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Biomedical subjects

Michael J Coughlin

Publications and source records attributed to Michael J Coughlin.

At least 19 recordsLinked to original sources
PubMed2006

Coralline hydroxyapatite bone graft substitute in hindfoot surgery.

BACKGROUND: Coralline hydroxyapatite bone graft substitute material is created by the conversion of the calcium carbonate structure of coral into hydroxyapatite. The microstructure of the material resembles cancellous bone and provides an osteoconductive scaffold for bone ingrowth. The use of this material is reported in the orthopedic oncology and trauma literature. Short-term reports in foot procedures have been reported. METHOD: A retrospective review identified 10 patients who had undergone hindfoot arthrodesis with coralline hydroxyapatite bone graft. The charts were reviewed for outcomes, operative complications, and time to union. Nine of the 10 patients were available for additional examination. RESULTS: The average followup was 6 years. There were three complications. One patient had sural nerve numbness with partial resolution which was unrelated to the graft material. A rheumatoid patient on methotrexate and prednisone developed a deep wound infection 9 months after surgery. One patient had a nonunion of the talonavicular joint. Eight of the 10 patients reported good or excellent results. Radiographs continued to demonstrate the presence of the graft material at 6 years. Radiographs showed extrusion of the graft from the joint in all patients. No patient had symptoms from the extruded material. DISCUSSION: Coralline hydroxyapatite bone graft substitute appears to be a clinically effective material for use in foot procedures. No adverse events could be linked to the graft material. The graft material is difficult to contain and extrusion was present in all patients. The slow resorption is a concerning characteristic of the graft material. At 6-year followup, the continued presence of the material has not shown any adverse effect.

Arthrodesis↗
PubMed2006

Prospective CT scan evaluation of hindfoot nonunions treated with revision surgery and low-intensity ultrasound stimulation.

BACKGROUND: The reported fusion rates of revision arthrodesis for hindfoot nonunions are relatively low compared to primary procedures. Exogenous ultrasound has been shown to accelerate the healing process of acute fractures and fracture nonunions but has not been previously evaluated for the treatment of hindfoot pseudarthroses. The purpose of this study was to evaluate the clinical and radiographic outcomes of revision hindfoot arthrodeses treated with postoperative low-intensity ultrasound. METHODS: Thirteen patients (13 feet) with established hindfoot nonunions were treated with revision arthrodesis and adjunctive postoperative low-intensity ultrasound. The patients were prospectively evaluated with hindfoot American Orthopaedic Foot Ankle Society (AOFAS) and pain visual analog scores, subjective satisfaction surveys, and serial radiographs. All patients underwent postoperative CT to evaluate the fusion mass, which was quantitated using a novel system. The mean follow-up from revision surgery was 16.3 (range 12 to 25) months. The 10 subtalar and three triple revision arthrodeses comprised a total of 19 joints. RESULTS: Based on the CT scans and the grading system devised, there was one nonunion (isolated subtalar revision), five partial unions, and 13 complete unions. The 10 isolated subtalar revision arthrodeses demonstrated a mean fusion ratio of 65.1% (range 14% to 100%). Excluding the one nonunion, the average fusion ratio for the subtalar revisions was 77.3%. The mean hindfoot AOFAS score improved significantly (p < 0.005) from 45.3 (range 18 to 65) preoperatively to 72.3 (range 47 to 92) postoperatively out of 94 possible points. There was a significant (p < 0.005) decrease in the pain visual analog scale (VAS) from a preoperative value of 7.7 (range 4 to 10) to a postoperative value of 2.5 (range 0 to 6). There was a weak inverse correlation between the fusion percentages and the pain VAS scores (r = -0.26) and a weak correlation (r = 0.29) between the fusion percentages and the final AOFAS scores. CONCLUSIONS: When used to evaluate hindfoot arthrodeses, plain radiographs may be misleading. CT provides a more accurate assessment of the healing, and we have devised a new system to quantitate the fusion mass. Postoperative low-intensity ultrasound is easy to apply and administer, with no identifiable risks or contraindications. Although this modality may facilitate the fusion process, we cannot definitely conclude the specific relative value of low-intensity ultrasound because this was not a controlled series.

Adolescent↗
PubMed2006

Dislocation of the posterior tibial tendon: a literature review and presentation of two cases.

Dislocation of the posterior tibial tendon has rarely been reported in the English literature. The most common mechanism is a traumatic injury. We present two patients with a traumatic dislocation. One patient was delayed in presentation to the treating physician by seven months. The second patient presented within one week. Both underwent surgical stabilization with repair of the torn retinaculum and deepening of the groove posterior to the medial malleolus. They have both returned to their pre-injury level of activity without any recurrence of dislocation.

Adult↗
PubMed2005

First metatarsophalangeal joint motion after hallux valgus correction: a cadaver study.

BACKGROUND: Surgical correction of hallux valgus deformities often results in decreased first metatarsophalangeal joint (MTPJ) range of motion. Loss of motion has been shown to affect patient satisfaction. The purpose of this study was to evaluate the immediate change in MTPJ range of motion that occurs after a distal soft-tissue reconstruction (DSTR) and proximal metatarsal osteotomy (PMO). METHODS: DSTR and PMO were done on 16 below-knee cadaver specimens with clinically apparent hallux valgus deformities. Two examiners assessed preoperative and postoperative dorsiflexion (DF), plantarflexion (PF), and the total range of motion of the first MTPJ. The hallux valgus angle (HVA) and 1-2 intermetatarsal angle (1-2 IMA) were measured on simulated weightbearing radiographs before and after operative correction. Changes in motion were analyzed and correlated with the angular measurements. RESULTS: The mean total range of motion preoperatively was 85.4 degrees (DF 70.5 degrees, PF 14.9 degrees) and significantly decreased (p < 0.005) 23.2 degrees to a postoperative value of 62.2 degrees (DF 47.9 degrees, PF 14.3 degrees). There was a significant (p < 0.005) decrease in DF (22.6 degrees) with the operative correction, but the loss of PF (0.6 degrees) was not significant (p = 0.7). There was no correlation between the magnitude of correction (HVA, 1-2 IMA) and the change in PF, DF, or total motion. CONCLUSIONS: Correction of a hallux valgus deformity with a DSTR and PMO is associated with an immediate loss of range of motion that primarily affects the DF arc of the first MTPJ. The selective loss of DF may be related to a nonisometric capsular repair or tight intrinsic musculature, although there was no correlation with the magnitude of angular correction. The immediate decrease in motion observed in this cadaver study underscores the importance of early postoperative joint mobilization to prevent long-term stiffness after bunion surgery.

Aged↗
PubMed2005

Arthrodesis of the first metatarsophalangeal joint for idiopathic hallux valgus: intermediate results.

BACKGROUND: Followup studies documenting the outcome of primary metatarsophalangeal (MTP) joint arthrodesis for treatment of hallux valgus deformities are rare. The purpose of this report was to evaluate the results of first MTP joint arthrodesis as treatment for moderate and severe hallux valgus deformities over a 22-year period in a single surgeon's practice. METHODS: All living patients treated between 1979 and 2001, for moderate and severe idiopathic hallux valgus deformities with first MTP joint arthrodesis were contacted and asked to return for a followup examination. Outcomes were assessed by comparing preoperative and postoperative pain, function, and radiographic appearance. First ray mobility and ligamentous laxity also were assessed postoperatively. RESULTS: Eighteen of 21 of the first MTP joints had successfully fused with the primary procedure at an average followup of 8.2 years (range 24 to 271 months). The time to union averaged 10 (range 7 to 15) weeks. Two of the three nonunions, both in the same patient, were asymptomatic and were not revised. One required a revision to achieve fusion. The average corrections in the hallux valgus angle and 1-2 intermetatarsal (IM) angle were 21 degrees and 6 degrees, respectively, and the average postoperative dorsiflexion angle was 22 degrees. Subjective satisfaction was rated as excellent in seventeen of 21 cases (80%) and good in the remaining four (20%). There was significant reduction in postoperative pain (p < 0.001), complete resolution of lateral metatarsalgia, and the postoperative American Orthopaedic Foot and Ankle Society (AOFAS) scores averaged 84 (range 72 to 90) at final followup. Major activity restrictions after surgery were uncommon, and all patients were able to wear conventional or comfort shoes. Interphalangeal (IP) joint arthritis progressed in seven of 21 feet (33%), but all of these changes were mild. CONCLUSIONS: In the present study, arthrodesis of the first MTP joint for idiopathic hallux valgus resulted in a high percentage of successful results at an average followup of over 8 years.

Aged↗
PubMed2005

The validity and reliability of the Klaue device.

BACKGROUND: Excessive first ray mobility has been implicated as the cause of many forefoot abnormalities. The association between hypermobility and forefoot pathology is controversial, and this is largely related to the difficulty in quantifying first ray motion. Manual examinations have been shown to be unreliable. Klaue etal. developed a device consisting of a modified ankle-foot orthosis with an attached micrometer to objectively measure first ray mobility. The purpose of this study was to evaluate the validity and reliability of this device. METHODS: Sixteen fresh-frozen, below-knee amputation specimens with hallux valgus were used for the study. The study was divided into two parts. Part I was an analysis of the validity of the Klaue device; first ray dorsal displacement was measured on lateral radiographs following manual manipulation, and values were statistically compared to the Klaue device measurements. Part II of the study was an evaluation of intraobserver and interobserver agreement. Two clinicians used the Klaue device on each of the cadaver limbs, and values of first ray sagittal mobility were recorded and compared. RESULTS: The mean value of first ray mobility measured with the Klaue device was 7.5 mm and the average displacement measured from the lateral radiographs was 7.4 mm. Paired t-testing showed no significant difference between the Klaue and radiographic measurements (p = 0.83). The mean first ray mobility by examiners 1 and 2 with the Klaue device were identical (10.5 mm), and statistical analysis showed no significant interobserver or intraobserver differences. CONCLUSIONS: The results confirm the validity of the Klaue device and limited variability of measurements between experienced users.

Aged↗
PubMed2005

A comparison of device measures of dorsal first ray mobility.

BACKGROUND: Devices built by Glasoe and Klaue have been used in several studies to measure first ray mobility. Both devices measure sagittal motion of the first ray in a dorsal direction. The primary difference in the devices is the method of the load imposed. This study investigates whether first ray mobility measured with the Glasoe device is similar to the amount of mobility measured with the Klaue device. METHODS: Using the devices described by Glasoe and Klaue, dorsal first ray mobility was measured in 39 patients who had foot and ankle problems. Paired t-tests were computed to assess for differences between device measures of dorsal mobility. Intraclass correlation coefficient (ICC) and absolute difference values were computed to further assess the agreement in measures. RESULTS: Dorsal mobility measured with the Glasoe device averaged 4.9 mm (1.8 to 9.3 mm). Dorsal mobility measured with the Klaue device averaged 5.2 mm (2.5 to 8.5 mm). Paired t-tests (p = 0.12) revealed no significant difference in measures. An ICC of 0.70 and a mean absolute difference of 0.9 mm (SD 0.8) were found between the two clinical measures further suggesting agreement. CONCLUSION: Results indicated that the two devices possess similar diagnostic accuracy in the measurement of dorsal first ray mobility.

Adolescent↗
PubMed2005

Proximal metatarsal osteotomy and distal soft tissue reconstruction as treatment for hallux valgus deformity.

The correction of a hallux valgus deformity with a proximal 1(st) metatarsal osteotomy and distal soft tissue repair is achieved with a three-incision technique. A lateral soft tissue release and reconstruction at the first metatarsophalangeal joint releases contracted structures including the lateral capsule, the transverse inter-metatarsal ligament and the conjoint adductor tendon. Rarely is the lateral sesamoid excised. Through a medial incision, the medial eminence or exostosis is resected. The sesamoids are realigned and the medial capsule is reefed. With a third incision, a proximal first metatarsal osteotomy is performed that corrects a widened 1-2 intermetatarsal angle. With correction of the hallux valgus and the 1-2 intermetatarsal angle, pronation of the hallux is corrected. This correction is routinely used for hallux valgus deformities characterized by subluxation of the metatarsophalangeal joint. In the presence of a mild hallux valgus deformity an osteotomy may not be necessary. With degenerative arthritis or a congruent metatarsophalangeal joint, alternative surgical procedures are indicated.

Adult↗
PubMed2004

Comprehensive reconstruction of the lateral ankle for chronic instability using a free gracilis graft.

PURPOSE: The purpose of this retrospective study was to assess the results of a novel surgical technique for the treatment of chronic lateral ankle instability using both a direct repair of the anterior talofibular ligament and a free gracilis tendon transfer to reconstruct anatomically the anterior talofibular and calcaneofibular ligaments. METHODS: Between December 1998 and February 2002, 28 patients (29 ankles) underwent an anatomic reconstruction of the lateral ankle ligaments for chronic ankle instability. Patients returned for a clinical and radiologic follow-up evaluation at an average of 23 months following surgery (range, 12-52 months). Outcomes were assessed by comparison of preoperative and postoperative American Orthopaedic Foot and Ankle Society (AOFAS) scores and visual analog pain scores as well as a postoperative Karlsson score. A subjective self-assessment rating was also obtained. All patients underwent preoperative and postoperative radiographic assessment including talar tilt and anterior drawer stress radiographs. RESULTS: Twenty-eight patients (29 ankles) (100%) returned for final evaluation. Good or excellent outcome was noted on patient subjective self-assessment, pain scores, AOFAS, and Karlsson scores at final follow-up in all patients. Ankle range of motion was not affected by lateral ankle reconstruction. The talar tilt was reduced from a mean of 13 degrees to 3 degrees (p <.0001) and the anterior drawer was reduced from a mean of 10 mm to 5 mm (p <.0001) by the lateral ankle ligamentous reconstruction. CONCLUSION: In the present study, lateral ankle reconstruction with a direct anterior talofibular ligament repair and free gracilis tendon graft augmentation resulted in a high percentage of successful results, excellent ankle stability with a minimal loss of ankle or hindfoot motion, and marked reduction of pain at an average follow-up of almost 2 years.

Adolescent↗
PubMed2004

Evaluation of the Esmark bandage as a tourniquet for forefoot surgery.

PURPOSE: Although used routinely as a tourniquet in forefoot surgery, the pressure under an Esmark bandage has had little evaluation, and its use has been discouraged by some. The purpose of this study was to quantitate the pressure generated by an elastic bandage in a clinical setting and compare several different types of commercially available Esmark bandages. METHODS: Five foot and ankle fellowship program directors and five foot and ankle fellowship trained surgeons comprised the volunteer group which performed clinical simulations with a 6-inch Esmark bandage at the ankle level. Variables were then added, including different padding, a change in the position of the surgeon, and a 4-inch Esmark bandage. A questionnaire on their use of an elastic bandage in practice was also administered. Differences in pressure between different types of available 6-inch Esmark bandages were also compared. Pressure measurements were recorded by a pressure monitor device. RESULTS: The average pressure of the 10 surgeons' trials for three wraps with a tuck was 222 mm Hg (range, 146-319 mm Hg); four wraps with a tuck averaged 288 mm Hg (range, 202-405 mm Hg). No significant difference was seen between the standard technique and when the surgeon stood (three wraps and a tuck, p =.26; four wraps and a tuck, p =.33), when cast padding was used (three wraps and a tuck, p =.62; four wraps and a tuck, p =.74), or a 4-inch Esmark bandage (three wraps and a tuck, p >.99; four wraps and a tuck, p =.34). There was a significant decrease in the pressure when a blue towel was used as padding (three wraps and a tuck, p =.05; four wraps and a tuck, p =.04). Pressures obtained by the 10 different volunteers were uniform with little variation (three wraps and a tuck = 222 +/- 61 mm Hg; four wraps and a tuck = 288 +/- 68 mm Hg). No significant difference was seen between the different types of 6-inch Esmark bandages (p >.05). The combined complication rate for the 10 surgeons is estimated to be less than 0.1%. CONCLUSION: The practice of using a 6-inch Esmark bandage as a tourniquet at the ankle level for forefoot procedures is a safe and reliable method. Although pressures between surgeons vary, the average pressure is in an effective yet safe range. Recommendations for the application of the Esmark bandage as a tourniquet are given.

Ankle↗
PubMed2004

The effect of ankle position on the exam for first ray mobility.

PURPOSE: The clinical assessment of first ray motion in the sagittal plane, as originally described by Morton, is difficult to quantify. Different reports have shown inconsistent values and variability between the manual exam and examination using an external measuring device. The authors hypothesize that when performing a manual examination for evidence of increased first ray motion, the magnitude of first ray mobility varies as the position of ankle dorsiflexion/plantarflexion varies. METHODS: Using an external caliper (a modified Klaue device), the authors quantified first ray motion in reference to variable ankle positions in a group of normal patients, a group of patients with untreated moderate and severe hallux valgus, a group who had undergone a successful metatarsophalangeal joint arthrodesis for hallux valgus, and a small group who had previously undergone a plantar fasciectomy. A total of 119 feet (109 patients) were measured. In addition to first ray motion, radiographic data were compared between groups. RESULTS: With the ankle in the neutral dorsiflexion position, the mean first ray motion was 4.9 mm for the control group, 7.0 mm for the hallux valgus group, 4.4 mm for the metatarsophalangeal fusion group, and 7.7 mm for the plantar fasciectomy group. There was a significant decrease (p < .05) in first ray motion when the ankle was moved to the dorsiflexed position for all four groups. There was a significant increase in first ray motion when the ankle was moved to the plantarflexed position (p < .01) for all groups except the plantar fasciectomy group. No significant difference in first ray motion was observed for the plantar fasciectomy group between the neutral and plantarflexed ankle positions (p < .05). CONCLUSION: The exam for first ray mobility is influenced by the position of the ankle and may explain the discrepancy between the manual exam and measurement with an external device. Recommendations for the manual exam of first ray mobility are given.

Adult↗
PubMed2004

Hallux valgus and first ray mobility: a cadaveric study.

BACKGROUND: Several studies have demonstrated that patients with hallux valgus (HV) deformities have increased first ray sagittal mobility. However, the change in mobility that occurs after surgical correction of HV deformities has not been extensively evaluated. This study was done to determine if surgical realignment of the first ray in cadaver specimens with a proximal crescentic osteotomy and distal soft tissue reconstruction (DSTR) would reduce the first ray sagittal motion as measured with an external-type micrometer (the Klaue device). METHODS: Twelve fresh-frozen below-knee cadaver specimens with an HV deformity (HV angle > 15 degrees, 1-2 IM angle > 9 degrees) were used for the study. Standardized simulated weightbearing radiographs were obtained before and after the surgical correction of the deformity. The first ray sagittal motion was measured with an external micrometer (Klaue device) before correction of the HV deformity and after the procedure. All specimens had correction of the hallux valgus deformity with a DSTR and proximal crescentic osteotomy. Internal fixation was applied to secure the osteotomy site. RESULTS: The HV angle was corrected from a mean of 28.6 degrees to a mean of 11.0 degrees. The 1-2 IM angle was corrected from a mean of 12.9 degrees to a mean of 6.8 degrees. The average preoperative first ray sagittal motion was 11.0 mm (range, 8.5 mm to 13.5 mm). After the surgical repair, the mean sagittal first ray motion was significantly decreased (p <.0005) to a mean of 5.2 mm (range, 3.5 mm to 7.5 mm). CONCLUSION: After correction of HV deformities with a DSTR and a proximal crescentic osteotomy, first ray mobility in cadaver specimens was significantly reduced. The stabilization of first ray mobility that occurred immediately after surgical correction despite leaving the capsule of the first metatarsocuneiform (MC) joint undisturbed suggests that extrinsic anatomic features may play a role in first ray mobility. Additionally, stability of the first ray may be restored with a bunion procedure that does not sacrifice the first MC joint.

Aged↗
PubMed2004

Evaluation of Morton's theory of second metatarsal hypertrophy.

BACKGROUND: Originally introduced by Morton, the concept of hypertrophy of the medial cortex and the entire shaft of the second metatarsal as an objective sign of increased mobility of the first ray has not been subjected to much scrutiny. The goal of the current study was to assess the clinical relevance and reliability of radiographic measures of hypertrophy of the second metatarsal in relation to mobility of the first ray, pes planus, and tightness of the gastrocnemiussoleus in both control subjects and patients with diagnosed disorders of the forefoot. METHODS: Four study groups of forty-three subjects each were evaluated. The cohort included an asymptomatic control group as well as three groups made up of patients with symptoms and a diagnosis of hallux valgus, hallux rigidus, or interdigital neuroma. Mobility of the first ray (as measured with a device and method described by Klaue et al.), arch height, and ankle dorsiflexion were measured on physical examination. Plain weight-bearing radiographs and previously established equations were used to determine hypertrophy and the length of the second metatarsal, and the hallux valgus and first-second intermetatarsal angles were measured on plain radiographs as well. RESULTS: There was no significant difference between the control and symptomatic groups with regard to the values for hypertrophy of the second metatarsal. The patients with hallux valgus deformity had significantly greater mobility of the first ray (p < 0.001) compared with the controls. No correlation was found between values for hypertrophy of the second metatarsal and mobility of the first ray, the length of the first metatarsal, pes planus, or restricted ankle dorsiflexion. No correlation was found between mobility of the first ray and either pes planus or restricted ankle dorsiflexion. A weak correlation (r = 0.4) was noted between increased mobility of the first ray and the hallux valgus angle. CONCLUSIONS: Our findings do not support Morton's concept that medial cortical hypertrophy and increased shaft width of the second metatarsal are associated with increased mobility of the first ray or relative shortness of the first metatarsal. In addition, hypertrophy of the second metatarsal was not associated with either pes planus or restricted ankle dorsiflexion. We found the practice of using hypertrophy of the second metatarsal as an indicator of mobility of the first ray to be unreliable, and thus we consider it to be an inappropriate indication for arthrodesis of the first metatarsocuneiform joint in the treatment of hallux valgus deformity.

Adult↗
PubMed2004

Hallux rigidus.

BACKGROUND: There have been few long-term studies documenting the outcome of surgical treatment of hallux rigidus. The purposes of this report were to evaluate the long-term results of the operative treatment of hallux rigidus over a nineteen-year period in one surgeon's practice and to assess a clinical grading system for use in the treatment of hallux rigidus. METHODS: All patients in whom degenerative hallux rigidus had been treated with cheilectomy or metatarsophalangeal joint arthrodesis between 1981 and 1999 and who were alive at the time of this review were identified and invited to return for a follow-up evaluation. At this follow-up evaluation, the hallux rigidus was graded with a new five-grade clinical and radiographic system. Outcomes were assessed by comparison of preoperative and postoperative pain and AOFAS (American Orthopaedic Foot and Ankle Society) scores and ranges of motion. These outcomes were then correlated with the preoperative grade and the radiographic appearance at the time of follow-up. RESULTS: One hundred and ten of 114 patients with a diagnosis of hallux rigidus returned for the final evaluation. Eighty patients (ninety-three feet) had undergone a cheilectomy, and thirty patients (thirty-four feet) had had an arthrodesis. The mean duration of follow-up was 9.6 years after the cheilectomies and 6.7 years after the arthrodeses. There was significant improvement in dorsiflexion and total motion following the cheilectomies (p = 0.0001) and significant improvement in postoperative pain and AOFAS scores in both treatment groups (p = 0.0001). A good or excellent outcome based on patient self-assessment, the pain score, and the AOFAS score did not correlate with the radiographic appearance of the joint at the time of final follow-up. Dorsiflexion stress radiographs demonstrated correction of the elevation of the first ray to nearly zero. There was no association between hallux rigidus and hypermobility of the first ray, functional hallux limitus, or metatarsus primus elevatus. CONCLUSIONS: Ninety-seven percent (107) of the 110 patients had a good or excellent subjective result, and 92% (eighty-six) of the ninety-three cheilectomy procedures were successful in terms of pain relief and function. Cheilectomy was used with predictable success to treat Grade-1 and 2 and selected Grade-3 cases. Patients with Grade-4 hallux rigidus or Grade-3 hallux rigidus with <50% of the metatarsal head cartilage remaining at the time of surgery should be treated with arthrodesis.

Arthrodesis↗
PubMed2003

Hallux valgus in men. Part II: First ray mobility after bunionectomy and factors associated with hallux valgus deformity.

PURPOSE: To determine the 1st ray mobility following a distal soft-tissue procedure with proximal osteotomy (DSTP-PMO) and any associated factors. METHODS: A retrospective study of 30 men (35 feet) was performed. First ray mobility, ankle dorsiflexion, pes planus, and metatarsus adductus were evaluated at the final follow-up. All internal fixation was routinely removed at six to eight weeks postoperatively. Standard radiographs were evaluated and angular measurements were calculated on all feet. RESULTS: The mean follow-up was 78 months. No cases of degenerative arthritis of the 1st MTC joint were noted on follow-up radiographs. DSTP-PMO resulted in a mean postoperative 1st ray mobility of 4.9 mm (range, 2.5 to 8). In those feet evaluated following bunion correction, there was no correlation with pes planus, limited ankle dorsiflexion or metatarsus adductus. The preoperative hallux valgus angle and 1-2 intermetatarsal angle correlated with toe pronation and a positive family history. Twenty-two patients had an AOFAS score of 90-100, seven of 80-89 and one less than 69. CONCLUSION: Hallux valgus in this group of male patients was not associated with limited ankle dorsiflexion or pes planus. Men with toe pronation and a positive family history had a greater hallux valgus deformity than those without after a distal soft tissue repair with proximal first metatarsal osteotomy. There was no evidence of first ray hypermobility after a DSTP-PMO.

Achilles Tendon↗
PubMed2003

Operative repair of fourth and fifth toe corns.

METHODS: We report a retrospective review of 57 consecutive patients (72 feet) over a period of 20 years who had been treated operatively for either a lateral fifth toe corn or an interdigital corn of the fourth interdigital space more than two years previously. Of these, 51 patients (62 feet) returned for a follow-up evaluation at a minimum of two years (average of over seven years) which included a review of the interval history since the surgery, a physical examination, a radiographic evaluation, and assessment of the patient's satisfaction with the alignment and results of surgery. Treatment of 31 lateral fifth toe corns involved either a lateral condylectomy and flexor tenotomy or a complete condylectomy. Treatment of 31 interdigital corns comprised either a single condylectomy, double condylectomy of adjacent corns, or a complete condylectomy (hammertoe repair) of a symptomatic corn. Treatment in each case was dependent upon the severity of the deformity. RESULTS: There was found to be no significant difference in comparison of the two major groups (interdigital corns and lateral fifth toe corns) with the measurement of the relative length of the fourth and fifth metatarsals, toe malalignment, angulation of the fourth and fifth toes (MTP-4, MTP-5 angles), and the phalangeal-5 angle. Pain was relieved in 58 of 62 feet (93%) and subjective acceptable alignment was achieved in 54 of 62 feet (87%). At final follow-up 53 feet were rated by patients as excellent, seven as good, one as fair, and one as poor. Complications included numbness of the involved digit (six feet). There were two superficial infections. There were two cases of joint instability due to excessive bone resection. Joint stiffness was commonly observed (34/62 feet, 55%), but was not associated with diminished satisfaction at final follow-up. Mild asymptomatic recurrence of a callosity was noted in 10 feet and moderate or severe recurrence was noted in two feet. Dissatisfaction was associated with moderate or severe recurrence. CONCLUSION: In this retrospective study at an average of more than seven years, we achieved a high level of patient satisfaction treating both lateral fifth toe corns and interdigital corns with a partial and/or complete condylectomy, the choice depending upon the magnitude of the deformity and the callus, and the fixed nature of the lesser toe deformity.

Adult↗
PubMed2003

Soft-tissue arthroplasty for hallux rigidus.

Seven patients (seven feet) were evaluated at an average follow-up of 42 months following soft-tissue interposition arthroplasty of the hallux metatarsophalangeal (MTP) joint for severe hallux rigidus. The technique involved reaming of the base of the proximal phalanx and metatarsal head to decompress the first MTP joint and placement of a soft-tissue tendon bundle as a biologic spacer. Six of seven patients had bilateral disease, and a positive family history of hallux rigidus. At final follow-up, all seven patients rated their result as good or excellent, the level of pain was substantially reduced, and the mean AOFAS score substantially improved from 46 to 86 points. Mild metatarsalgia was noted by four patients and characterized by mild plantar callosities in these cases. The mean MTP dorsiflexion improved from 9 degrees to 34 degrees and patients demonstrated good to excellent plantarflexion strength on manual muscle testing and with toe rise. Physical examination of the involved feet demonstrated no evidence of pes planus, metatarsus primus elevatus, Achilles tendon contracture, or metatarsocuneiform joint hypermobility in any of the seven. The technique of soft-tissue interposition arthroplasty as described gave excellent pain relief and reliable function of the hallux, and is an alternative treatment to MTP arthrodesis in select cases of severe hallux rigidus.

Arthroplasty↗