A technique to improve foot appearance after trimmed toe or hallux harvesting

We describe a technique to improve the appearance of the donor site after hallux harvesting. The surgery has been used in 6 consecutive patients having a trimmed-toe-type transfer. Instead of the classic stump closure advised by Wei, the following steps were performed on the donor site: (1) removal en bloc of the second metatarsal and transposition of the second toe on top of the proximal phalanx of the hallux, (2) interposition of a tibial (medial) glabrous flap from the tibial aspect of the hallux onto the tibial side of the second toe to increase its size, and (3) eponichial flap to increase the nail show on the second toe. Fixation of the toe was achieved with K-wires and cerclage wire. Crossed K-wires stabilized the first to the third metatarsals for 4 to 6 weeks. Ambulation with a stiff sole was allowed a few days after surgery. The main advantage of this technique is the improved donor site appearance. As a bonus, the amount of skin that can be harvested with the trimmed toe is slightly increased. The main drawback is that the number of toes is reduced to 4.     

甲沟解剖重建术治疗 趾嵌甲症的临床研究

目的：探讨甲皱襞和甲床楔形切除甲沟解剖重建治疗　趾嵌甲症的疗效及　趾嵌甲症与甲沟解剖的关系。方法：2001年4月至2007年12月，采用部分甲皱襞和甲床楔形切除，缝合甲皱襞与甲床重建甲沟的方法治疗　趾嵌甲症126例。同时测量40例甲沟深度。结果：术后伤口甲级愈合占87.3%（110例），乙级愈合占9.5%（12例），丙级愈合占3.2%（4例），趾甲生长良好，解除了　趾疼痛，甲沟炎无复发。嵌甲症　趾甲沟深度：男性(5.73±0.49 )mm，女性(4.99±0.63)mm。甲沟深度男女差异有统计学意义（P<0.01）。结论：　趾甲沟的深度与嵌甲症的发生有密切关系，甲沟解剖重建术是治疗　趾嵌甲症的有效方法。     

A Comparison of the Crescentic and Mau Osteotomies for Correction of Hallux Valgus

We retrospectively compared crescentic and Mau osteotomies used to treat a total of 39 cases of hallux abductovalgus. Follow-up was possible in 10 of the crescentic cases (mean 228 days) and 24 of the Mau cases (mean 245 days). Preoperatively, the mean first intermetatarsal and hallux abductus angles were 17.5 degrees and 35.4 degrees , respectively, in the crescentic group; and 16.6 degrees and 31.3 degrees , respectively, in the Mau group. Postoperatively, these same radiographic angles were 11.7 degrees and 18.9 degrees , respectively, in the crescentic group; and 9.8 degrees and 12.9 degrees , respectively, in the Mau group, and these differences were not statistically significant. Complications included metatarsus primus elevatus (crescentic 7, Mau 2), lesser metatarsal transfer lesion (crescentic 1, Mau 0), nonunion (crescentic 5, Mau 1), revisional surgery (crescentic 0, Mau 1), and transarticular hardware (crescentic 3, Mau 0). The incidence of complications in the crescentic group was 60%, whereas that in the Mau group was 37.5%; this difference was not statistically significant (P = .276). Analysis by the type of complication revealed statistically significant differences between the crescentic and Mau groups in regard to metatarsus primus elevatus (70% versus 8.3%, P = .001), transarticular hardware (30% versus 0%, P = .02), and nonunion (50% versus 4.2%, P = .006). In conclusion, crescentic and Mau osteotomies satisfactorily corrected the first intermetatarsal and hallux abductus angles in patients that fit our inclusion criteria, although the incidence of postoperative metatarsus primus elevatus, delayed union, and transarticular hardware placement, was higher in the crescentic osteotomy group. Level of Clinical Evidence: 2.     

Surgical treatment options in hallux rigidus

Relief of pain and potential improvement in range of motion are the goals in the surgical treatment of hallux rigidus.For less advanced disease, cheilectomy, with or without the addition of a proximal phalangeal osteotomy, is the mainstay of treatment. An arthrodesis or resection arthroplasty of the first metatarsophalangeal joint is an appropriate consideration in patients with advanced disease. Capsular interposition arthroplasty is an attractive alternative to an arthrodesis, particularly in younger, active individuals.     

Interphalangeal sesamoid bones of the great toe: an anatomic variant demanding careful scrutiny of radiographs

We describe a patient who was found to have two sesamoid bones at the interphalangeal joint of the right great toe after radiographs for dislocation of the joint. Recognition of the sesamoids required careful scrutiny of the films. Interphalangeal sesamoids may cause painful callosities plantar to the joint or may become incarcerated in a dislocated joint. Our patient made a good recovery. The presence of sesamoid bones on the medial and lateral sides of the joint was unusual.     

Hallux valgus: Indications and technique of proximal chevron osteotomy combined with distal soft tissue release

Acquired hallux valgus deformity arises from progressively changing relationships of the bones in the first ray of the foot. Ligamentous laxity develops at the medial capsule of the first metatarsophalangeal (MTP) joint and the lateral capsule of the first metatarsocuneiform joint. The adductor hallucis tendons and the transverse metatarsal ligament tether the sesamoid bones and the base of the proximal phalanx of the great toe while the intermetatarsal angle (IMA) increases. These deforming forces are addressed by the distal soft tissue release in the first web space and the soft tissue plication at the medial aspect of the first MTP joint. The addition of the proximal chevron osteotomy of the first metatarsal shaft permits complete correction of the increased hallux valgus and intermetatarsal angles. The improved stability of the proximal chevron osteotomy over other types of osteotomies theoretically reduces the incidence of delayed transfer metatarsalgia. This article will show the anatomy of acquired hallux valgus, as well as the theories and techniques behind the authors' method of surgical correction.     

小切口截骨术矫正(足母)外翻

目的探讨小切口截骨术矫正外翻的治疗效果。方法对42例外翻患者共72只足实行小切口截骨术矫正治疗,手术后、术后1年X线检查并结合临床分析评价手术治疗效果。结果根据临床实际和X线检查结果并参考有关文献评定标准分析,小切口截骨术矫正外翻术后跟踪观察1年疗效:优60足(83.3%),良10足(13.9%),差2足(2.8%)。结论小切口截骨术矫正外翻,临床效果可信、稳定。     

The modified Hohmann osteotomy: An alternative joint salvage procedure for hallux rigidus

The purpose of this study was to evaluate the effectiveness of the modified Hohmann osteotomy for treatment of hallux rigidus. By allowing plantarflexion of the first metatarsal head, this osteotomy was theorized to protect gliding motion and to decompress the joint. Twenty-two patients (25 procedures) were assessed preoperatively and postoperatively for the first metatarsal plantarflexory osteotomy. The average postoperative follow-up was 12 months, with a range of 6 to 60 months. Postoperative subjective patient questionnaires showed the following: 96% reported excellent subjective ratings with no fair or poor ratings, 80% reported a return to normal activity within 1 to 2 months, no patients reported any significant limitations in their activity or reoccurrence of pain, and no patients reported any need for a revision surgery other than hardware removal. A goniometer was used to measure preoperative and postoperative dorsiflexion and plantarflexion at the first metatarsophalangeal joint. The patient first metatarsophalangeal joint dorsiflexion increased from a mean 17.76 degrees preoperatively to a mean 58.92 degrees postoperatively. The ability to hold a piece of paper under the hallux for purchase power was also evaluated. Only 2 of 25 procedures lacked the purchase power to effectively hold a piece of paper with the hallux. Thus, the modified Hohmann osteotomy provides an excellent alternative joint-salvaging procedure for moderate to severe hallux rigidus.     

Hallux rigidus: a review

Hallux rigidus is a degenerative joint condition affecting the first metatarso-phalangeal joint and is characterized by a painful and stiff joint. It is the most common form of arthritis in the foot and the pathophysiology is believed to be multi-factorial. In this review we discuss the clinical evaluation of the condition and explore both non-surgical and surgical treatment options. Our preferred treatment algorithm for different presentations of the condition is also included in the paper.