重塑第一跖趾关节骨形态治疗(足母)外翻

目的评价Keller手术治疗外翻术中重塑第1跖趾关节骨形态的生理活动解剖结构变化。方法2004年4月～2006年11月,采用Keller手术术中重塑第1跖趾关节面骨形态方法治疗外翻11例22足。男3例,女8例;年龄51～73岁。跖趾关节面分型采用Piggot法:型偏斜型17足,型半脱位型5足。外翻角(hallux valgus angle,HVA)24～49°,平均37°;第1跖间角(intermetatarsal angle,IMA)角9.0～13.5°,平均11.5°。结果术后11例22足均获随访6～30个月,平均14个月。参照朱丽华等评定标准:优18足,良3足,差1足。X线片示,14足形成第1跖趾杵臼样假关节,8足假关节面部分咬合。术后HVA7～16°,平均11°;IMA9.0～13.5°,平均11.5°。术后跖趾关节面Piggot法分型:型适合型12足,型偏斜型10足。结论Keller手术中重塑第1跖趾关节骨形态对外翻术后HAV的纠正及症状改善,及关节稳定性有良好改善,减少了术后肌力不足的发生。     

改良Mitchell手术治疗(足母)外翻

[目的]观察改良Mitchell手术治疗外翻的疗效.[方法]自2000年4月～2003年10月对18例28足(足母)外翻患者行改良Mitchell手术.术前摄负重X线片,测量(足母)外翻角(hallux valgus angle,HVA)平均为30.5°,第1、2跖骨间角(Intermetatarso-phalangeal angle,IMA)13.5°.本术式与传统Mitchell手术不同的是在第1跖骨远端只行一次横行截骨,不留外侧棘,根据IMA的大小决定截骨远端外移的多少,再向跖侧移位2～3 mm,用可吸收螺钉固定.[结果]随访28足,随访时间为10～32个月,优24足,良3足,差1足,优良率为92.9%.术后负重X线片测量HVA 15.5°,平均改善15°;IMA平均为8.5°,平均改善5°.[结论]改良Mitchell手术可矫正第1跖骨内翻,更重要的在于矫正畸形而不破坏(足母)趾的生物力学作用,第1跖骨头的跖侧移位,重建了足横弓,恢复了(足母)趾的负重功能.     

改良Austin手术治疗(足母)外翻34例62足

[目的]探讨改良Austin手术治疗外翻的手术适应证、手术方法和疗效。[方法]自1998年10月～2006年4月采用改良Austin手术治疗外翻患者34例62足,男13例22足,女21例40足;年龄32～67岁,平均43岁。术前、术后2周、随访时分别摄负重位X线片,测量外翻角(HVA)、第1、2跖骨间角(IMA)、近端关节固定角(PASA)、远端关节固定角(DASA),并观察其变化和测量角度数据进行对比分析。手术方法根据患者术前症状和测量角度个体化选择Austin手术改良式即chevron-gerbert或chevron-youngswick截骨术。[结果]全部获得随访,随访时间1～8年,平均3.6年;患者外翻角(HVA)术前为33.50°±1.02°,术后为13.6°±0.826°;第1、2跖骨间角(IMA)术前为16.0°±0.837°,术后为8.6°±1.078°;根据美国足与踝关节协会AOFAS制定的足趾功能评分标准评价。AOFAS评分术前为(44.8±5.7)分,术后为(87.6±4.2)分。优46足,良10足,可5足,差1足,优良率90.3%。[结论]改良Austin手术是治疗外翻畸形的一种操作简单、疗效可靠的手术方法。尤其更适合矫正PA-SA增大的重度外翻。对年龄较轻的轻、中度外翻患者手术应尽量不必干扰内收肌和籽骨也可达到矫形的目的。     

小切口斜行截断及楔形截骨术矫治(足母)外翻畸形

目的探讨第一跖骨头囊内楔形截骨术矫正跨外翻畸形的可行性。方法2000年9月-2005年12月，我们对蹲外翻足畸形行局部小切口，切除第一跖骨头内侧骨赘，在跖趾关节囊内完成跖骨头楔形截骨、跖骨头横向外侧移位和内侧关节囊收紧，矫正跨外翻畸形。结果每足手术时间25～30min，术中出血量5～10ml。249例随访6—24个月，平均15个月，跨外翻畸形完全矫正，优215足（86．3％），良29足（11．7％），差5足（2．0％），优良率98．0％，无并发症。结论小切口斜行截断及楔形截骨术矫治跨外翻畸形可行，创伤小，术后的外形和功能得到全面改善。     

第1跖骨基底斜行闭合截骨治疗中重度(足母)外翻畸形

[目的] 回顾性研究第1跖骨基底长斜行闭合截骨治疗足母外翻的临床效果.[方法]2007年2月～2008年11月间行第1跖骨基底长斜形截骨结合远端软组织松解内侧关节囊重叠缝合治疗<足母>外翻共21例24足,均属中重度足母外翻,第1、2跖间角均大于15°,行第1跖骨基底斜行闭合截骨螺钉内固定术.[结果]平均随访7.6个月,术前平均HVA、IM 1-2角分别为31.30°±6.68°和16.62°±2.65°,术后平均HVA、IM 1-2角分别为12.96°±7.15°和9.80°±2.43°,平均矫正HAV角19.6°、IM角8.2°,术前、术后平均有明显统计学差异(P<0.001),第1跖骨长度与第2跖骨长度比术前、术后分别为(89±6.7)%、(84±5.6)%,有明显统计学差异(P<0.05).[结论] 第1跖骨基底长斜形闭合截骨手术方法治疗中重度<足母>外翻畸形可以取得比较好的矫正结果.     

小切口微创治疗(足母)外翻

目的探讨小切口微创治疗(足母)外翻的有效方法. 方法 2002年8月～2004年6月,采用小切口微创手术和术后弹性外固定治疗(足母)外翻136例263足.其中男7例,女129例.年龄19～84岁.按Coughlin分型,轻度24例,中度63例,重度49例.263足均伴不同程度疼痛、足内弓塌陷和扁平足.经随访观察,对症状、体征及X线片测量结果进行疗效评定. 结果术后伤口均Ⅰ期愈合.本组获随访8～26个月,平均19个月.(足母)外翻畸形完全矫正, 足疼痛完全消失, 无骨不愈合及骨坏死征象,足内弓塌陷平均改善5°,跖趾关节功能及皮肤感觉基本正常;X线片示(足母)外翻角<12°、第1、2跖骨间角<9°及胫侧籽骨半脱位矫正<50% 105足,基本矫正158足.足疗效评定:优84例,良48例,中3例,差1例,优良率为97%. 结论小切口微创治疗(足母)外翻是一种损伤小、痛苦少、矫正彻底及不易复发的较理想治疗方法.     

关节镜下行(足母)外翻外侧松解背侧入路的研究

目的探讨关节镜下行躅外翻外侧松解背侧入路的可行性及方法。方法解剖研究采用10具新鲜保留踝关节的足部标本。在关节镜监视下,以钩刀松解外侧关节囊和躅内收肌斜头。观察各入路与周围神经血管、肌腱之间的关系,并统计松解范围。临床研究对5例躅外翻患者行关节镜下外侧松解加内侧软组织紧缩手术,患者均为女性,平均年龄30岁。术前躅外翻角为24^o-38^o,平均30^o,跖间角为9^o-11^o,平均10^o。结果解剖研究近侧切口与躅短伸肌腱非常接近,为0—3mm,平均1．5mm;与躅长伸肌腱相距为1—4mm,平均2．4mm。远侧切口与第一趾背动脉和趾背神经非常接近,为1～3mm,平均1、4mm,极易损伤。6例正常足中,1例松解跖籽骨韧带,1例作部分松解（70％）。在4例足母外翻足中,2例松解跖籽骨韧带,1例作了部分松解（50％）。临床研究5例患者平均随访时间9个月。最后一次随访时X线片示足母外翻角4^o-9^o,平均7^o,跖间角8^o～10^o,平均9^o。患者均恢复良好,对外形满意,未见肌腱损伤、麻木、感染、跖趾关节僵硬等并发症发生。结论背侧入路关节镜下外侧松解是可行的,其手术切口较小,镜下视野清晰,可以根据需要松解外侧结构的各个部分,由于不损伤血管,减少了跖骨头坏死的发生。     

联合Lapidus手术治疗合并第1跖楔关节不稳的老年人(足母)外翻

[目的]探讨联合Lapidus手术治疗合并第1跖楔关节不稳的老年人(足母)外翻的近期疗效.[方法]2005年11月～2009年7月,采用联合Lapidus手术治疗合并第1跖楔关节不稳的老年人(足母)外翻23例37足;年龄61～76岁,平均67.9岁,术中所有患者均行第1跖趾关节外侧软组织松解术,一些患者还行了(足母)趾近节趾骨Akin手术;第1跖楔关节不稳的诊断以Lee和Young的外观直接测量法为诊断标准,术前、术后12个月摄负重位X线片,测量(足母)外翻角(HVA),第1跖骨间角(IMA),术前、术后各组数据采用t检验进行统计学处理分析.[结果]19例31足得到随访,最短随访到术后12个月,最长的1例随访到术后31个月,平均随访时间13.7个月,31足第1跖楔关节最终都获得骨性愈合,其中6足术后延长石膏固定半个月;足底疼痛性胼胝都有不同程度的减轻或消失,(足母)外翻角较术前改善21°(P<0.05),第1、2跖骨间角较术前改善6.4°(P<0.05);根据顾湘杰等的评价标准,患者主观评价:优17足,良9足,可5足,优良率83.87%.[结论]联合Lapidus手术治疗合并第1跖楔关节不稳的老年人(足母)外翻,可以纠正前足横弓的塌陷,近期疗效可靠.     

(足母)展肌腱转位联合Scarf截骨治疗中重度(足母)外翻

[目的]介绍(足母)展肌腱转位联合Scarf截骨治疗中重度(足母)外翻的手术技术。[方法] 2017年1月～2017年09月,采用Scarf截骨联合(足母)展肌腱转位治疗中、重度(足母)外翻患者32例(45足)。倒"L"形切开关节囊,显露第一跖骨内侧骨赘、矢状沟和踇展肌。自(足母)展肌腱止点处切取约1/3～1/2宽度(足母)展肌腱,切除骨赘,充分松解外侧关节囊及(足母)收肌。第一跖骨行Scarf截骨,向外侧推移第一跖骨远端,纠正增大的IMA,修整多余骨皮质,将自体骨回植于截骨间隙,防止第一跖骨头上抬,两枚螺钉固定。维持(足母)趾于正确的生理位置,缩紧缝合关节囊,将(足母)展肌断端缝合于关节囊背侧。[结果]本组患者32例共45足,第一跖骨截骨均在8周内愈合,未出现内固定松动、骨折延迟愈合及第一跖骨头坏死等并发症。末次随访时所有患者Maryland评分和影像测量的IMA、HVA、PASA均较术前显著改善,差异有统计学意义(P0.05),尽管两时间点间第一跖趾关节活动度无显著变化(P0.05)。[结论]应用(足母)展肌腱转位联合Scarf截骨可有效矫正中重度(足母)外翻畸形,且未见手术相关并发症发生。     

小切口第一跖骨远端截骨术矫正(足母)外翻畸形

目的:探讨小切口第一跖骨远端截骨术矫正蹄外翻畸形的疗效.方法:2003年以来采用小切口第一跖骨远端截骨术治疗(足母)外翻畸形300例共542只足,不做内固定.对所有患者采用美国骨科足踝外科学会(AOFAS)(足母)趾-跖趾-趾间评分标准进行临床评估,并结合影像学诊断综合评价手术疗效.结果:AOFAS总平均分为89.4±10.2分.影像学评估,术后(足母)外翻角(HVA)为12.8°±5.8°(4°～22°),较术前34.6°±9.6°(18°～68°)改善22°±8.4°;第一二跖骨间角(IMA)为7.6°±1.8(6°～11°),较术前14.3°±3.2°(11°～21°)改善6.7°±2.4°,P＜0.05表示有显著性差异.542只患足,498只对术后疗效满意,满意率91.5%.结论:小切口第一跖骨远端截骨术矫正(足母)外翻,临床效果可靠,不需内固定,手术切口美观,值得推广.     

Dorsal bunion after clubfoot surgery: outcome of reverse Jones procedure

BACKGROUND: The dorsal bunion deformity consists of the elevation of first metatarsal head, plantar flexion contracture at the first metatarsophalangeal joint, and dorsiflexion contracture of the tarsometatarsal joint. A reverse Jones procedure with transfer of the flexor hallucis longus to the metatarsal head has been an effective method in correcting this deformity. METHODS: This is a retrospective review of 27 patients with 33 feet who had reverse Jones procedure with or without metatarsal osteotomy between 1983 and 2002. All patients had previous soft tissue releases for clubfoot deformity. Clinical reviews included muscle function test and radiographic evaluation before and after procedures. We used the American Orthopaedic Foot and Ankle Society Hallux Metatarsophalangeal-interphalangeal scale for functional outcome results. RESULTS: The average follow-up was 4.96 years. There were 21 boys and 6 girls. Average age at time of procedure was 13.7 years. With the reverse Jones procedure, there were 18 first metatarsal osteotomies and 12 split anterior tibial tendon transfers. Before surgery, decreased muscle strength in triceps surae (73%), tibialis posterior (76%), peroneus longus (67%), and extensor hallucis longus (76%) was noted. Patients (84.9%) had normal tibialis anterior and flexor hallucis longus power. In radiographic evaluations, the operation resulted in decreased elevation of the first metatarsal by measuring the metatarsal-horizontal angle. The lateral metatarsophalangeal angle improved from 23 degrees plantar flexion to 1 degree in dorsiflexion. The average global American Orthopaedic Foot and Ankle Society Hallux Metatarsophalangeal-interphalangeal score was 70 preoperatively and 92 postoperatively with improvement of subscores in pain, activity, footwear, range of motion, callus, and alignment. CONCLUSIONS: Dorsal bunion is a recognized long-term complication after clubfoot surgery. The causes of the deformity are weakness of Achilles tendon, overpowering of flexor hallucis longus, and strong anterior tibial tendon with weakness of peroneus longus. The reverse Jones procedure improved the condition in this series and provided a long-lasting and effective correction of the dorsal bunion deformity. LEVEL OF EVIDENCE: Level 4.     

Function after correction of a clawed great toe by a modified Robert Jones transfer

We carried out a cross-sectional study in 51 patients (81 feet) with a clawed hallux in association with a cavus foot after a modified Robert Jones tendon transfer. The mean follow-up was 42 months (9 to 88). In all feet, concomitant procedures had been undertaken, such as extension osteotomy of the first metatarsal and transfer of the tendon of the peroneus longus to peroneus brevis, to correct the underlying foot deformity. All patients were evaluated clinically and radiologically. The overall rate of patient satisfaction was 86%. The deformity of the hallux was corrected in 80 feet. Catching of the big toe when walking barefoot, transfer lesions and metatarsalgia, hallux flexus, hallux limitus and asymptomatic nonunion of the interphalangeal joint were the most frequent complications. Hallux limitus was more likely when elevation of the first ray occurred (p = 0.012). Additional transfer of the tendon of peroneus longus to peroneus brevis was a significant risk factor for elevation of the first metatarsal (p < 0.0001). The deforming force of extensor hallucis longus is effectively eliminated by the Jones transfer, but the mechanics of the first metatarsophalangeal joint are altered. The muscle balance and stability of the entire first ray should be taken into consideration in the management of clawed hallux.     

Die Rückversetzung der Sehne des Musculus extensor hallucis longus in der modifizierten Technik nach Robert Jones

Zusammenfassung Operationsziel Korrektur einer Klauenzehenfehlstellung der Großzehe durch Rückversetzung des Musculus extensor hallucis longus und damit Ausschaltung der pathologischen Wirkung der extrinsischen Zehenmuskulatur sowie Schaffung einer aktiven Elevationswirkung auf das Os metatarsale I durch Rückversetzung des Musculus extensor hallucis longus auf das Os metatarsale I. Indikationen Funktionelle Beschwerden durch eine Klauenzehenfehlstellung der ersten Zehe infolge einer Überaktivität oder eines Übergewichts der extrinsischen über die intrinsische Muskulatur. Voraussetzung für die Operation ist ein normaler oder fast normaler Kraftgrad des Musculus extensor hallucis longus. Die alleinige Operation nach Robert Jones ist nur bei flexibler Flexionsstellung des Os metatarsale I wirksam; bei fixierter Stellung sollte sie mit einer extendierenden Osteotomie der Basis des Os metatarsale I kombiniert werden. Kontraindikationen Fehlende Kraft des Musculus extensor hallucis longus. Operationstechnik Ansatznahes Ablösen der Sehne des Musculus extensor hallucis longus und transossäre Rückversetzung auf das Os metatarsale I. Ergebnisse 65 Patienten wurden von 06/1990 bis 07/1997 in einer modifizierten Technik nach Robert Jones operiert. 51 von ihnen (19 Frauen, 32 Männer) mit 81 Rückversetzungen der Sehne des Musculus extensor hallucis longus konnten nach durchschnittlich 42 Monaten (neun bis 88 Monate) kontrolliert werden. Nach den Bewertungskriterien von Tynan und Klenerman waren die Patienten mit dem Ergebnis 36-mal sehr zufrieden, 38-mal bedingt zufrieden und sieben mal unzufrieden. Die Zehenfehlstellung wurde bei allen Füßen beseitigt. Summary Objectives Transfer of the extensor hallucis longus tendon to the neck of the first metatarsal to correct a claw toe deformity of the great toe. This transfer counteracts the pathologic action of the extrinsic toe muscles and produced an active elevation of the first metatarsal. Indications Activity-related complaints due to a claw deformity of the great toe secondary to a hyperactivity of the extrinsic muscles or a predominance of the extrinsic over the intrinsic muscles. Prerequisite: normal or near normal power of the extensor hallucis longus. This procedure is only indicated in instances of a flexible malposition of the first metatarsal. It must be combined with an extension osteotomy of the first metatarsal for a fixed deformity. Contraindications Insufficient power of the extensor hallucis longus. State after compartment syndrome or after posttraumatic malalignment. Surgical Technique Detachment of the tendon of the extensor hallucis longus close to its insertion and transfer to the neck of the first metatarsal. Results Between June 1990 and July 1997, the modified Jones technique was used in 65 patients. In 51 patients (19 women, 32 men) with 81 transfers, a follow-up examination was done after an average of 42 months (9 to 88 months). Using the assessment criteria of Tynan and Klenerman, the patients regarded the result as excellent in 36 cases, as satisfactory in 38 and as unsatisfactory in 7. The malposition of the toe was corrected in all feet.     

Results of modified Robert Jones operation for clawed hallux.

The results of modified Robert Jones operation for clawed hallux carried out on 36 feet were reviewed by clinical and radiological investigations. Twenty-nine feet (80 per cent) achieved good results while 3 feet (8-5 per cent) obtained fair results and in 4 feet (11 per cent) the results were poor. Better results were obtained in the poliomyelitis cases than in the other groups. Correction of deformity appears to be achieved by the transferred extensor hallucis longus elevating the first metatarsal neck and by the flexor hallucis longus flexing the rigid toe obtained by interphalangeal arthrodesis. Tendon regeneration which is associated with recurrent clawing remains a problem. Internal fixation should be used for the interphalangeal arthrodesis.     

Calcaneus deformity in spina bifida: results of anterolateral release.

We reviewed a group of patients with 76 feet treated operatively for a calcaneus or a calcaneovalgus deformity by a simple anterior (tenotomy of the tibialis anterior, extensor digitorum communis and extensor hallucis longus), or anterolateral (associated tenotomy of the peroneus longus and brevis) release. The results were assessed considering bracing and shoewear problems or presence of pressure sores. The mean follow-up time was 4.66 years, and a good result was achieved in 62 feet (81.5%), with 14 poor results in 18.5%. Among the 14 poor results, six deformities have recurred and were operatively treated by the same technique and eight feet developed an equinus deformity requiring a heel cord release.     

Die „Ludloff“-Osteotomie zur Korrektur der Hallux-valgus-Deformität

OBJECTIVE: Correction of a symptomatic hallux valgus deformity. INDICATIONS: A hallux valgus deformity in which the intermetatarsal angle I-II exceeds 15 degrees and the shaft of the first metatarsal is broad enough to allow a rotational osteotomy. CONTRAINDICATIONS: Hypermobility of the first ray. Severe osteoporosis. Degenerative arthritis of the first metatarsophalangeal joint. SURGICAL TECHNIQUE: Longitudinal incision over the first intermetatarsal space. Division of the metatarsosesamoid ligament together with the tendon of the adductor hallucis muscle. Opening of the lateral articular capsule of the first metatarsophalangeal joint allowing a tension-free realignment of the head of the first metatarsal with the sesamoids. Medial longitudinal incision along the first metatarsal starting over the medial cuneiform bone and ending at the proximal phalanx of the great toe. Oblique osteotomy of the proximal two thirds of the first metatarsal in a proximal dorsal to distal plantar direction and lateral rotation of the distal fragment around a proximally placed 3-mm AO screw. Additional fixation with one BOLD screw. Trimming of the protruding bone and of bunion. Medial metatarsophalangeal capsulorraphy. RESULTS: Between September 1998 and October 1999, 76 feet underwent a Ludloff osteotomy. Patients were followed up clinically and radiographically for 36 months (24-56 months). The mean hallux valgus angle was reduced from 37 degrees to 14 degrees and the mean intermetatarsal angle I-II from 18 degrees to 9 degrees. Using a four-point scale 81% of the patients were satisfied or very satisfied with the result of the operation. 95% of them felt no or very mild pain.     

Anatomy of the Dorsomedial Cutaneous Nerve to Hallux and Surgical Implications According to the Severity of Hallux Valgus Deformity: A Cadaveric Study

The dorsomedial cutaneous nerve to hallux provides sensation to the dorsomedial aspect of the first metatarsophalangeal joint and hallux. Postoperative damage to the dorsomedial cutaneous nerve to hallux have been reported with the dorsomedial approach and symptoms can be very debilitating. The present study aims to understand how the distance between this nerve and the extensor hallucis longus tendon are affected by the severity of the hallux valgus deformity, at the level of the first metatarsophalangeal joint. We performed a cadaveric study using 35 cadaveric lower extremities (N = 35). Each specimen was classified according to the hallux valgus severity through a 30 kg partial weight-bearing antero-posterior radiograph. Before dissection, the lower extremities’ greater saphenous vein was injected with black latex to simplify the distinction between anatomical structures. We concluded that as the hallux valgus angle and the first intermetatarsal angle increase, the distance between the dorsomedial cutaneous nerve to hallux and the extensor hallucis longus tendon also increases, ranging from 12 mm in normal feet to 19 mm in severely deformed feet. Hallux valgus is a three-dimensional deformity that changes traditional surgical landmarks. To avoid harming this nerve, we established a danger zone ranging from 12 mm to 19 mm medial from the extensor hallucis longus tendon, at the level of the first metatarsophalangeal joint. The mid-medial approach to MTP should be preferred as it is out of the danger zone.     

Dynamic inversion of the forefoot and dorsiflexion of the big toe treated by transfer of extensor hallucis longus

Dynamic hyperextension of the big toe and supination of the forefoot may occur in the swing phase of walking in children with various neurological disorders. Symptoms arising from this have been successfully corrected in 13 feet of 11 children by transfer of extensor hallucis longus to the insertion of peroneus brevis.     

Failure after soft-tissue release with tendon transfer for flexible iatrogenic hallux varus: a systematic review

Hallux valgus is a common forefoot pathology often requiring surgical intervention for symptomatic relief. One complication of hallux valgus correction is flexible hallux varus. Iatrogenic flexible hallux varus often requires surgical repair; however, the most advantageous surgical procedure for repair of iatrogenic flexible hallux varus and their sustainability remains unclear. Therefore, we performed a systematic review to determine the sustainability of soft-tissue release with tendon transfer for the correction of iatrogenic flexible hallux varus. Studies were eligible for inclusion only if they involved failure of soft-tissue release with tendon transfer for flexible iatrogenic hallux varus. Eight studies met our inclusion criteria, seven of which were evidence-based medicine level IV studies and one was level V. A total of 52 patients, all female, involving 68 feet, were included. All studies included soft-tissue release of the first metatarsal-phalangeal joint capsule and 1 of the following procedures: Johnson transfer of the extensor hallucis longus tendon with arthrodesis of the hallux interphalangeal joint (41 feet); Hawkins transfer of the abductor hallucis tendon (9 feet); reverse Hawkins transfer (7 feet); Valtin transfer of the first dorsal interosseous tendon (7 feet); and Myerson transfer of the extensor hallucis brevis tendon (4 feet). The weighted mean age of the patients was 50.4 years, and the weighted mean follow-up was 30.2 months. A total of 11 complications (16.2%) occurred. Of note, only 3 cases (4.4%) of recurrent hallux varus deformity developed, all of which occurred after Johnson transfer of the extensor hallucis longus tendon, with arthrodesis of the hallux interphalangeal joint. Our results support that sustainable correction of iatrogenic flexible hallux varus can be achieved with soft-tissue release of the first metatarsal-phalangeal joint combined with a variety of tendon transfer procedures. However, given the limited data available, potential areas for additional prospective investigation remain.     

A new method of functional tendon transfer for the dysfunction of extensor hallucis longus

A surgical technique of functional tendon transfer for the treatment of extensor hallucis longus (EHL) rupture is described. By using the extensor digitorum longus tendon of the second toe, the patient regains active dorsiflexion of the big toe and the deformity of the toe is corrected.