First metatarsal shortening after hallux valgus surgery: Benefits of treatment with distraction osteogenesis

Q2 Health Professions
Foot Pub Date : 2024-06-27 DOI:10.1016/j.foot.2024.102117
Frans-Jozef Vandeputte , Fernando Garcia-Barrado , Giovanni Matricali , Johan Lammens
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引用次数: 0

Abstract

Introduction

Iatrogenic shortening and elevation of the first metatarsal (MT1) is a common complication of hallux valgus surgery, inducing metatarsalgia underneath the lesser rays, a reason for patient dissatisfaction. For resolving this problem, different types of revision surgery are described, of which lengthening MT1 by distraction osteogenesis is underreported and therefore undervalued.

Materials and methods

We present three cases with iatrogenic shortening after hallux valgus surgery treated by distraction osteogenesis of MT1 using a custom-made frame, made of Ilizarov equipment. To evaluate the amount of lengthening, the length of the first and second metatarsal (MT2) and the parabolic distribution of the metatarsal heads were compared before and after distraction. To evaluate correction in the sagittal plane, Meary’s angle was measured pre- and post-lengthening. Pain was noted by a visual analogic score during follow-up.

Results

In our series of three cases, lengthening of MT1 between 7 mm and 18 mm, resulted in an improved parabolic distribution of the MT heads. The average difference between the second and first MT-head, relative to the SM4 axis (M2–M1) improved from 9.4 mm (± 0.9 mm) to 2.8 mm (± 0.7 mm) resolving corresponding pain in all patients. Meary’s angle was normalized in one case. The average duration of treatment was 116 days (± 9 days). Minimal follow up was 11 years.

Conclusion

Using Ilizarov equipment for distraction osteogenesis of MT1 is a low-cost and effective method. Over time, this technique has proven its utility in pronounced iatrogenic shortening of MT1. The possibility to lengthen more than 1 cm, to correct in multiple planes, as well as early mobilization and weight bearing are additional advantages, but one must be careful to avoid overcorrection. The need for strict follow-up with multiple radiographs and rigorous patient selection is mandatory.

外翻手术后第一跖骨缩短:牵张成骨疗法的益处。
导言:第一跖骨(MT1)的先天性缩短和抬高是足外翻手术的常见并发症,会引起小腿下方的跖骨痛,这也是患者不满意的一个原因。为解决这一问题,我们介绍了不同类型的翻修手术,其中通过牵引成骨法延长第一跖骨(MT1)的手术报道较少,因此价值被低估:我们介绍了三例在外翻手术后出现先天性缩短的病例,通过使用Ilizarov设备定制的框架对MT1进行牵张成骨治疗。为了评估延长量,我们比较了牵引前后第一和第二跖骨(MT2)的长度以及跖骨头的抛物线分布。为了评估矢状面的矫正情况,对拉伸前后的 Meary's 角进行了测量。随访期间通过视觉类比评分记录疼痛情况:在我们的三个病例系列中,MT1的延长幅度在7毫米到18毫米之间,从而改善了MT头的抛物线分布。相对于 SM4 轴(M2-M1),第二个 MT 头和第一个 MT 头之间的平均差值从 9.4 毫米(± 0.9 毫米)减少到 2.8 毫米(± 0.7 毫米),从而解决了所有患者的相应疼痛。一个病例的 Meary's 角恢复正常。平均治疗时间为 116 天(± 9 天)。最短随访时间为 11 年:结论:使用 Ilizarov 设备对 MT1 进行牵张成骨是一种低成本、有效的方法。随着时间的推移,该技术已被证明在明显的MT1先天性缩短方面具有实用性。可延长超过1厘米、多平面矫正以及早期活动和负重是其额外的优势,但必须注意避免过度矫正。必须通过多次拍片进行严格随访,并严格选择患者。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Foot
Foot Health Professions-Podiatry
CiteScore
2.00
自引率
0.00%
发文量
37
期刊介绍: The Foot is an international peer-reviewed journal covering all aspects of scientific approaches and medical and surgical treatment of the foot. The Foot aims to provide a multidisciplinary platform for all specialties involved in treating disorders of the foot. At present it is the only journal which provides this inter-disciplinary opportunity. Primary research papers cover a wide range of disorders of the foot and their treatment, including diabetes, vascular disease, neurological, dermatological and infectious conditions, sports injuries, biomechanics, bioengineering, orthoses and prostheses.
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