Capsular Interposition for the Keller Bunionectomy with the Use of Soft-Tissue Anchors

2005 ◽  
Vol 95 (2) ◽  
pp. 180-182 ◽  
Author(s):  
Keith D. Cook
Keyword(s):  
Soft Tissue ◽  
Metatarsophalangeal Joint ◽  
Joint Space ◽  
Joint Capsule ◽  
Past Century ◽  
First Metatarsophalangeal Joint ◽  
The Past ◽  
Joint Pathology ◽  
Capsular Flap

The Keller procedure has been used during the past century for the treatment of first metatarsophalangeal joint pathology. Many modifications to the procedure have been made, including interposition of the joint capsule into the first metatarsophalangeal joint space. Capsular interposition is often the most difficult step in performing the Keller bunionectomy. This article describes a new, simplified technique for capsular interposition with the use of a dorsal capsular flap and soft-tissue anchors. (J Am Podiatr Med Assoc 95(2): 180–182, 2005)

Modified Austin Procedure for Correction of Hallux Valgus

1997 ◽  
Vol 18 (3) ◽  
pp. 119-127 ◽  
Author(s):  
Hans-Jörg Trnka ◽  
Alexander Zembsch ◽  
Hermann Wiesauer ◽  
Marc Hungerford ◽  
Martin Salzer ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Hallux Valgus ◽  
Metatarsophalangeal Joint ◽  
Metatarsal Head ◽  
Hallux Valgus Angle ◽  
First Metatarsophalangeal Joint ◽  
Intermetatarsal Angle ◽  
Soft Tissue Procedure ◽  
Valgus Angle

The Austin osteotomy is a widely accepted method for correction of mild and moderate hallux valgus. In view of publications by Kitaoka et al. in 1991 and by Mann and colleagues, a more radical lateral soft tissue procedure was added to the originally described procedure. From September 1992 to January 1994, 85 patients underwent an Austin osteotomy combined with a lateral soft tissue procedure to correct their hallux valgus deformities. Seventy-nine patients (94 feet) were available for follow-up. The average patient age at the time of the operation was 47.1 years, and the average follow-up was 16.2 months. The average preoperative intermetatarsal angle was 13.9°, and the average hallux valgus angle was 29.7°. After surgery, the feet were corrected to an average intermetatarsal angle of 5.8° and an average hallux valgus angle of 11.9°. Sesamoid position was corrected from 2.1 before surgery to 0.5 after surgery. The results were also graded according to the Hallux Metatarsophalangeal Interphalangeal Score, and the functional and cosmetic outcomes were graded by the patient. Dissection of the plantar transverse ligament and release of the lateral capsule repositioned the tibial sesamoid and restored the biomechanics around the first metatarsophalangeal joint. There was no increased incidence of avascular necrosis of the first metatarsal head compared with the original technique.

Reverse Distally Based Abductor Hallucis Muscle Flap for Soft Tissue Coverage of the First Metatarsophalangeal Joint Wounds

2017 ◽  
Vol 16 (3) ◽  
pp. 208-211 ◽  
Author(s):  
Edgardo R. Rodriguez-Collazo ◽  
Ryan J. Pereira ◽  
Grace C. Craig
Keyword(s):  
Soft Tissue ◽  
Structural Integrity ◽  
Wound Care ◽  
Muscle Flap ◽  
Metatarsophalangeal Joint ◽  
Soft Tissue Coverage ◽  
Abductor Hallucis ◽  
First Metatarsophalangeal Joint ◽  
Secondary Intention ◽  
Abductor Hallucis Muscle

Loss of soft tissue coverage distally around the foot poses threats of amputation of the exposed boney structures. An amputation of a portion of the foot leads to loss of the biomechanical structural integrity of the foot. This promulgates an imbalance with its inherent risks of developing new ulcers. This in turn potentiates the limb loss cycle. The reverse abductor hallucis muscle flap is ideally suited for small to moderate-sized defects in the vicinity of the first metatarsophalangeal joint based on its arc of rotation. In this article, we present cases of 5 patients who failed local wound care and healing by secondary intention for at least 6 months duration. The patients were treated successfully using reverse abductor hallucis muscle flap.

Negative-Pressure Wound Therapy and External Fixation for Infection and Hematoma After Hallux Abducto Valgus Surgery

2007 ◽  
Vol 97 (5) ◽  
pp. 410-414 ◽  
Author(s):  
Edward Ferdinando ◽  
Laura Guerin ◽  
Aluko O. Jervis ◽  
Henrietta Obidigbo
Keyword(s):  
Soft Tissue ◽  
External Fixation ◽  
Negative Pressure ◽  
Negative Pressure Wound Therapy ◽  
Early Recognition ◽  
Metatarsophalangeal Joint ◽  
Postoperative Phase ◽  
Soft Tissue Coverage ◽  
Wound Therapy ◽  
First Metatarsophalangeal Joint

Hematoma refers to the collection or extravasation of blood, usually clotted, in a closed tissue space. It is caused by leakage from local vessels damaged by blunt trauma, local injury, or surgical dissection. In the postoperative phase, a hematoma often results in edema, pain, wound dehiscence, infection, and scarring of the surgical wound. We describe a 44-year-old woman who developed severe complications, including hematoma, abscess, failure of internal fixation, and loss of soft-tissue structures, after hallux abducto valgus surgery. Hospitalization was required for infection control, soft-tissue coverage through negative-pressure wound therapy, and first metatarsophalangeal joint stabilization through external fixation. Early recognition of the signs of infection and hematoma can help decrease the incidence of postoperative complications. (J Am Podiatr Med Assoc 97(5): 410–414, 2007)

scholarly journals Allograft Tendon Interposition Arthroplasty of the Hallux Metatarsophalangeal Joint: A Technique Guide and Literature Review

2018 ◽  
Vol 40 (1) ◽  
pp. 113-119 ◽  
Author(s):  
Troy S. Watson ◽  
Jordan Panicco ◽  
Amit Parekh
Keyword(s):  
Soft Tissue ◽  
Metatarsophalangeal Joint ◽  
Joint Space ◽  
Hallux Rigidus ◽  
Senior Author ◽  
Bone Tunnel ◽  
Interposition Arthroplasty ◽  
Level Of Evidence ◽  
Tissue Handling ◽  
Tendon Interposition

The “anchovy” interpositional arthroplasty technique can be used as a salvage option for failed hallux rigidus procedures. The operative technique utilized by the senior author is described. Careful soft-tissue handling, meticulous joint space and graft preparation, and interposition graft stabilization using a bone tunnel and suture anchors are unique aspects of this technique, which in the authors’ experience have contributed to improved outcomes. Current literature regarding indications and outcomes is limited and controversial. The proposed benefits of soft-tissue interposition arthroplasty of the hallux metatarsophalangeal joint for patients with prior failed implant arthroplasty are improved pain scores and preservation of range of motion. Level of Evidence: Level V, technique guide.

Gait style as an etiology to chronic postural pain. Part II. Postural compensatory process

1993 ◽  
Vol 83 (11) ◽  
pp. 615-624 ◽  
Author(s):  
HJ Dananberg
Keyword(s):  
Kinetic Energy ◽  
Sagittal Plane ◽  
Center Of Mass ◽  
Metatarsophalangeal Joint ◽  
Specific Pattern ◽  
The Body ◽  
First Metatarsophalangeal Joint ◽  
The Past ◽  
Compensatory Process ◽  
Methods Of Treatment

The body is designed to pull the center of mass over a single pivotal site formed by dorsiflexion of the first metatarsophalangeal joint. If this response dorsiflexion motion is blocked by functional hallux limitus, then the kinetic energy, which is created for this motion, must somehow be dissipated. The process by which this dissipation occurs creates a specific pattern of compensations which, in the past, has been seen as primary motions unrelated to sagittal plane blockade. These compensatory motions are described along with a brief section concerning the methods of treatment.

scholarly journals Interphanlangeal and First Metatarsophalangeal Joint Fusion for Osteomyelitis and Septic Arthritis in Patients with Forefoot Diabetic Foot Ulcers

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0042
Author(s):  
Martin K. Ulrich ◽  
Lukas D Iselin
Keyword(s):  
Soft Tissue ◽  
Septic Arthritis ◽  
Acute Phase ◽  
Diabetic Foot ◽  
Treatment Protocol ◽  
Metatarsophalangeal Joint ◽  
Foot Ulcers ◽  
Safe Procedure ◽  
Diabetic Foot Ulcers ◽  
First Metatarsophalangeal Joint

Category: Diabetes, infection Introduction/Purpose: In cases of Diabetic Foot ulcers over joints with assocuated septic arthritis or osteomylitis, the erradication of the infection can be difficult to achieve. In order to avoid amputations which are often associated with reduced quality of life, we try to be as conservative as possible in order to save as many big toes as possible. The backbone of our noval treatment protocol involve performing a thorough soft tissue and bony debridement, stabilizing the infected bones or joint by fusing them in the acute phase, and closing the skin over the infected ulcer. We present our experience of this concept. Methods: Retrospective study between the years 2012-2016, in a single centre, treating diabetic foot patients. 29 patients, 31 feet, were identified with IPj or 1st MTPJ fusion for Infection. All patients had a combination of bone and soft tissue infections. All patients had a preoperative radiograph, 22patients had a pre-operative MRI scan to define the extent of the bony and soft-tissue infection. In all cases the involved joint was fused in the acute phase using screws, kw’s, plates, combination of the above fusion techniques. In all cases the skin was closed above the infected ulcer. Results: Closed ulcers of the fitst ray after fusing the infected joint were achieved in 26 patients (84%) by 12 months after surgery. The radiographic fusion rate was 55% by one year after surgery while 77% of the cases were clinically stable by 1 year after surgery. 5 patients (16%) endend up with an amputation. In 4 of them the base of the proximal phalangx could be left to ensure the biomechanical properties as good as possible. 1 patient needed a BKA. In 26 patients, pathogens could be identified; in 77%, polymicrobial flora were found. Conclusion: Arthrodesis of IPJ- or 1st MTPJ in diabetic foot patients presents a successful way of treatmentin order to achieve a stable situation which allow healing of bony and soft-tissue problems. Fusing an infected joint is a safe procedure that allows maintaining functional capabilities.

A Novel Technique for Soft-Tissue Defect Repair After Traumatic Rupture of the Extensor Hallucis Longus Tendon

2021 ◽  
Vol 111 (3) ◽  
Author(s):  
Ellianne Nasser ◽  
William Clark ◽  
Michael Gibboney
Keyword(s):  
Tendon Rupture ◽  
Metatarsophalangeal Joint ◽  
Soft Tissue Defect ◽  
Joint Capsule ◽  
Traumatic Rupture ◽  
First Metatarsophalangeal Joint ◽  
Novel Approach ◽  
Extensor Hallucis Longus ◽  
Physiologic Function ◽  
Capsular Defect

Background Surgical repair of extensor hallucis longus (EHL) tendon rupture with a concomitant capsular defect has not been reported in the literature. This case presents a novel approach to EHL tendon rupture repair along with repair of a first metatarsophalangeal joint capsule defect. Methods A case study is presented of a 61-year-old man with a traumatic EHL tendon rupture and capsular defect treated with an EHL tendon turndown flap and tenodesis to the extensor hallucis brevis and capsularis tendons with autograft flap reconstruction of the first metatarsophalangeal joint capsule. Discussion A 61-year-old man presented with an acute traumatic EHL tendon rupture and first metatarsophalangeal joint capsule compromise after a chainsaw injury. He subsequently lost dorsiflexion of his hallux, and magnetic resonance imaging confirmed a 2.2-cm gap in the EHL tendon. He was treated with an EHL tendon turndown flap and tenodesis to the extensor hallucis brevis and capsularis tendons to reestablish dorsiflexion to the hallux. The injury was noted to infiltrate the first metatarsophalangeal joint capsule and was treated with an autograft of the first metatarsophalangeal joint capsule for a capsular defect. At 1-year follow-up the patient has regained dorsiflexion of the hallux and is back to activities such as snow skiing without pain. Conclusions Ruptures of the EHL tendon with first metatarsophalangeal joint capsule defects have not been reported in the literature. Herein, a novel approach was used to reestablish physiologic function to the EHL tendon and provide sufficient coverage of the first metatarsophalangeal joint.

Turf Toe: Soft Tissue and Osteocartilaginous Injury to the First Metatarsophalangeal Joint

2010 ◽  
Vol 38 (1) ◽  
pp. 91-100 ◽  
Author(s):  
Michael J. Coughlin ◽  
Travis J. Kemp ◽  
Christopher B. Hirose
Keyword(s):  
Soft Tissue ◽  
Metatarsophalangeal Joint ◽  
First Metatarsophalangeal Joint ◽  
Turf Toe

scholarly journals Effect of Displacement Degree of Distal Chevron Osteotomy on Metatarsal Stress: A Finite Element Method

Biology ◽  
2022 ◽  
Vol 11 (1) ◽  
pp. 127
Author(s):  
Qiaolin Zhang ◽  
Yan Zhang ◽  
Jialu Huang ◽  
Ee Chon Teo ◽  
Yaodong Gu
Keyword(s):  
Finite Element ◽  
Soft Tissue ◽  
Hallux Valgus ◽  
Metatarsophalangeal Joint ◽  
Plantar Fascia ◽  
First Metatarsophalangeal Joint ◽  
Intermetatarsal Angle ◽  
First Metatarsal ◽  
Chevron Osteotomy ◽  
Valgus Angle

Background: The stress of foot bone can effectively evaluate the functional damage caused by foot deformity and the results of operation. In this study, the finite element method was used to investigate the degree of displacement of distal chevron osteotomy on metatarsal stress and metatarsophalangeal joint load; Methods: Four finite element models of displacement were established by using the CT images of a patient with moderate hallux valgus (hallux valgus angle and intermetatarsal angle were 26.74° and 14.09°, respectively), and the validity of the model was verified. Each finite element model consisted of bones and various cartilage structures, ligaments, and plantar fascia, as well as encapsulated soft tissue. Except for soft tissue, the material properties of other parts were isotropic linear elastic material, and the encapsulated soft tissue was set as nonlinear hyperelastic material. The mesh was tetrahedral mesh. Link elements were used in ligament and plantar fascia. A ground reaction force with a half-body weight was applied at the bottom of the floor to simulate the ground reaction when standing. The upper surfaces of the encapsulated soft tissue, distal tibia, and distal fibula were fixed. The stress distribution of metatarsals and the stress of cartilage of the first metatarsophalangeal joint were compared and analyzed; Results: Compared with the hallux valgus without osteotomy, the stress of the first metatarsals and second metatarsals of 2–4 mm decreased, and the stress of the interarticular cartilage of the first metatarsophalangeal joint with 4 mm was reduced. In the case of 6 mm, the stress value between the first metatarsal and the first metatarsophalangeal joint increased, and 4 mm was the most suitable distance; Conclusions: Compared with the hallux valgus without osteotomy, the stress of the first metatarsals and second metatarsals of 2–4 mm decreased, and the stress of the interarticular cartilage of the first metatarsophalangeal joint with 4 mm was reduced. In the case of 6 mm, the stress value between the first metatarsal and the first metatarsophalangeal joint increased, and 4 mm was the most suitable distance. For the degree of displacement of the distal chevron osteotomy, the postoperative stability and the stress distribution of metatarsal bone should be considered. Factors such as hallux valgus angle, intermetatarsal angle, patient’s age, body weight, and metatarsal width should be considered comprehensively. The factors affecting osteotomy need to be further explored. The degree of displacement of osteotomy can be evaluated by FE method before the operation, and the most suitable distance can be obtained.

scholarly journals Hallux valgus

2011 ◽  
Vol 58 (3) ◽  
pp. 107-111 ◽  
Author(s):  
Zoran Bascarevic ◽  
Zoran Vukasinovic ◽  
Violeta Bascarevic ◽  
Vladan Stevanovic ◽  
Dusko Spasovski ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Disease Prevention ◽  
Hallux Valgus ◽  
Operative Treatment ◽  
Joint Angle ◽  
Metatarsophalangeal Joint ◽  
Resection Arthroplasty ◽  
Operative Procedures ◽  
Lateral Deviation ◽  
First Metatarsophalangeal Joint

Hallux valgus is a complex deformity of the forefoot. Beside the lateral deviation of the first metatarsophalangeal joint angle exceeding 15-20 degrees and intermetatarsalvarus exceeding 8-9 degrees, it is also characterized by extensive changes of the soft tissue arch, sesamoid mechanism and metatarsocuneiform joint. It occurs almost exclusively in humans wearing shoes. Although in some measure it can be treated non-operatively, by corrective separators and inserts, operative treatment is predominant. There are numerous operative procedures aimed at the correction of the deformity and inducing normal biomechanics of the forefoot. There are seven conceptually different procedures starting from simple bunionectomy, through various soft tissue procedures, metatarsal and phalangeal osteotomies, to resection arthroplasty and metatarsophalangeal arthrodesis. All have clear indications, and none of them has advantages over the others. In accordance with the etiopathogenesis of the disease prevention is easy; wearing comfortable shoes.

Sign in / Sign up

Export Citation Format

Share Document