deformity, radiographic angular measurements are frequently used. The objective of this study was to determine the reliability and reproducibility of these angular measurements. METHODS: Thirty unique weightbearing dorsoplantar digital radiographs of pathologic feet were compiled. For these 30 radiographs and for ten repeated radiographs, six practicing clinicians measured the following angles: the fourth to fifth intermetatarsal angle, the lateral deviation angle, and the fifth metatarsophalangeal angle. Both traditional and modified versions of the fourth to fifth intermetatarsal angle were included. RESULTS: Intraclass correlation coefficient values were calculated for each of the angles studied. Intrarater reliability was highest for the fifth metatarsophalangeal angle and lowest for the lateral deviation angle. Intrarater reliability was higher for the traditional fourth to fifth intermetatarsal angle than for the modified version. The interrater reliability calculations revealed parallel findings. CONCLUSIONS: Accurate assessment is critical when planning for surgical intervention. Awareness of the relative reliability of these radiographic angular measurements can aid in preoperative planning and may be of benefit in procedure selection.

Clinical and radiographic outcomes of the Kramer osteotomy in the treatment of bunionette deformity.

BACKGROUND: Bunionette deformity is a painful bony prominence of the 5th metatarsal. We evaluated outcomes of using a Kramer osteotomy to treat this condition. METHODS: Retrospective study of patients treated with a Kramer osteotomy from 2003 and 2016. Outcome measures included Foot Functional Index (FFI) and radiographic measurements. RESULTS: 38 patients (43 feet) with an average follow-up of 55 months. Mean postoperative FFI1 was 19.4. Mean 4-5 IMA2 improved 3.9°, from 8.3° preoperatively to 4.4° on final postoperative films (p<0.01). Mean MTP-53 angle improved 13.2° from 13.6° preoperatively to 0.4° at final follow-up (p<0.01). There were 5 delayed unions (11.6%) and 1 non-union (2.3%). CONCLUSIONS: The Kramer osteotomy is an effective treatment option in patients with bunionette deformity, with significant correction of the 4-5 IM2 and MTP-53 angles and few complications.

Fifth Metatarsal Osteotomies for Treatment of Bunionette Deformity: A Meta-Analysis of Angle Correction and Clinical Condition.

We assessed which type of osteotomy would be most suited for correcting an increased fourth to fifth intermetatarsal angle (IMA) and metatarsophalangeal angle (MPA) and would have the best results regarding the clinical condition and satisfaction. The study design was a systematic review and meta-analysis. The main outcome measures were the IMA, MPA, and American Orthopaedic Foot and Ankle Society Lesser Metatarsophalangeal-Interphalangeal scale and satisfaction scores. A systematic search was performed in Medline, Embase, Cochrane, SPORTdiscus, and CINAHL up to September 2016. Prospective and retrospective studies that had evaluated the outcomes of fifth metatarsal osteotomies to correct a bunionette deformity at all patient ages were included. The outcomes were determined from clinical or radiographic evaluations. The search yielded 28 studies suitable for inclusion in our meta-analysis. All groups of osteotomies achieved significant IMA changes, with proximal osteotomies resulting in significantly greater changes than diaphyseal or distal osteotomies. The overall effect of osteotomies on the MPA was of a significant reduction. Proximal and diaphyseal osteotomies both resulted in significant differences in MPA correction compared with distal osteotomies. The incidence of major complications was the least in the distal osteotomy group. The overall mean success rate of bunionette surgery was 93%. The patients were most satisfied with proximal osteotomies, followed by distal and diaphyseal osteotomies (100% and 92%, respectively). In conclusion, every type of osteotomy has the capability of significantly reducing the fourth to fifth IMA and MPA. The fewest complications occurred with distal osteotomies, and the greatest satisfaction score was achieved with proximal osteotomies. However, only 1 study evaluated these results for proximal osteotomies. Distal osteotomies resulted in a high satisfaction rate and were the most represented osteotomy in our meta-analysis. Thus, when major IMA and MPA reduction is not required, the distal osteotomy could be the treatment of choice owing to its low complication rate.

Percutaneous hardware free corrective osteotomy for bunionnette deformity.

When bunionette deformities are not responding to conservative treatment, several surgical procedures are available. Recently, minimal invasive techniques have been proposed with good results. We present our results of a strictly percutaneous 5th metatarsal osteotomy to correct the deformity with bandage after care. We present a retrospective review on 20 percutaneous distal oblique 5th metatarsal osteotomies for correction of bunionette deformity. Aftercare consisted of 5-6 weeks of corrective taping with full weight bearing using a post-op shoe. Patients were evaluated radiographically and clinically by the American Orthopaedic Foot & Ankle Society (AOFAS) Lesser Toe Metatarsophalangeal-Inter-phalangeal scale, Visual Analogue scale (VAS) and Coughlin classification. At a mean follow-up of 27.05 months, the AOFAS improved from a mean of 51 points to 91.6 points (max 100). 90% of patients had good or excellent clinical result and a mean pain score on the visual analog scale was 0.7 out of 10. Radiographic evaluation showed a good correction of the intermetatarsal and metatarsophalangeal angle. We did not encounter any complications such as infections, wound breakdown, neurovascular problems, non-union or recurrence. The percutaneous hardware free corrective osteotomy is an effective, reliable and safe procedure concerning the treatment of bunionette deformity. The results are comparable with previously published outcomes of open and minimal invasive procedures with considerable less soft tissue damage, shorter operating time and the lack of internal fixation.

Bunionette.

PURPOSE: The purpose of this study is to review the most recent literature available on the treatment of bunionette (also named tailor's bunion) with percutaneous and minimally invasive techniques. Focusing especially on clinical outcomes, studies related to this type of techniques were examined in order to evaluate the success of this practice that is, fusion rate and complications. The hypothesis is that these techniques are safe and successful procedures. METHODS: In July 2015, a topical review of the PubMed/MEDLINE, EMBASE, and Google Scholar databases was conducted using the keywords percutaneous (OR mini-invasive OR minimally invasive) AND bunionette (OR tailor's bunion) AND treatment (OR surgery). Studies reporting the outcomes of the surgical treatment of bunionette were also included in our review. RESULTS: The search yielded a total of 111 publications from PubMed/MEDLINE, EMBASE, and Google Scholar. After evaluating abstracts and full-text reviews, 9 articles were included in this review. Treatment methods were divided into 2 main surgical treatment categories: with or without fixation of the osteotomy. The most commonly used technique was that with fixation. The scores of success for techniques with and without fixation were 93.5 and 97.8, respectively. CONCLUSION: The current evidence for the treatment of bunionette deformity is limited to retrospective case series. Therefore, no conclusion can be made regarding the gold standard technique for bunionette deformity. The results published are very satisfactory, but the literature is still poor. LEVELS OF EVIDENCE: IV: Topical review.

The Reverse Ludloff Osteotomy for Bunionette Deformity.

UNLABELLED: Background The typical bunionette deformity often presents as pain over the lateral margin of the fifth metatarsal head. There have been numerous operative treatments described for this pathology. The purpose of this study was to evaluate the results after a reverse Ludloff osteotomy in cases of severe bunionette deformities. Methods Between 2008 and 2012, 16 patients received a reverse Ludloff osteotomy of the fifth metatarsal due to a symptomatic type II or III bunionette that failed nonoperative treatment. We retrospectively reviewed charts, radiographic images, postoperative AOFAS (American Orthopaedic Foot and Ankle Society) lesser toe scores, and the EQ-5D at a mean of 41.9 months (range, 31-74 months) of follow-up. Additionally, limitation in activities of daily living, pain, and patient satisfaction were assessed. Results At latest follow-up, the mean AOFAS lesser toe score was 86.6 points and the mean EQ-5D score was 14.1. Fifteen patients had no or only little limitations. Fifteen out of 16 patients were satisfied or predominantly satisfied. Radiographic analysis showed for type II deformities a correction of the lateral bowing from 8.1° down to 0.67° (P < .001). The fourth-fifth intermetatarsal angle (4-5 IMA) improved from a mean of 13.2° to a mean of 5.2° (P < .001). The length of the fifth metatarsal was unchanged (P > .05). There were no observed complications, and no revision was necessary. Conclusion In the present study, the reverse Ludloff osteotomy had a high satisfaction rate and no complications. It provided radiographic correction of the deformity and may be considered in the surgical treatment of severe bunionette deformities. LEVELS OF EVIDENCE: Therapeutic, Level IV: Case series.

Radiographic Morphologic Characteristics of Bunionette Deformity.

BACKGROUND: Bunionette deformity is characterized as head hypertrophy, lateral bowing, or splaying of the fifth metatarsal, or a combination of these deformities. Most previous studies have focused on the fourth and fifth metatarsals; few have analyzed the radiographic morphologic characteristics of the entire foot. The morphologic characteristics of the entire foot in cases of symptomatic bunionette deformity were analyzed with a radiographic image-mapping system. METHODS: The system was used for the morphologic analysis of 112 feet with symptomatic deformity and 123 asymptomatic control feet. The mapping system includes 2-dimensional coordinates. We compared morphologies of both groups on the basis of simple models prepared from x and y coordinates of each reference point, calculated by using the mapping system and various angle measurements. We set cutoff values and categorized cases according to Fallat's system. We evaluated the characteristics of each type and a new deformity type (type V) wherein no measurement exceeded the cutoff values. RESULTS: The heads of the third, fourth, and fifth metatarsals were more laterally displaced, and the angles between the metatarsal axes were larger in the deformity group. Comparison of deformity types showed that the morphology of the fifth metatarsal might be only one cause of deformity. The intermetatarsal angles between the second and third metatarsals and between the third and fourth metatarsals were larger in deformity type II and type V feet than in control feet. Additionally, the intermetatarsal angles between the third and fourth metatarsals and between the fourth and fifth metatarsals were larger in deformity type III and type IV feet than in control feet. CONCLUSION: We believe it is necessary to not only focus on the fourth and fifth metatarsals, but also assess the morphologic characteristics of the entire foot in patients with a bunionette, including splaying of all the metatarsals and the forefoot width, when planning surgery. LEVEL OF EVIDENCE: Level III, retrospective comparative study.

Revisiting the tailor's bunion and adductovarus deformity of the fifth digit.

Correction of the fifth digit deformity and Tailor's Bunion can be rewarding as well as challenging for a foot and ankle surgeon. Immense care should be taken when performing these reconstructive surgical procedure, especially to avoid and minimize complication rates and mainly to prevent neurovascular damage. Appropriate surgical procedure selection for the fifth digit deformity and Tailor's Bunion is necessary in order to obtain a long term predictable outcome.

Percutaneous bunionette correction.

BACKGROUND: Treatment of tailor's bunion is largely conservative. For severe or refractory cases surgical intervention is necessary. The aim of this study is to evaluate a percutaneous technique for correcting such bunionette deformities. METHODS: Twenty-one procedures were performed on 20 patients using a percutaneous technique. Patients were scored using the American Orthopaedic Foot & Ankle Society (AOFAS) Lesser Toe Metatarsophalangeal-Interphalangeal Scale. RESULTS: No wound healing problems, infections, non-unions or mal-unions occurred. Functional assessments revealed very good results. Radiographic evaluation confirmed good average correction of the fourth-fifth intermetatarsal angle and metatarsophalangeal angle. CONCLUSIONS: This percutaneous technique is a reliable and effective approach for the treatment of bunionette deformity. The results obtained were comparable to those reported using traditional open techniques, but major complications due to soft tissue damage were averted. This technique can be adapted depending on the type of deformity, and does not require internal fixation.

Subcaptial oblique fifth metatarsal osteotomy versus distal chevron osteotomy for correction of bunionette deformity: a cadaveric study.

UNLABELLED: The aim of this study was to compare a distal subcapital oblique fifth metatarsal with a distal chevron osteotomy for correction of bunionette deformity. MATERIALS AND METHODS: Twenty cadaveric feet were randomly assigned to undergo either a subcapital oblique or chevron osteotomy of the distal fifth metatarsal. Radiographic measurements, including 4-5 intermetatarsal angle (IMA), fifth metatarsophalangeal angle (5-MPA) and foot width, were compared between the 2 groups. RESULTS: Foot width and 5-MPA was significantly decreased in both groups with no difference between the groups. The 4-5 IMA was not significantly altered in either group. CONCLUSION: Decrease in foot width and 5-MPA was similarly achieved with either distal chevron or subcapital oblique osteotomy of the fifth metatarsal in normal cadaveric specimens. No significant difference was found between the 2 techniques in any of the radiographic parameters measured.

'Reverse' scarf osteotomy for bunionette correction: Initial results of a new surgical technique.

BACKGROUND: The bunionette or tailor's bunion is a lateral prominence of the fifth metatarsal head. It is usually characterised by a wide intermetatarsal angle (IMA) between the 4th and 5th metatarsals, varus of the metatarsophalangeal (MTP) joint, pain and callus formation. Various distal, shaft and basal osteotomies have been described in the literature. We have described a reverse scarf osteotomy for bunionette correction. PATIENTS AND METHODS: We have used a 'reverse' scarf osteotomy in 12 cases (10F: 2M) with a mean follow-up of 12 months (range 5-22 months) with radiographs and clinical scoring. RESULTS: Post operatively, mean IMA improved from 13.1° to 7.27° (range 2.0-11.5°); mean 5th MTP angle improved from 19.9° to 6.36° (range 2.8-9.0°) and postoperative mean AOFAS improved from 54.25 to 89.58 (range 70-100). CONCLUSION: 'Reverse' scarf osteotomy in the correction of bunionette deformity offers promising results in the short term.

Early results of distal metatarsal osteotomy with K-wire fixation in the treatment of tailor's bunion.

OBJECTIVE: Tailor's bunion deformity is a lateral side bone and soft tissue prominence of the fifth metatarsal bone. The aim of our study was to assess the clinical and radiographic results of distal metatarsal osteotomies in patients with tailor's bunion deformity. METHODS: This study included 24 feet of 14 patients with tailor's bunion who were treated with distal metatarsal osteotomy of the 5th metatarsal between 2006 and 2009. The mean follow-up time was 24.45 (range: 12 to 47) months. Patients were evaluated clinically and radiographically, using the American Orthopaedic Foot and Ankle Society (AOFAS) scoring system with weight-bearing anteroposterior and lateral foot radiographs. RESULTS: Average AOFAS scores of the patients were 64.83 preoperatively and 91.62 at the final follow-up. Three patients had complications; avascular necrosis, delayed union, and superficial wound infection. CONCLUSION: Distal metatarsal osteotomy is a safe and easy treatment option for the painful tailor's bunion deformity and provides patient satisfaction rate of up to 96%.

Scarf osteotomy for correction of Tailor's bunion: mid- to long-term followup.

BACKGROUND: The purpose of the study was to evaluate the increased correction possible with a mid shaft rotational osteotomy with the stability and ease of fixation associated with a scarf osteotomy. MATERIALS AND METHODS: Between September 1999 and September 2006, 63 patients underwent operative repair of 77 Tailor's bunion deformities. Twenty eight patients (36 feet) were available for a final review (nine males and 19 females). A further seven patients (nine feet) completed a questionnaire. The mean followup period for the 28 patients reviewed in clinic was 6.5 years, (79.5 months; SD, 22). RESULTS: Eighty-six percent were completely satisfied, 11.4% were satisfied with reservations and 3% were dissatisfied. Ninety-one percent considered themselves better than before their surgery while 8.6% felt they were no better. Ninety-one percent of patients said they would undergo surgery under the same conditions again. Preoperatively, the mean 4-5 intermetatarsal angle measured on weightbearing X-rays was 9.9 degrees (SD, 2.2), the mean postoperative intermetatarsal angle was 5.7 degrees (SD, 2.0). The mean preoperative AOFAS score was 44.1 (SD, 14.5) and the mean postoperative score at 6-month review was 91.8 (SD, 20.2). The AOFAS score at final review was 88.1 (SD, 11.6). CONCLUSION: The rotational scarf osteotomy was a reliable procedure for the correction of Tailor's bunion deformities. The osteotomy allowed for early mobilization and had few associated complications. The rotational scarf osteotomy facilitated correction of the intermetatarsal angle while maintaining excellent sagittal and transverse plane stability.

Scarfette osteotomy for surgical treatment of bunionette deformity.

Numerous procedures have been described for a bunionette deformity. Choosing a specific osteotomy depends largely on the degree of the deformity and surgeon preference. The Scarfette osteotomy is a versatile procedure that addresses specific etiologic factors associated with bunionette deformities. The primary aim of this study is to show the versatility of the Scarfette osteotomy in varying degrees of bunionette deformities. A retrospective review of 50 cases was performed with a follow-up of 12 months. Objective information was obtained by measuring specific radiographic variables on preoperative and postoperative weight-bearing radiographs. Mean radiographic results are presented for the intermetatarsal 4-5 angle, lateral deviation angle, and fifth metatarsophalangeal angles postoperatively. The authors report short-term results of the Scarfette osteotomy in the correction of bunionette deformities. The Scarfette is a predictable and versatile osteotomy to correct varying degrees of bunionette deformities. The Scarfette is not technically demanding and allows early postoperative ambulation.

The minimally invasive osteotomy "S.E.R.I." (simple, effective, rapid, inexpensive) for correction of bunionette deformity.

BACKGROUND: A bunionette is a deformity of the fifth metatarsal bone with a varus deviation of the toe which can require surgical correction. Although numerous bony or soft tissue surgical procedures have been described, the ideal treatment has not yet been identified. The aim of this study was to retrospectively evaluate the results of a series of 50 consecutive feet affected by symptomatic bunionette deformity treated by S.E.R.I. (simple, effective, rapid, inexpensive) osteotomy. MATERIALS AND METHODS: Between February 1998 and March 2004, 50 feet with symptomatic type II-III bunionette deformity in 32 patients (18 bilateral) underwent S.E.R.I osteotomy. The average age of the patients at the time of operation was 33 +/- 13 years. The average followup was 4.8 (range, 2 to 8) years. RESULTS: The average modified lesser toe AOFAS score increased from 62.8 +/- 15.2 points preoperatively to 94 +/- 6.8 points at last followup (p < 0.0005). The average fifth metatarsophalangeal (MTP) angle decreased from 16.8 +/- 5.1 degrees preoperatively to 7.9 +/- 3.1 degrees at final followup (p < 0.0005). The 4-5 intermetatarsal angle (I.M.A) averaged 12 +/- 1.7 degrees preoperatively, while postoperatively was 6.7 +/- 1.7 degrees (p < 0.0005). Complications included a skin inflammatory reaction around the Kirschner wire and 2 symptomatic plantar callosities under the fourth metatarsal heads. CONCLUSIONS: The minimally invasive osteotomy is an effective and reliable technique for the treatment of painful bunionette, and it achieved more than 90% excellent and good results with reduced surgical time and complications.

Transverse medial slide osteotomy for bunionette deformity: long-term results.

BACKGROUND: Bunionette deformity of the fifth metatarsal infrequently requires operative treatment. This study presents the long-term results of a simple operative technique. METHODS: Forty-four distal metatarsal medial slide osteotomies with pin fixation were performed for symptomatic bunionette deformity in 30 patients. After an average of 7 years and 8 months (range 69 to 110 months), 30 feet in 21 patients were available for clinical and radiographic evaluation. RESULTS: The patients' subjective assessment was excellent and good in 81% and fair and poor in 19% of feet. The mean pain score on a visual analogue scale was 1.8 (range 0 to 7) and the mean American Orthopaedic Foot and Ankle Society (AOFAS) score was 88.2 (range 47 to 100). Postoperative complications included pin track infection in three feet and delayed union in one. One patient developed transfer metatarsalgia and another patient had repeat surgery for recurrent symptoms on both feet after 5 years. CONCLUSIONS: This procedure combines technical simplicity with satisfactory and predictable long-term results in the operative treatment of bunionette deformity in the lateral forefoot.