Correction method for moderate and severe degrees of hallux valgus associated with transfer metatarsalgia

BACKGROUND Hallux valgus(HV)is a common foot deformity that manifests with increasing age,especially in women.The associated foot pain causes impaired gait and decreases quality of life.Moderate and severe HV is a deformity that is charac-terized by the involvement of lesser rays and requires complex surgical treatment.In this study,we attempted to develop a procedure for this condition.AIM To analyse the treatment results of patients who underwent simultaneous surgical correction of all parts of a static forefoot deformity.METHODS We conducted a prospective clinical trial between 2016 and 2021 in which 30 feet with moderate or severe HV associated with Tailor’s bunion and metatarsalgia were surgically treated via a new method involving surgical correction of all associated problems.This method included a modified Lapidus procedure,M2M3 tarsometatarsal arthrodesis,intermetatarsal fusion of the M4 and M5 bases,and the use of an original external fixation apparatus to enhance correction power.Preoperative,postoperative,and final follow-up radiographic data and American Orthopaedic Foot and Ankle Society(AOFAS)scores were compared,and P values<0.05 were considered to indicate statistical significance.RESULTS The study included 28 females(93.3%)and 2 males feet(6.7%),20(66.7%)of whom had a moderate degree of HV and 10(33.3%)of whom had severe deformity.M2 and M3 metatarsalgia was observed in 21 feet,and 9 feet experienced pain only at M2.The mean follow-up duration was 11 months.All patients had good correction of the HV angle[preoperative median,36.5 degrees,interquartile range(IQR):30-45;postoperative median,10 degrees,IQR:8.8-10;follow-up median,11.5 degrees,IQR:10-14;P<0.01].At follow-up,metatarsalgia was resolved in most patients(30 vs 5).There was a clinically negligible decrease in the corrected angles at the final follow-up,and the overall AOFAS score was significantly better(median,65 points,IQR:53.8-70;vs 80 points,IQR:75-85;P<0.01).CONCLUSION The developed method showed good sustainability of correction power in a small sample of patients at the one-year follow-up.Randomized clinical trials with larger samples,as well as long-term outcome assessments,are needed in the future.

Multiple floating metatarsals： a unique injury

Concomitant dislocation of the tar- sometatarsal and metatarsophalangeal joints of foot is an extremely rare injury. Such injuries presenting in a single or adjacent dual rays have been described in few cases previously. We describe such an injury in adjacent three metatarsals of a polytrauma patient. These injuries are likely to be missed in the initial assessment of a polytrauma patient. These patients are at risk of an overlooked diagnosis but the consequences of missing this type of injury may be quite severe. This case is presented in view of its unique- ness along with possible mechanism of injury, the sequence of reduction and follow-up. Knowledge of such injury and its proper management may be useful to the trauma surgeons

Fifth metatarsal fractures and current treatment

Metatarsal fractures are one of the most common injuries of the foot. There has been conflicting literatureon management of fifth metatarsal fractures due to inconsistency with respect to classification of these fractures. This article provides a thorough review of fifth metatarsal fractures with examination of relevant literature to describe the management of fifth metatarsal fractures especially the proximal fracture. A description of nonoperative and operative management for fifth metatarsal fractures according to anatomical region is provided.

Existing fixation modalities for Jones type fifth metatarsal fracture fixation pose high rates of complications and nonunion

Jones type fifth metatarsal fractures pose a challenge to the foot and ankle surgeon,given documented high nonunion rates as well as high complication rates including hardware prominence,nerve injury,and screw breakage for existing treatment modalities including screw and plantar plate fixation.We call for the design of innovative Jones-fracture specific implants which contour to the natural curve of the fifth metatarsal.Future research should aim to expand upon existing literature for Jones fracture fixation and evaluate efficacy of novel implants which are designed to address unacceptably high complication rates for existing treatment modalities.

Jones type fifth metatarsal fracture fixation in athletes:A review and current concept

Jones type fifth metatarsal fracture is a common occurrence among athletes at all levels.These fractures may occur due to several mechanisms,but inversions and twisting injuries are considered some of the leading causes in sports.However,while Jones fracture incidences are frequent in the sporting world,there is still a lack of consensus on how such fractures should be effectively managed.There are numerous treatment options for patients with fifth metatarsal Jones fractures.The role of nonoperative treatment remains controversial,with concerns about delayed union and nonunion.Surgical stabilization of metatarsal Jones fractures is therefore often recommended for athletes,as it is often associated with a low number of complications and a higher rate of union than nonoperative management.This review will focus on literature regarding the prevalence of Jones type fifth metatarsal fracture,alongside the efficacy of both conservative and surgical treatment within this population.

Traumatic Floating Bone. About 11 Cases and a Literature Review

Introduction: Floating bone injury or bipolar dislocation is a concurrent dislocation at both ends of a long bone or a flat bone. It is an exceptional injury. We report 11 consecutives cases of floating bones. Objectives: The aim of the study is to analyze the frequency, the mechanism of injury and clinical forms of floating bones, and to present the results of their management. Material and Methods: A ten years ongoing retrospective study was held in four trauma departments. Eleven cases of floating bones were identified. The floating bones characteristics such as the injured bone, the patient age and sex, the mechanism of injury, the dislocations directions, the associated complications, the treatment and the outcome were studied. Results: Nine male and two female patients, with a mean age of 37 years [19 - 65 years range] presented a concurrent bipolar dislocation of one bone or a group of bones. They sustained a road traffic accident (n = 5), a workplace accident (n = 3), a fall from height (n = 2), and a sport accident (n = 1). The clavicle (n = 3) and the first metatarsal (n = 3) were the most frequently involved. The others floating bones were the radius-ulna complex (n = 1), the radius-lunatum complex (n = 1), the first metacarpal (n = 1), the first phalanx (n = 1) and the femur (n = 1). The floating bones ends displacement occurred in the sagittal plane (the forearm, the femur, the first phalanx and the first metatarsal) and in the horizontal plane (the clavicle, the first metatarsal and the first metacarpal). We defined direction displacements as bidirectional asymmetric (n = 10) or unidirectional symmetric (n = 1). Associated complications were fractures (wrist, hip, tarso-metatarsal joints) and wounds (fingers, metatarso-phalangeal joint). Dislocations were treated conservatively (n = 5) and surgically (n = 17) with excellent results (n = 13/16 joints). Three patients were lost of view. Conclusion: Our study described the characteristics of this exceptional injury. For any joint dislocation, we promote the systematic examination of the other end of the dislocated bone.

SURGICAL TREATMENT OF HALLUX VALGLUS BY RECONSTRUCTION OF METATARSAL ARCH AND MODIFIED MCBRIDE OPERATION（40 CASES REPORT）

feet with hallux valgus among 40 patients treated by reconstruction of metatarsal arch and modified McBride operation are reported in this paper. After an average of 4. 5 years of postoperative follow-up, the results showed an overll 9° and 3° correction of the hallux abductus angle and the intermetatarsal angle, respectively. 95% of the cases of bunions disappeared, 66% calli under the heads of the first and second metatarsal disappeared, and 9l% patients were satisfied with the changes of their feet appearance.

Avascular necrosis of the first metatarsal head in a young female adult:A case report and review of literature

BACKGROUND This case study describes an atypical presentation of avascular necrosis(AVN)of the first metatarsal head,which is largely unfounded in the literature.CASE SUMMARY A healthy 24-year-old female initially presented with pain at the first metatarsophalangeal joint(MTPJ)and was diagnosed with AVN by physical examination and magnetic resonance imaging.The patient demonstrated atypically poor progress in recovery,despite being in otherwise good health and being of young age,with no history of corticosteroid or alcohol use.The patient also did not have any history or clinical features of autoimmune disease or vasculitis,such as systemic lupus erythematosus.The patient was managed with conservative treatment for 18 mo,which allowed for gradual return of full range of motion of the first MTPJ and subsiding pain,permitting the patient to return to highintensity sports training and full weight-bearing.Throughout her recovery,many differential diagnoses were ruled out through specific investigations leading to further reinforcement of the diagnosis of AVN of the 1st metatarsal head.CONCLUSION Atypical AVN may occur with no predisposing risk factors.Treatment is mainly conservative,with unclear guidelines in literature on management.

PRESSURE DISTRIBUTION UNDER NORMAL FEET DURING STANDING AND LEVEL WALKING

Foot pressure measurements were performed during standing and level walkingon a series of 30 normal subjects (15 males, 15 females, a total of 60 feet) with amean age of 37.6 yrs and a mean body weight of 66.3 kg. A significant difference wasfound in the peak pressure under the second metatarsal head between males and femaleswith females showing higher pressures than males daring walking (P【0. 01). The meanpeak pressure and standard deviation for all 7 areas selected for 30 adult subjects duringstanding and walding were obtained. The rise time to peak pressure at each selected areafor walking was recorded and analysed. The practical application and clinical significanceof these data were also discussed.

Metatarsal Fracture Reduction and Fixation by Kirschner Wires: Technical Tip

The incidence of metatarsal fractures is not precisely known. Malposition might cause future metatarsalgia, mid-foot pain and discomfort, which may dictate an on-going need for in-shoe orthosis, shoe modification and, occasionally, operative correction. To minimize and prevent these problems, we describe a simple technique for reduction and fixation of metatarsal fractures by Kirschner wires. We have found this technique to be a simple and efficient way of reducing and fixing metatarsal fractures. It is applied easily by the closed and open technique.

A comparative study on imaging parameters of Chevron combined with Akin osteotomy and Scarf combined with Akin osteotomy for the correction of hallux valgus in patients at different ages

Objective:To study the imaging parameters of Chevron combined with Akin and Scarf combined with Akin for the correction of hallux valgus in patients of different ages.Methods:Eighty patients(152 feet)with hallux valgus who underwent Chevron combined with Akin and Scarf combined with Akin in our hospital were randomly selected.The patients were divided into young and middle-aged groups.Measure the hallux valgus angles(HVA),distal metatarsal articular angle(DMAA)and intermetatarsal angles(IMA)with professional X-ray measurement software and then reseach the effect of two the operation methods.Results:Young group:Chevron combined with Akin and Scarf combined with Akin significantly improved HVA and IMA,the difference had statistical significance(P<0.05),but the improvement effect of the two groups was similar,and the difference had no statistical significance(P>0.05).The improvement effect of the two groups on DMAA in young patients was not significant,and the difference had no statistical significance(P>0.05);Middle-aged group:Chevron combined with Akin and Scarf combined with Akin also significantly improved HVA and IMA(P<0.05),but the improvement effect of the two groups was similar,and the difference had no statistical significance(P>0.05).Chevron combined with Akin significantly improved DMAA in middle-aged and elderly patients,and the difference had statistical significance(P<0.05).Scarf combined with Akin did not significantly improve DMAA in middle-aged and elderly patients,and the difference had no statistical significance(P<0.05).Conclusion:Both Chevron combined with Akin and Scarf combined with Akin are effective and widely used.Chevron combined with Akin was able to improve DMAA in middle-aged and elderly patients.Therefore,Chevron combined with Akin is recommended for middle-aged and elderly patients with hallux valgus.

Bilateral Fracture of the Base of the Fifth Metatarsal. A Case Report and Review of the Literature

We report an unusual case of basic bilateral fracture of fifth metatarsals in a 48 years old post-menopausal woman. She had previously been treated for arterial high blood pressure, parathyroidectomy and rheumatoid arthritis by a long corticotherapy treatment. The lesion was caused by an indirect mechanism in an overweight context. The diagnosis of a pseudarthrosis of the base of the fifth metatarsals was maintained after 7-month treatment. The patient received a treatment of both pseudarthrosis. The post-operative periods were simple. After a 9-month follow-up, the treatment allowed consolidation with painless feet allowing her to resume work.

Donor site reconstruction by adjacent half-width metatarsal after full-width metatarsal transfer for metacarpal reconstruction in severe thumb hypoplasia

The treatment of Manske type IIIB and IV thumb hypoplasia remains controversial,and parents increasingly expect to maintain the hypoplastic thumb in preference to a five-digit hand.[1,2]There has been a recent increased number of reports regarding the reconstruction of severe thumb hypoplasia with the use of free metatarsal transfers(MTs).Tsujino et al[3]reconstructed a thumb with a nonvascularized 4th metatarsal,and filled the bone defect with an iliac graft.Chow et al[4]reported on thumb reconstruction with hemi-width MT,which reduced not only the sacrifice of the donor foot but also the strength of the reconstructed metacarpal.

Reversed vascularized second metatarsal flap for reconstruction of Manske type ⅢB and Ⅳ thumb hypoplasia with reduced donor site morbidity

Background:The predominant method for Manske type ⅢB and Ⅳ thumb hypoplasia is pollicization.However,for those who are not willing to sacrifice the index finger,a method that could reconstruct a functionally capable and aesthetically acceptable thumb remains desirable.This study aimed to investigate and assess the functional and radiographic outcomes of utilizing a reversed vascularized second metatarsal composite flap for thumb reconstruction as a new alternative.Methods:From May 2014 to January 2017,15 patients with Manske type ⅢB or Ⅳ thumb hypoplasia who were admitted to the Department of Hand Surgery,Beijing Jishuitan Hospital were included in this study.An osteocutaneous flap containing a section of second metatarsal and its distal head was transferred in reversed position to reconstruct carpometacarpal joint.The donor site was reconstructed by a split half of the third metatarsal.Various functional reconstructions were commenced at second stage.The reconstructed thumbs were evaluated using the Kapandji score,pinch force,and the capacities of performing daily activities through a detailed questionnaire.Results:Among these 15 patients(seven type ⅢB and eight type Ⅳ),there were ten boys and five girls with median age of 4.2 years(range:2.0–7.0 years).There were seven right,three left,and five bilateral thumbs for whom only the right thumb received surgery.There were 14 metatarsal flaps survived(14/15).With an average follow-up of 19.2 months,the reconstructed thumbs had acceptable functional and aesthetic outcomes and the donor foot presented in decent appearance without signs of impaired function.All 15 children have improved the Kapandji score(from 0 to an average of 6.7),pinch force(from 0 to an average of 1.5 kg),with ability of grip and pen holding.X-ray indicated continuous bone growth.Patients and parents had good acceptance of the new thumb.Conclusions:Reconstruction of an unstable hypoplastic thumb(Manske type ⅢB and Ⅳ)with use of a vascularized metatarsal is an effective strategy.It offers an alternative solution for parents insisting on saving the thumb.

Biomechanical Functions of the Canine Metacarpal and Metatarsal Pads during Locomotion:A Comparative Analysis

It is generally known that forelimbs and hindlimbs play different roles during locomotion,but the possible differences in the biomechanical functions of the metacarpal pad and metatarsal pad remain unknown.This study combined kinematic and pressure data from dogs to investigate the key roles of the metacarpal and metatarsal pads.The peak vertical ground reaction force of the metacarpal pad was found to be larger than that of the metatarsal pad,whereas the peak vertical ground reaction force of the fore toes was equal to that of hind toes,and the vertical defonnations of the metacarpal and metatarsal pads were almost equal;moreover,the obtained stiffness of the metacarpal pad was several times greater than that of metatarsal pad based on in vivo measurement data.The results showed that the metacarpal pad demonstrated the biomechanical characteristics of cushion and support;however,the support characteristics of the metatarsal pad were weak.Furthermore,magnetic resonance imaging was performed to gather evidence to interpret the various roles played by the metacarpal pad and the metatarsal pad.It was found that the morphology and volumes of internal adipose tissues were closely related to the functions played by the metapodial pad during movement.

Brachymetatarsia with accessory navicular in right foot： A rare coincidental finding

A 33 years old female patient presented with posttraumatic pain in the right ibot tor which radiographs of the right foot was advised. No fracture was detected on radiographs and patient was managed conservatively on medications and posterior splint immobilization. We found coincidentally a short fourth metatarsal and an accessory navicular bone in the right foot radiographs. After 3 weeks of immobilization, she underwent mobilization of the right foot, weight bearing and intensive physio- therapy for 6 weeks. After two months of injury she was still complaining of pain on the plantar aspect of right foot which was diagnosed as metatarsalgia and operated on by excision of the neuroma present in the 3rd web space of the right foot. After surgery she was completely relieved of pain and could do activities well related to the right foot.