The plantar incision for procedures involving the forefoot. An evaluation of one hundred and fifty incisions in one hundred and fifteen patients.

Between 1984 and 1990, 172 plantar incisions were used in 137 patients. Eighty-nine of these patients returned for a personal interview and examination, twenty-six were interviewed by telephone, and twenty-two were lost to follow-up. Of the eighty-nine patients (124 incisions) who returned for follow-up examination at an average of twenty-five months (range, six to seventy-seven months), eighty-five (96 per cent) were pleased with the result of the plantar incision.

Hallux valgus repair. DuVries modified McBride procedure.

The DuVries modification of the McBride procedure was investigated in 72 feet in 47 patients with hallux valgus deformity. Overall, the patient satisfaction rate was 92%. The hallux valgus averaged 32 degrees preoperatively, and 16 degrees postoperatively.

Basal osteotomy of the fifth metatarsal for the bunionette.

A proximal basal chevron osteotomy was carried out on 20 patients (22 feet) with a Tailor's bunion deformity. The follow-up was of a minimum of 3 years for all patients. Direct surgery on the fifth metatarsophalangeal joint for bunionette treatment has often been unsuccessful and there have been recurrences due to metatarsophalangeal instability.

Tibial sesamoid planing for intractable plantar keratoses.

Partial tibial sesamoidectomy or sesamoid planing is an alternative to complete sesamoidectomy or nonoperative maintenance of a plantar keratosis. It can be performed through a very small incision and is a relatively uncomplicated, yet effective, procedure for relieving the effects of abnormal shearing forces from a prominent or malpositioned medial sesamoid. A retrospective study of 13 patients extending for 10 years representing 17 procedures was conducted.

Proximal metatarsal segmental resection: a treatment for intractable plantar keratoses.

For the past 15 years, a procedure the authors have termed proximal metatarsal segmental resection has been used for the treatment of intractable, painful, submetatarsal plantar keratoses which have failed nonoperative treatments. This simple procedure basically is the resection of a cylindrical segment of proximal metatarsal bone approximately 0.5 cm long.

Distal metatarsal osteotomy for intractable plantar keratoses.

A relatively simple distal osteotomy of the metatarsal necks is presented. Twenty-one feet were followed for an average of 31 months with a diagnosis of intractable plantar keratosis causing metatarsalgia. A treatment plan is given that indicates which metatarsals to osteotomize, depending on location of the keratosis.

Medial displacement metatarsal osteotomy for treatment of painful bunionette.

A medial displacement metatarsal osteotomy was performed in 23 feet of 16 patients who had painful bunionette deformities. The mean follow-up period was 22 months. Relief of symptoms, e.

Distal metatarsal osteotomy for bunionette deformity.

Surgical treatment of a bunionette deformity was carried out in 54 feet (36 patients) using the Hohmann displacement osteotomy modified by Thomasen on the fifth metatarsal. Forty-eight operated feet (32 patients) were evaluated 69 months postoperatively (median). The patients were fully satisfied in 88% of the cases and partly satisfied or unsatisfied in 12%.

Silicone implant arthroplasty for second metatarsophalangeal joint disorders with and without hallux valgus deformities.

Subluxation or dislocation of the second metatarsophalangeal joint (MTPJ) is usually associated with a hammertoe deformity and, frequently, with a significant hallux valgus deformity. Although the joint itself may be painful, there is also pain in the hammertoe deformity, especially when the patient is wearing closed shoes. A painful intractable plantar keratosis is usually present.

Distal oblique osteotomy for intractable plantar keratosis of the middle three metatarsals.

On the middle metatarsals of 49 patients with symptomatic intractable plantar keratosis, 69 distal oblique osteotomies were performed. With an average follow-up time of 16 months, 83% of the results were rated good. This procedure is contraindicated for an intractable plantar keratosis with an associated fixed metatarsphalangeal joint deformity, however.

Arthrodesis of the first metatarsophalangeal joint as salvage for the failed Keller procedure.

Arthrodesis of the first metatarsophalangeal joint was performed in eleven patients (sixteen feet) after a Keller procedure had failed. Multiple intramedullary threaded Steinmann pins were used to fix the bone at the site of the arthrodesis, and a successful arthrodesis was achieved in each patient. Interposition of a graft of bone from the iliac crest was done in four feet with an excessively short hallux.

Intramedullary decompression with condylectomy for intractable plantar keratoma.

A previously unreported method to relieve excessive plantargrade pressure which may create an intractable plantar keratoma associated with metatarsal head pain is presented. This method is referred to as an intramedullary metatarsal decompression with condylectomy and is performed through a dorsal minimum incision. The rotary action of the bur is demonstrated.

The tilt-up osteotomy for correction of intractable plantar keratoses.

The purpose of this paper is to describe and follow-up a new surgical technique used for the correction of intractable plantar keratoses. Twenty-five osteotomies were studied from 8 to 20 months postoperatively. The results showed a 60% success rate, but a patient satisfaction rate of 92%.

Intractable plantar keratosis.

As I mentioned in the beginning of this discussion, it is imperative to treat all of these intractable plantar keratoses conservatively with proper shoes, metatarsal supports, and local care of the lesion before considering any type of surgical intervention. Many patients will respond to conservative management, and it is certainly the treatment of choice if the patient is satisfied with it.

Evaluation of the V-osteotomy as a procedure to alleviate the intractable plantar keratoma.

This paper will discuss the distal V-osteotomy procedure of the lesser metatarsals as performed at the Hugar Surgery Center. Sixty-six patients in this study had V-osteotomies performed upon one or more of the middle metatarsals within a 2-year period. Evaluation was based upon patient satisfaction and clinical improvement as measured by the alleviation of the original lesion and the presence of any transfer lesions under the adjacent metatarsal heads.