Lesser metatarsophalangeal joint instability: prospective evaluation and repair of plantar plate and capsular insufficiency.

Background: Anatomical dissection of the second metatarsophalangeal (MTP) joint suggests that the plantar plate is the major stabilizing structure of the joint due to its central location and multiple important attachments. Many surgical procedures have been recommended when conservative treatment has failed, but some have had limited clinical success. The aim of our prospective study was to show the results obtained in the treatment of a group of patients with plantar plate tears by direct repair through a dorsal approach combined with a Weil metatarsal osteotomy with a minimum followup of 12 months.

Subcaptial oblique fifth metatarsal osteotomy versus distal chevron osteotomy for correction of bunionette deformity: a cadaveric study.

Unlabelled: The aim of this study was to compare a distal subcapital oblique fifth metatarsal with a distal chevron osteotomy for correction of bunionette deformity.

Materials And Methods: Twenty cadaveric feet were randomly assigned to undergo either a subcapital oblique or chevron osteotomy of the distal fifth metatarsal. Radiographic measurements, including 4-5 intermetatarsal angle (IMA), fifth metatarsophalangeal angle (5-MPA) and foot width, were compared between the 2 groups.

Three-dimensional matrix-induced autologous chondrocytes implantation for osteochondral lesions of the talus: midterm results.

Introduction. We evaluate the midterm results of thirty patients who underwent autologous chondrocytes implantation for talus osteochondral lesions treatment. Materials and Methods.

Metatarsophalangeal joint pathology in crossover second toe deformity: a cadaveric study.

Background: Ligamentous and capsular insufficiency of the second metatarsophalangeal joint has been surgically treated for over two decades, mainly with indirect surgical repairs, which stabilize adjacent soft tissue and shorten or decompress the osseous structures. While ligamentous insufficiency has been described and recognized, degeneration of the plantar plate and tears of the capsule have rarely been documented. The purpose of this study was to document and describe the presence and pattern of plantar plate tears in specimens with crossover second toe deformities, and based on this, to develop an anatomical grading system to assist in the assessment and treatment of this condition.

Hammertoes and clawtoes: proximal interphalangeal joint correction.

Hammertoe and clawtoe deformities are common forefoot problems. The deformity exists owing to the underlying pathoanatomy. Hallux valgus, longer metatarsals, and intrinsic imbalance are the most common etiologies.

Second MTP joint instability: grading of the deformity and description of surgical repair of capsular insufficiency.

A crossover second toe is a commonly seen forefoot problem, usually occurring in women aged > 50 years, and often in association with a bunion deformity. The plantar plate is the principal static stabilizer of the second metatarsophalangeal (MTP) joint. Different authors have proposed classifications to define instability of the second MTP joint, but only describe clinical progression of the deformity.

Does it matter how we measure metatarsal length?

Introduction: Variations in the relative lengths of the metatarsal bones have been implicated as a cause of forefoot pain. Osteotomies to balance the metatarsal lengths have been described as therapy. Although measurement of metatarsal length is required for these osteotomies, there is no gold standard method to measure it radiologically.

Surgical treatment of advanced hallux rigidus by interpositional arthroplasty.

Background: While arthrodesis is the gold-standard for end-stage hallux rigidus, it leads to loss of mobility. The purpose of this paper was to report our clinical results with modified interpositional arthroplasty for the treatment of advanced (Grade III and IV of Coughlin and Shurnas) hallux rigidus.

Material And Methods: Twenty-five feet with Grade III and IV hallux rigidus underwent cheilectomy, minimal proximal phalanx resection (modified Keller) and interposition of the dorsal capsule and EHB.

Sequential dissection for exposure of the second metatarsophalangeal joint.

Background: Instability of the second metatarsophalangeal (MTP) joint is relatively common, and although the anatomy of the joint has been well described and plantar plate pathology has been identified, little has been written about its exposure and repair. The goal of this study was to elucidate the necessary dissection to expose and potentially repair the lesions of the plantar plate through a dorsal approach.

Materials And Methods: Sequential dorsal dissection of the second MTP joint was carried out in eight cadaveric specimens.

Symptomatic bunionette deformity in adolescents: surgical treatment with metatarsal sliding osteotomy.

Background: Bunionette deformity is a painful osseous prominence on the lateral aspect of the head of the fifth metatarsal. The purpose of this study is to evaluate the results of a fifth metatarsal sliding osteotomy for the treatment of this deformity in patients under 18 years of age.

Methods: We retrospectively evaluated 13 feet in 11 consecutive patients with bunionette deformity treated from January 2003 to January 2008 at 2 referral centers.

Interposition arthroplasty in the treatment of hallux rigidus.

Objectives: We evaluated the outcomes of interposition arthroplasty performed for the treatment of hallux rigidus.

Methods: The study included 19 feet (4 left, 15 right) of 17 patients (14 females, 3 males; mean age 61+/-5 years; range 55 to 71 years) who were treated with interposition arthroplasty for hallux rigidus. According to the grading system of Coughlin and Shurnas, 18 feet were grade 3, one foot was grade 4.

Second metatarsophalangeal joint instability and second metatarsal length association depends on the method of measurement.

Introduction: Second metatarsophalangeal joint (MTPJ) instability is an important cause of forefoot pain and its causation multi-factorial. There is debate over an association with a relatively increased second metatarsal length and numerous measurement techniques. It is not known which, if any correlate with second MTPJ instability or their accuracy.

Turf toe: soft tissue and osteocartilaginous injury to the first metatarsophalangeal joint.

The use of artificial turf in the United States has created a dramatic increase in first metatarsophalangeal joint dorsiflexion injuries. Turf toe has been reported to occur in athletes who participate in sporting activities. An injury to the plantar capsular ligamentous complex can result in acute and chronic pain, resulting in time lost from sports participation for a short- or long-term period.

Treatment of hallux valgus with increased distal metatarsal articular angle: use of double and triple osteotomies.

The treatment of the congruent hallux valgus deformity requires special consideration for a successful outcome to be obtained. The distal metatarsal articular angle is of critical importance in this deformity. The goal of correction is to achieve a realigned first ray and preserve the congruent first metatarsophalangeal articulation.

Disorders of the lesser toes.

Lesser toe disorders are an often under-appreciated source of pain and disability in athletes. Patients may have significant symptoms from corns, hammertoe and mallet toe deformities, and metatarsalgia resulting from neuromas and metatarsophalangeal joint instability. Although patients may present with vague symptoms, a careful history and physical examination will point a clinician to an accurate diagnosis.

Correlation of Harris mats, physical exam, pictures, and radiographic measurements in adult flatfoot deformity.

Introduction: In many reports describing flatfoot deformities, the abnormality is described using observations from physical examination, radiographs, or foot imprints. Correlation of these measurements is often lacking, making determination of the magnitude of the deformity or its surgical correction difficult to quantify.

Material And Methods: Weightbearing AP and lateral radiographs were obtained on 25 patients (39 feet) with a clinically apparent flatfoot deformity and an asymptomatic control group of 28 subjects (56 feet).

Prospective controlled trial of STAR total ankle replacement versus ankle fusion: initial results.

Background: Mobile-bearing ankle replacements have become popular outside of the United States over the past two decades. The goal of the present study was to perform a prospective evaluation of the safety and efficacy of a mobile-bearing prosthesis to treat end stage ankle arthritis. We report the results of three separate cohorts of patients: a group of Scandanavian Total Ankle Replacement (STAR) patients and a control group of ankle fusion patients (the Pivotal Study Groups) and another group of STAR total ankle patients (Continued Access Group) whose surgery was performed following the completion of enrollment in the Pivotal Study.

Lateral ankle instability and revision surgery alternatives in the athlete.

Ankle instability in the athlete is a common problem that is routinely treated non-operatively, with a 90% success rate. With proprioceptive training, preventive equipment (bracing/taping), and closed kinetic chain strengthening, surgery for ankle instability is uncommon. Nonetheless, some athletes present with recurrent ankle instability that, despite work-up and conservative treatment, requires surgical correction.

[Treatment of capsulitis of little toe with minimal incisional osteotomy and manipulations].

Objective: To study therapeutic effects of capsulitis of little toe treated with minimal incisional osteotomy and manipulations procedures.

Methods: From 2003.7 to 2008.

The first metatarsocuneiform joint, hypermobility, and hallux valgus: what does it all mean?

The etiology and treatment of the hallux valgus deformity has long been a subject of controversy. Early reports focused on increased first metatarsocuneiform joint mobility as the primary cause of the deformity. While this theory was widely accepted, little evidence was offered in its support.