Hallux valgus (HV) is a common forefoot condition and patients frequently present for surgical correction. Despite many years of collective surgical experience, a variety of first metatarsal osteotomies and techniques are available to the orthopedic surgeon with no consensus of a preferred technique. How does one navigate the field of differing osteotomies for HV? Are there some osteotomies with certain advantages over others? This paper seeks to answer these questions and will discuss the pathoanatomy of HV, the principles and objectives of surgical correction, and the osteotomies currently in popular use in orthopedic practice.
Morton's neuroma is a common cause of forefoot pain. It most commonly affects middle-aged females and involves the third web space. A thorough history and examination should be adequate to diagnose with ultrasound (US) being the investigation of choice. Treatment usually involves conservative measures including analgesia; footwear and orthotic; local steroid injection; and in cases of failed nonoperative measures, open excision is performed.
Mini Symposium: Forefoot Disorders
Sean HS Lai,
Camelia QY Tang,
Forefoot injuries are common injuries in high-impact sports. The forefoot experiences a large amount of stress during the late stance phase of the gait cycle. Repetitive load applied to the forefoot without adequate rest can lead to tissue breakdown, resulting in injury. Forefoot sporting injuries can deteriorate gait function, sporting performance, and quality of life. In this article, we review the typical presentation, approach, and treatment modalities of the commonest forefoot sporting injuries. These include metatarsal stress fractures, second metatarsophalangeal joint (MTPJ) instability, turf toe injury, sesamoid pathologies, as well as hallux valgus and rigidus. Metatarsal stress fractures are frequent overuse injuries. They can be managed conservatively with activity modification and protected weight-bearing or surgically with open internal fixation. Second MTPJ instability typically involves disruption of the second MTPJ ligamentous joint capsule. Management of this condition includes customized orthotics, physiotherapy, hydrocortisone and lignocaine (H&L) injections, osseous procedures for phalangeal alignment, and plantar plate repairs. Turf toe injury refers to a hyperextension injury of the plantar capsuloligamentous structure of the hallux MTPJ. Plantar plate repairs are typically indicated in grade III injuries or when conservative treatment has failed. Sesamoid injuries include stress fractures, infections, degenerative disease, and osteochondral lesions. Customized orthotics limiting flexion across MTPJ while providing sesamoid stress relief is helpful, while surgical treatment involves fixation with possible bone grafting or partial sometimes complete sesamoidectomy. While hallux valgus and rigidus are not specific to sportsmen, treatment should take into account the patient's athletic demand. These conditions are typically treated surgically with realignment osteotomies if refractory to conservative treatments such as foot orthoses and physiotherapy.
The treatment of hallux valgus has been a challenge for surgeons over the last 100 years. It is fascinating because it provides infinite variations on the one diagnosis. And along with the infinite variations, there have been almost an infinite number of procedures described to solve these problems. This article will focus on the indications, techniques, pearls, and pitfalls of minimally invasive hallux valgus correction.
Navicular stress fractures (NSF) can be difficult injuries to diagnose and can end up career in athletes. The lack of blood supply to the navicular bone makes this injury difficult to heal and confoundingly gives minimal visible symptoms such as swelling and bruising.
Hallux rigidus is the most common arthritis of the foot, characterized by dorsiflexion restriction with osteophyte formation. Patients complain of pain and loss of motion. Nonsurgical treatments can be tried successfully in early-stage patients. The surgical treatment options can be a joint-preserving technique or not. Arthrodesis has been the main treatment option for advanced-stage patients. Arthroplasty has also been an available option. There are other treatment options available for the treatment of hallux rigidus, and these are to be discussed in the present article, accompanied by the literature.
DOI: 10.5005/jp-journals-10040-1123 |
Open Access |
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Shah R, Wachche GS, Desai DN. A Rare Case of Flexor Hallucis Longus Tendinitis Due to Sesamoid Bone at the Interphalangeal Joint of the Great Toe: A Case Report. J Foot Ankle Surg Asia-Pacific 2020; 7 (2):70-72.
Aim: This study aims to describe the rare case of flexor hallucis longus (FHL) tendinitis due to the sesamoid bone at the interphalangeal joint of the great toe. Background: Sesamoids are the intertendinous bone, which is rarely found at the hallucal interphalangeal joint. Occasionally, these bones may be associated with pain syndromes. A high index of suspicion should be exercised for the diagnosis. Detailed clinical examination and sound evaluation of radiology will help to establish the diagnosis. Case description: Forty-five-year-old male patient presented with pain in the great toe of the left foot and the inability to weight-bear over the forefoot for three years. He could not use the closed footwear because of fixed dorsiflexion at the first interphalangeal joint with severe pain. The patient was diagnosed to have an sesamoid bone in the tendon of FHL at the level of the interphalangeal joint. Excision of sesamoid bone cured him. Conclusion: The accessory bones are commonly treated conservatively, but those causing tendinitis and chronic pain should be treated surgically with excision. Clinical significance: The sesamoid bone in tendon of FHL can lead to tendinitis causing chronic pain and difficulty in walking. A high index of suspicion can only help in early diagnosis.
Transmetatarsal amputation (TMA) aims to preserve the length of the foot as much as possible in patients with traumatic mangled foot injuries or diabetic foot. In this article, we give an overview of the evolution of technique of TMA, management of complications, its postoperative care, with utmost emphasis on preoperative and intraoperative steps to achieve best results. We have formulated a treatment algorithm as per our institutional practice for systematic application of principles for the management of TMA.
Calcaneus fractures are a complex injury. Since the calcaneus plays a key role in weight-bearing and gait cycle, rehabilitation after injury needs to be individualized, and a structured program needs to be implemented. The rehabilitation protocol also varies depending on the type of injury, the associated injuries, and the management of the injury itself, be it surgical or conservative. It is important to understand that mobilization starts much earlier than weight-bearing. The nonweight-bearing time period also differs from patient to patient as that too depends on the type of approach that has been taken to manage the injury. That being said, weight-bearing is very important to minimize reflex sympathetic dystrophy syndrome and osteopenia, so the patients should be encouraged to start weight-bearing as soon as possible. Protocols will differ between patients having bilateral and unilateral calcaneal fractures. The structuring of the rehabilitation program according to the patients’ needs is what is essential to ensure good outcomes and will determine the return to activity and work. Stress fractures are a unique problem, and periodization of rehabilitation is the key.
I recognized in early April 2020 that many of the national and international academic and educational conferences had been postponed or canceled due to the impact of the world coronavirus disease-2019 (COVID-19) crisis. Our Steps2Walk humanitarian organization was forced to postpone many of our global programs in 2020, yet the ongoing need to fulfill our mission remained prescient. It was not clear when resumption of traditional meetings would take place, so I used this opportunity to develop the concept of an international Web-based meeting. This had never been attempted previously but I believed that it could take place with the resources that Steps2Walk could provide, the support of the world's foot and ankle leaders, and a strategic corporate partner. The goal of the Congress was therefore to support all surgeons during this time of crisis, recognizing the need to sustain our colleagues with a unique educational opportunity.