Foot & ankle international最新文献

{"title":"Transosseous Flexor Hallucis Longus Tendon Transfer for Large Achilles Tendon Defects: Surgery Technique and Outcome.","authors":"Philipp Friederichsen, Simone Zwicky, Anika Stephan, Vincent A Stadelmann, Pascal Rippstein","doi":"10.1177/10711007241303745","DOIUrl":"10.1177/10711007241303745","url":null,"abstract":"<p><strong>Background: </strong>Operative management of chronic Achilles tendinopathy with large defects can be surgically challenging. Concerns exist regarding transosseous transfer of the flexor hallucis longus (FHL) tendon because of the shortened lever arm of flexion and weakening of the big toe. The aim of this study was to demonstrate the 2-year outcome of transosseous FHL transfer for the treatment of large Achilles tendon defects.</p><p><strong>Methods: </strong>We retrospectively analyzed 28 patients who underwent FHL transfer. The extent of the defect was measured with magnetic resonance imaging. Outcome parameters were the German Foot Function Index (FFI-D) evaluated at baseline and 6, 12, and 24 months postoperatively, the University of California-Los Angeles (UCLA) activity scale, 2 questions about patient satisfaction, reports on complications, or plantar flexion weakness of the great toe.</p><p><strong>Results: </strong>Mean FFI-D scores of pain and disability improved from 37.2 and 52.3, respectively, at baseline to 6.9 and 15.0, respectively, 24 months postsurgery. (<i>P</i> < .001). At 24 months, 57% of patients were very satisfied and 25% were satisfied with the current symptoms related to their Achilles tendon. All patients noted a relevant improvement at the 2 year follow-up; 1 patient noted weakness of big toe flexion without relevant functional limitation. Complications occurred in 3 patients in the initial postoperative course (2 with delayed wound healing, and 1 with severe perifocal wound necrosis); all resolved completely.</p><p><strong>Conclusion: </strong>We found transosseous FHL transfer using the long, open harvest method and additional bridging of large Achilles defects to be a successful treatment. The majority of patients experienced a significant improvement in both function and pain level and were satisfied with the outcome. Flexion weakness of the big toe does not appear to be a clinically relevant issue after this treatment for chronic Achilles tendinopathy.</p>","PeriodicalId":94011,"journal":{"name":"Foot & ankle international","volume":" ","pages":"159-167"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142967652","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Symptomatic Accessory Navicular Treated With Endoscopic Accessory Navicular and Partial Navicular Resection.","authors":"Kenichiro Nakajima","doi":"10.1177/10711007241308863","DOIUrl":"10.1177/10711007241308863","url":null,"abstract":"<p><strong>Background: </strong>This study aims to report the results of the patients with symptomatic accessory navicular (AN) who underwent endoscopic AN and partial navicular resection.</p><p><strong>Methods: </strong>The medical records of patients with type 2 symptomatic AN who underwent the aforementioned surgery at our hospital from November 2019 to May 2022 with a follow-up of >2 years were reviewed. Data on clinical, radiographic, and patient-reported outcomes were obtained.</p><p><strong>Results: </strong>The analysis included 29 patients (20 females; mean age, 19.6 years; mean body mass index, 21.5) with a mean follow-up duration of 39.5 months. Comparing the preoperative and postoperative scores, visual analog scale score improved from 74.6 to 5.4, and the Japanese Society for Surgery of the Foot score improved from 63.0 to 95.9. We had one wound dehiscence and no other recognized complications. Magnetic resonance and ultrasonographic imaging done 1 year postoperatively revealed that the empty space that remained after resection of the AN was filled with tendonlike tissue.</p><p><strong>Conclusion: </strong>Endoscopic AN and partial navicular resection for treating symptomatic AN resulted in good outcomes and only one case with wound complications.</p>","PeriodicalId":94011,"journal":{"name":"Foot & ankle international","volume":" ","pages":"192-199"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143018899","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical and Radiologic Outcomes Following Autologous Osteochondral Transplantation for Lateral Osteochondral Lesions of the Talus.","authors":"Sung-Hoo Kim, Byung-Ki Cho, Seung-Myung Choi, Sun-Ho Kim","doi":"10.1177/10711007241308576","DOIUrl":"10.1177/10711007241308576","url":null,"abstract":"<p><strong>Background: </strong>Autologous osteochondral transplantation (AOT) is an option to treat large osteochondral lesions of the talus (OLTs), accompanying subchondral cyst, and previous unsuccessful bone marrow stimulation (BMS) procedures. Although there is extensive literature on the outcomes of surgical interventions for medial osteochondral lesions, research focusing on lateral lesions remains limited. This article presents the intermediate-term clinical and radiologic outcomes following AOT for lateral OLTs.</p><p><strong>Methods: </strong>Twenty-eight patients with lateral OLTs were followed up for a minimum of 3 years after AOT. Clinical evaluations included the Foot and Ankle Outcome Score (FAOS) and Foot and Ankle Ability Measure (FAAM). Radiographic assessments evaluated articular surface (subchondral plate) irregularity, progression of degenerative arthritis, and changes in talar tilt and anterior talar translation. The quality of osteochondral graft was evaluated using the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score.</p><p><strong>Results: </strong>The average FAOS and FAAM scores significantly increased from 39.6 to 91.2 and from 37.8 to 89.8 points, respectively, at the final follow-up (<i>P</i> < .001). Radiologic assessments revealed 2 patients (7.1%) with articular step-off ≥2 mm and 1 patient (3.6%) with progressive arthritis. The average MOCART score reached 92.8 points. Postoperative complications included 2 patients with wound problems, 1 with a superficial peroneal nerve injury, and 1 with donor site morbidity. The rate of return to preinjury level of sports activity was 82.1%. At a mean follow-up of 68.5 months, no patient required reoperation for OLT or recurrent ankle instability.</p><p><strong>Conclusion: </strong>AOT for lateral OLTs demonstrated favorable intermediate-term clinical and radiologic outcomes. Most lateral OLTs were accessible via lateral ankle ligament division and capsulotomy, with minimal occurrence of iatrogenic complications such as recurrent ankle instability. AOT appears to be an effective surgical option for patients with large lateral osteochondral lesions unresponsive to conservative treatment, large subchondral cysts, and prior unsuccessful BMS procedures.</p>","PeriodicalId":94011,"journal":{"name":"Foot & ankle international","volume":" ","pages":"182-191"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143018869","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Education Calendar.","authors":"","doi":"10.1177/10711007251317791","DOIUrl":"https://doi.org/10.1177/10711007251317791","url":null,"abstract":"","PeriodicalId":94011,"journal":{"name":"Foot & ankle international","volume":"46 2","pages":"255"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143627247","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction Target of Supramalleolar Osteotomy for Early Varus Ankle Arthritis: Is Overcorrection Necessary?","authors":"SeungMyung Choi, Jaeyoung Kim, Young Yi, Woo-Chun Lee","doi":"10.1177/10711007241300331","DOIUrl":"10.1177/10711007241300331","url":null,"abstract":"<p><strong>Background: </strong>The aim of this study was to investigate the clinical and radiologic outcomes following supramalleolar osteotomy for early varus ankle arthritis with the medial translation of the talus, wherein the lateral translation of the talus center to the tibial axis was used as a correction target. Another aim was to compare the results between the ankles with a normal range of medial distal tibial angle (MDTA) and overcorrected MDTA at the postoperative period to investigate the role of overcorrected MDTA after the supramalleolar osteotomy.</p><p><strong>Methods: </strong>The study comprised 90 patients (93 ankles) with Takakura stage 2 or 3a varus ankle arthritis with the medial translation of the talus, which underwent medial opening supramalleolar osteotomy with fibular osteotomy, and the mean duration of follow-up was 50.7 (range, 24-84) months. Clinical assessments were done with a visual analog scale for pain and the Foot Function Index. The correction target was set at the lateral placement of the talus center to the tibial axis. Radiographic parameters, talus center migration (TCM) and tibial axis-talus ratio (TT ratio), were used to evaluate talus positioning related to the tibial axis. Two groups were established based on postoperative MDTA: a neutral group (MDTA < 94 degrees) and an overcorrected group (MDTA ≥ 94 degrees).</p><p><strong>Results: </strong>Postoperatively, clinical and radiographic outcomes improved in all patients (<i>P</i> < .01). TCM and TT ratio showed a lateral shift of the talus (TCM: from 2.0 ± 1.7 mm to -1.3 ± 1.6 mm, TT ratio: from 55.5% ± 5.4% to 44.7% ± 5.0%, both <i>P</i> < .01). As expected, the overcorrected MDTA group had a larger MDTA than the neutral group preoperatively (<i>P</i> < .01). However, there were no differences in clinical outcomes or changes in various radiographic parameters between the groups.</p><p><strong>Conclusion: </strong>Lateral translation of the talus center relative to the tibial axis can be used as a correction target for medial opening supramalleolar osteotomy to treat early varus ankle arthritis with medial translation of the talus. Overcorrection of the tibial plafond to valgus does not seem necessary.</p><p><strong>Level of evidence: </strong>Level IV, retrospective case series study.</p>","PeriodicalId":94011,"journal":{"name":"Foot & ankle international","volume":" ","pages":"135-145"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142840627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relationship Between the Relative Length of the Second Metatarsal and Occurrence of Metatarsalgia in Patients With Hallux Valgus.","authors":"Kosho Togei, Hiroaki Shima, Yoshihiro Hirai, Ken Tanaka, Hozumi Kumano, Toshito Yasuda, Masashi Neo","doi":"10.1177/10711007241298682","DOIUrl":"10.1177/10711007241298682","url":null,"abstract":"<p><strong>Background: </strong>Patients with hallux valgus (HV) may develop metatarsalgia, which is partly attributed to second metatarsal relative length (RL2M). However, no study has analyzed RL2Ms measured by various methods as predictors for metatarsalgia in HV patients. This study aimed to investigate the predictors for metatarsalgia in HV patients and calculate the cutoff values for metatarsalgia in preoperative planning for lesser metatarsal shortening osteotomy.</p><p><strong>Methods: </strong>In this retrospective cohort study, 103 female patients (131 feet) with HV were investigated for metatarsalgia (metatarsalgia-positive [MP] group: 55 feet; metatarsalgia-negative [MN] group: 76 feet). The HV angle (HVA) and intermetatarsal angles (IMAs) (1/2 and 1/5), lateral talo-first metatarsal angle, calcaneal pitch angle, first metatarsal-medial cuneiform angle, and first metatarsal lift (LIFT) were measured using weightbearing radiographs. RL2Ms were assessed using the 4 methods described by Morton and Nilsonne (method A), Coughlin (method B), Hardy and Clapham (method C), and Kumano (method D). RL2M (method D) was calculated as the ratio of this distance to the second metatarsal length. These measurements were compared between the groups. Multivariate logistic regression analysis was performed to determine the predictors of developing metatarsalgia. The cutoff values were calculated using receiver operating characteristic curve analysis.</p><p><strong>Results: </strong>HVA, IMAs (1/2 and 1/5), LIFT, and RL2M (method D) were significantly higher in the MP group than in the MN group. In the multivariate analysis, HVA and RL2M (method D) were independent predictors for metatarsalgia. The cutoff values for HVA and the value and ratio of RL2M (method D) were 37.0 degrees, 13.1 mm, and 18.8%, respectively.</p><p><strong>Conclusion: </strong>HVA and RL2M measured by method D were independently associated with the occurrence of metatarsalgia in HV patients.</p>","PeriodicalId":94011,"journal":{"name":"Foot & ankle international","volume":" ","pages":"217-226"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142718151","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Arthroscopic Anatomic Reconstruction of the Interosseous Talocalcaneal Ligament Using a Gracilis Autograft for Subtalar Instability: 6- to 12-Year Retrospective Follow-up.","authors":"Tong Su, Xiang-Yun Cheng, Yi-Chuan Zhu, Qin-Wei Guo, Yue-Lin Hu, Chen Jiao, Dong Jiang","doi":"10.1177/10711007241293780","DOIUrl":"10.1177/10711007241293780","url":null,"abstract":"<p><strong>Background: </strong>Several surgical techniques have been reported of subtalar instability (STI), but it remains a controversial topic without long-term clinical evidence. This study aimed to report the all-inside arthroscopic anatomic interosseous talocalcaneal ligament (ITCL) reconstruction technique and its long-term outcomes in STI patients with confirmed ITCL rupture.</p><p><strong>Methods: </strong>A retrospective study was conducted on consecutive series of STI patients who underwent all-inside arthroscopic anatomic reconstruction of the ITCL using a gracilis autograft between January 2010 and December 2016. The American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot scale, Karlsson-Peterson score, visual analog scale (VAS) pain score, and Tegner activity scale were assessed preoperatively and postoperatively. Furthermore, Foot and Ankle Ability Measure activities of daily living (FAAM-ADL) and sports (FAAM-Sports) scores, and whether patients returned to daily work, recreational activities, and preinjury sports were recorded at follow-up. Complications including postoperative sprain recurrence, range of motion (ROM) restriction, and incision numbness were evaluated at the final follow-up.</p><p><strong>Results: </strong>A total of 25 patients, with a mean age of 33.3 ± 8.8 years, were included in the follow-up analysis at a mean duration of 110.7 ± 20.4 months. The mean Karlsson-Peterson and AOFAS scores significantly increased from 61.8 ± 9.9 preoperatively to 93.8 ± 7.2 (<i>P</i> < .001) at the final follow-up and from 68.8 ± 7.4 to 95.1 ± 6.7 (<i>P</i> < .001), respectively. Additionally, the mean VAS pain score significantly decreased from 4.5 ± 1.1 to 0.6 ± 1.0 (<i>P</i> < .001). Regarding normal daily activities (FAAM-ADL), 22 patients (88%) obtained good to excellent (≥80) results; for sports-related activities, 18 patients (72%) had good to excellent FAAM-Sports scores and 19 patients (76%) returned to preinjury sports activities. Four patients (16%) reported mild to moderate ROM restrictions.</p><p><strong>Conclusion: </strong>All-inside arthroscopic anatomic reconstruction of the ITCL demonstrated with gracilis autograft was associated with satisfactory long-term outcomes in restoring function and facilitating a return to sports for STI patients with ITCL injury.</p>","PeriodicalId":94011,"journal":{"name":"Foot & ankle international","volume":" ","pages":"146-156"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142824834","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Coronal Plane Alignment of the Medial Column in Isolated Hallux Valgus, Isolated Flatfoot, and Combined Hallux Valgus-Flatfoot.","authors":"Matthieu Lalevee, Philippe Beaudet, Mo Saffarini, Chinyelum Agu, Floris Van Rooij, Nacime Salomao Barbachan Mansur, Kepler Carvalho, Kevin Dibbern, Cesar de Cesar Netto","doi":"10.1177/10711007241308580","DOIUrl":"10.1177/10711007241308580","url":null,"abstract":"<p><strong>Background: </strong>To provide improved treatment for hallux valgus (HV), we sought to understand more about the pathophysiologic connection between flatfoot deformity and HV by comparing coronal plane alignment of the medial column of the foot for patients with isolated HV, isolated flatfoot, and combined HV-flatfoot vs controls.</p><p><strong>Methods: </strong>This study retrospectively assessed a consecutive series of 33 patients with combined symptomatic and radiographic HV and flatfoot, 33 isolated symptomatic HV, 33 isolated symptomatic flatfoot, and 33 controls. The medial column alignment was assessed in the coronal plane using 3-dimensional weightbearing computed tomography (WBCT); rotation was measured for the navicular, medial cuneiform, and first metatarsal (M1). The position of the first naviculocuneiform (NC) and tarsometatarsal (TMT) joints were determined.</p><p><strong>Results: </strong>M1 intrinsic pronation was significantly greater in patients with combined HV-flatfoot (-12.0 ± 7.0 degrees; <i>P</i> < .001), isolated HV (-12.1 ± 6.6 degrees; <i>P</i> < .001), and isolated flatfoot (-11.8 ± 8.5 degrees; <i>P</i> < .001), compared with control patients (-19.4 ± 6.7 degrees). TMT was significantly more pronated in patients with combined HV-flatfoot (30.9 ± 6.2 degrees) compared with isolated flatfoot (25.3 ± 9.3 degrees; <i>P</i> = .007), and control (25.9 ± 5.2 degrees; <i>P</i> = .005), as it was in patients with isolated HV (33.2 ± 8.2 degrees) compared with isolated flatfoot (<i>P</i> < .001), and control (<i>P</i> < .001). NC was significantly more supinated in patients with combined HV-flatfoot (-23.7 ± 3.9 degrees) compared to isolated flatfoot (-18.0 ± 9.8 degrees; <i>P</i> = .001), and control (-18.0 ± 4.5 degrees; <i>P</i> < .001), as it was for patients with isolated HV (-24.8 ± 7.1 degrees) compared with isolated flatfoot (<i>P</i> = .003), and control (<i>P</i> < .001).</p><p><strong>Conclusion: </strong>In our study, we found that patients with isolated HV, isolated flatfoot, or combined HV-flatfoot presented a similar increase in M1 intrinsic pronation of approximately 7.5 degrees, compared with controls. Moreover, patients with isolated HV or combined HV-flatfoot had greater TMT pronation and NC supination, compared with patients with isolated flatfoot and controls.</p>","PeriodicalId":94011,"journal":{"name":"Foot & ankle international","volume":" ","pages":"236-245"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143018871","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of the Foot and Ankle Activity Level Scale (FAALS) Instrument.","authors":"Lauren M Matheny, Thomas O Clanton, Jonathon D Backus, Norman E Waldrop, Karen K Briggs, Marilee P Horan, Anastasia Robinson","doi":"10.1177/10711007241311907","DOIUrl":"https://doi.org/10.1177/10711007241311907","url":null,"abstract":"<p><strong>Background: </strong>Activity level is a benchmark to document patient recovery; however, there is a lack of instrumentation to measure activity level specific to the foot and ankle. The purpose of this study was to develop a foot and ankle activity level scale (FAALS) instrument that will serve as an effective clinical tool for practitioners by assigning an activity level to patients.</p><p><strong>Methods: </strong>This was a 4-phase study with 3 rounds of data collection (n = 1432). Phase 1 was item generation using an expert panel to determine content validity (101 items). In phase 2, all items from phase 1 were piloted (n = 100) to remove poorly performing items (77 items). In phase 3 (n = 505), item reduction, reliability, and validity Rasch analyses were conducted, leaving a total of 22 items. Validity was assessed using outfit mean-square (MNSQ) and infit MNSQ statistics, with acceptable values between 0.5 and 1.5. An additional round of data collection was completed to serve as a validation data set to confirm FAALS instrument structure and psychometric analytics (n = 827). Correlation analysis was performed to assess convergent and divergent validity. Multiple linear regression analysis was conducted to determine whether the FAALS could detect differences in scores between groups with previously proven factors that affect functional status.</p><p><strong>Results: </strong>Person reliability was 0.92 and item reliability was 1.00, demonstrating excellent reliability. There was excellent evidence of validity, with mean-square values between 0.5 and 1.5. The 22 FAALS items are summed for a total score that corresponds to one of 4 activity levels. The FAALS instrument demonstrated sensitivity in the ability to discern between groups with expected foot and ankle functional differences for previous ankle surgery status, <i>t</i>(502) = -7.69, <i>P</i> < .001, and body mass index, <i>t</i>(502) = -3.41, <i>P</i> < .001.</p><p><strong>Conclusion: </strong>The FAALS instrument is a short, clinically useful tool to measure activity level specific to the foot and ankle. FAALS normative values provide valuable information for physician-patient communication, which may serve to facilitate shared decision-making, improve postoperative care, and allow physicians to track recovery progress.</p>","PeriodicalId":94011,"journal":{"name":"Foot & ankle international","volume":" ","pages":"10711007241311907"},"PeriodicalIF":0.0,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143018873","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anatomical and Micro-CT Assessment of the First Metatarsal Head Vascularization and Soft Tissue Envelope Following Minimally Invasive Chevron Osteotomy for Hallux Valgus Deformity.","authors":"Kepler Alencar Mendes de Carvalho, Aly Fayed, Nacime Salomao Barbachan Mansur, Alexandre Leme Godoy-Santos, Paul Talusan, Bopha Chrea, Cesar de Cesar Netto, Anne H Johnson, Miki Dalmau-Pastor","doi":"10.1177/10711007241298681","DOIUrl":"10.1177/10711007241298681","url":null,"abstract":"<p><strong>Background: </strong>Minimally invasive surgical (MIS) chevron-type osteotomy for hallux valgus (HV) treatment offers a surgical alternative to open surgery with minimal surgical dissection and a hypothetical decreased risk for soft tissue complications. The objectives of this study were to assess the incidence of injuries to the soft tissue envelope and to the blood supply of the first metatarsal head through gross dissection and, using micro-computed tomography (micro-CT), to identify the safe position to perform the MIS chevron-type osteotomy of the first metatarsal head based on the anatomical data.</p><p><strong>Methods: </strong>Twenty cadaveric specimens with HV were used for the study. Seven specimens were perfused with a low-viscosity radiopaque polymer preoperatively. All specimens underwent MIS chevron-type osteotomy executed using a 20 × 2-mm Shannon burr at the metatarsal neck's flare. Anatomical dissection of all specimens was then performed to assess macroscopic injury to the first metatarsal head complex soft tissue structures and blood supply. The 7 specimens that were preinjected then underwent micro-CT assessment to assess the first metatarsal head blood supply.</p><p><strong>Results: </strong>Two soft tissue injuries in 2 cadavers were identified, including a 2-mm injury to the flexor hallucis brevis in one specimen and a 1-mm injury to the dorsomedial nerve. No arterial injuries were identified in either the gross dissection or micro-CT imaging. Micro-CT has pinpointed a secure location to complete the chevron-type osteotomy. We found that finalizing the dorsal arm of the MIS chevron-type osteotomy at a median distance of 25.6 mm, and the plantar arm at 23.9 mm from the most distal point of the first metatarsal head, ensured safety in the specimens we used.</p><p><strong>Conclusion: </strong>As tested in this cadaveric study on 20 specimens, the MIS chevron-type osteotomy procedure preserved the soft tissue envelope of the first metatarsal head complex and the blood supply of the first metatarsal head, with a low number of injuries. Completing the dorsal arm of the MIS chevron-type osteotomy at a median distance of 25.6 mm, and the plantar arm at 23.9 mm from the furthest point of the first metatarsal head, while ensuring the Shannon burr does not exceed 3.9 mm dorsolaterally and 4.0 mm plantar-laterally from the cortical bone exit point, appeared crucial to avoid vascular damage.</p>","PeriodicalId":94011,"journal":{"name":"Foot & ankle international","volume":" ","pages":"102-114"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142752577","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}