Degree of Impact of Tailor’s Bunion on Quality of Life: A Case–Control Study

Tailor’s bunion (TB) disease should be considered one of the foot injuries that causes disability in feet as well as general health. This case–control descriptive study investigated and contrasted the effects of different TB types in a sociodemographic population using the Foot Health Status Questionnaire (FHSQ). A sample of 100 subjects with a mean age of 51.70 ± 17.78 years was recruited and requested to reply to a foot health survey. Results were self-reported. Subjects were scored. Participants with TB type III (TB3) registered lower scores for foot pain, foot function, footwear, and foot health. Physical activity and social capacity had higher scores, and vigor and general health were lower. A Kruskal–Wallis test was used for systematic differences between the FHSQ and different TB types. In all analyses, statistical significance was considered a p-value <0.05 with a 95% confidence interval. Statistically significant differences were found between all domains of the FHSQ and TB, except for the social capacity domain and vigor. The FHSQ is an important measurement tool in TB subjects, showing that factors such as sex, age, and footwear used throughout an individual’s life are significantly associated with the development of TB3 and its influence on foot pain and foot health.

Percutaneous Oblique Distal Osteotomy of the Fifth Metatarsal for Bunionette Correction: A Prospective Cohort Study

Category: Lesser Toes; Midfoot/Forefoot Introduction/Purpose: Bunionette is a very common foot disorder, and several kinds of corrective surgery have been described. With the popularization of minimally invasive surgeries, the forefoot region became a suitable area for this kind of technique. The aim of this study was to evaluate the results of oblique distal osteotomy of the fifth metatarsal adapted for the percutaneous approach. Methods: We prospectively evaluated 31 consecutive tailor’s bunion patients who underwent surgical correction after failure of conservative treatment between 2016 and 2019, totaling 42 feet. Clinical outcomes such as pain (VAS), function (AOFAS), criteria of personal satisfaction, and complications were evaluated. Radiographic aspects were also included. The Shapiro and Mann- Whitney statistical tests were run in the Stats package within the R environment. Results: The average age of the patients was 69.54 years, and the average follow-up was 13.14 months. There was a decrease of 6.67 points in the VAS for pain (p<0.001) and an increase of 34.94 in AOFAS (p<0.001) after the surgical procedure. Radiographic correction was achieved at both the fifth metatarsophalangeal angle (p<0.001) and intermetatarsal angle (p<0.001), which showed decreased values. There was one case of superficial infection and two cases of nonconsolidation (asymptomatic). A large majority of patients considered the procedure outcome satisfactory. Conclusion: The percutaneous oblique distal osteotomy of the fifth metatarsal for bunionette deformity showed improvement in pain and function and a high rate of personal satisfaction with a low incidence of complications and high capacity to correct the deformity.

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.

The modified coughlin osteotomy for surgical treatment of high-grade tailor’s bunion

Category: Lesser Toes Introduction/Purpose: To explore the surgical method of using the modified coughlin osteotomy for surgical treatment of high-grade tailor’s bunion and report the clinical outcomes Methods: From March 2013 to April 2015, the modified coughlin osteotomy was used for surgical treatment of high-grade tailor’s bunion. Twenty-two patients with 31 feet high-grade tailor’s bunion were hospitalized for treament in Xuzhou Central Hospital. There were 3 male (3 feet) and 19 female (28 feet) cases, aged 26 -78 years (mean 45.3y) old. The mean course of the painful bunionette disease was 6.7 years (range, 2 to 38 y). The average 4-5 intermetatarsal angle, fifth metatarsophalangeal angle and lateral deviation of the fifth metatarsal angle were 16.3°±5.1°, 10.7°±3.5° and 5.8°±2.6°, respectively. Main outcome measures included the 4-5 intermetatarsal angle, the fifth metatarsophalangeal angle, pain and appearance. Patients were scored using the American Orthopaedic Foot & Ankle Society (AOFAS) Lesser Toe Metatarsophalangeal-Interphalangeal Scale. Results: All operations were performed with no complications. Primarily healing of the wound was achieved in all cases. All the patients were followed up for a mean time of 17.8 months (range, 6 to 30 months). The mean fracture healing time was 11.6 weeks(range, 6 to 14 weeks), X-ray photograph proved fracture healing with a good positoin.All the patients had satisfactory appearance and sensory function witout callosum and metastatic metatarsalgiaat the final follow-up. The preoperatively average 4- 5 intermetatarsal angle, fifth metatarsophalangeal angle and lateral deviation of the fifth metatarsal angle were 5.9°±1.6°, 6.1°±2.3° and 2.2°±1.2°, respectively. The mean AOFAS score was 89.0±8.4. Conclusion: The modified coughlin osteotomy is a safe and easy treatment option for the high-grade tailor’s bunion deformity and provides patient satisfaction results

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.

Experience of treatment of forefoot pain syndrome of various genesis

Aim. Defining the causes of metatarsalgia and methods of its elimination. Methods. With the use of clinical and radiologic methods the results of conventional and surgical treatment were studied in 132 patients treated at Foot surgery center of the international clinic «MEDEM» from September 2014 to September 2016 with initial diagnosis of metatarsalgia of unknown origin. Females comprised 74.2%, males - 25.8%. Results. Physical examination, Х-ray, CT- and MRI-scan, and ultrasound of soft tissues of feet were performed. In all cases, the exact cause of metatarsalgia was established: transverse platypodia - 20.4%, longitudinal platypodia - 11.3%, anterior tibialis tendinitis - 10.6%, plantar fasciitis - 9.1%, tailor’s bunion - 7.6%, peroneal tendinitis - 6.8%, Haglund’s deformity - 6.8%, achilotendinitis - 6.1%, hallucis extensor tendinitis - 6.1%, Morton’s neuroma (neurofibroma) - 5.3%, congenital long second toes - 3%, Keller’s disease II - 2.3%, Ledderhose disease - 2.3%, stress metatarsal fractures - 1.5%, Mueller-Weiss disease - 0.8%. Conservative treatment was conducted in 55.3% of cases, surgical treatment - in 44.7%. Follow-up period was 6 to 30 months. No complications were registered. Evaluation of the results was carried out with the use of visual analogue scale - the average score was 6 (73 before treatment); American Orthopaedic Foot and Ankle Society (AOFAS) scale - the average score was 97 (64 before surgery); scale of Nizhny Novgorod Research Institute of Traumatology and Orthopedics - the average score was 40 (27 before surgery). Conclusion. Metatarsalgia is a manifestation of multiple foot diseases; robust diagnosis, a combination of conventional and surgical methods of treatment, early activation and dynamic follow-up provide an accurate identification of etiology and rapid relief of pain syndrome.

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

An Overlooked Deformity in Patients with Hallux Valgus

Background Tailor's bunion is a deformity of the fifth toe, and its concomitance with hallux valgus (HV) is defined as splayfoot deformity. Treatment is focused on the HV deformity in splayfoot, and the tailor's bunion deformity can be overlooked. The frequency of HV concomitant with tailor's bunion in splayfoot has not been reported in the literature. Methods A retrospective evaluation was performed to detect the existence of tailor's bunion deformity in 203 patients (376 feet) treated for HV. Standing anteroposterior and lateral radiographs were used in the radiologic evaluation. Fallat's classification was used to grade tailor's bunion. Surgery for HV was applied to 86 patients (136 feet), and conservative treatment was applied to 117 patients (240 feet). Mean follow-up was 28.3 months (range, 18–42 months). Clinical evaluation was by American Orthopaedic Foot and Ankle Society (AOFAS) score. Results Of the 376 feet with HV, 28 (7.4%) had tailor's bunion, of which 17 (60.7%) were overlooked according to the surgery criteria for tailor's bunion. In the HV surgery group, there were no differences in preoperative mean AOFAS scores according to concurrence with tailor's bunion, but postoperative AOFAS scores were low in patients with accompanying tailor's bunion (P &lt; .001). In the conservative group, no differences were determined in mean AOFAS scores according to tailor's bunion. Conclusions Tailor's bunion deformity sometimes goes undiagnosed in patients with treated HV. This deformity must be kept in mind for patients with HV to improve clinical results.