By Louis-Samuel Barouk
For a very long time, forefoot surgical procedure had many hazards together with a painful postoperative interval and recurrence of deformities. New strategies – particularly shawl, the 1st metatarsal osteotomy and the Weil osteotomy of the lesser metatarsal – offer an important development within the therapy of static forefoot problems. the good toe osteotomy has additionally been tremendously enhanced. considering that 1991, the writer has brought those ideas in lots of nations, whereas constructing and learning the corresponding implants and the postoperative interval. He has additionally constructed surgical administration strategies that bridge those assorted osteotomies. greater than a thousand surgeons around the globe are utilizing those strategies, that are now commonly taught. during this moment variation of the ebook the final presentation is clearer and extra friendly and lots of images were changed. a number of subject matters are emphasised, particularly the good toe proximal phalanx osteotomy, the joint preservative surgical procedure in serious forefoot problems, together with revision after failed bunionectomy and rheumatoid forefoot following the "ms” element for a correct and powerful metatarsal shortening. finally, new methods are uncovered, quite in Claw toe and hammer with the PIP plantar unlock and the surgical procedure of the center phalanx and likewise the Weil osteotomy of the 1st metatarsal in hallux limitus.
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Extra info for Forefoot Reconstruction
Sometimes the correction may be obtained without DMAA correction but with pinching the medial part of the cartilage, with pain and stiffness. Fig. 07b5. DMAA operative findings. 1. Ordinarily the assessment of the DMAA is the same on preoperative X-rays and operative findings. 2. In arthritic hallux valgus, preoperative X-ray is insufficient to assess the DMAA; only the operative view (same case) shows clearly the lateral location of the head cartilage, needing correction. In case of severe hallux valgus deformity, DMAA correction has to be combined with an important lateral shift.
Both cuts are directed proximally to allow easier lateral displacement. The proximal cut is performed first in order not to jeopardize the distal fragment when performing the proximal cut. The proximal cut is accurately and harmlessly performed thanks to the PPE. The distal cut is 37 directed less proximally than the proximal cut to obtain good distal contact between the two fragments; it is performed just proximally to the dorsal capsule, thus remaining extra articular. Once the cuts are performed, the two fragments become separated.
This lowering should compensate the shortening but does not cancel the necessity to harmonize the metatarsal parabola. On this example, Wei! osteotomy on the lesser metatarsals is combined. Fig. 07f6. Scarf M 1 shortening: Relationships with the lesser metatarsals. I, 2, 3. Arthritic hallux valgus: The M I shortening is compensated by lowering. But this example is a limit: If the correction is longer than Smm we also have to shorten the 2nd metatarsal. 4. Shortening was needed to correct 27° of IM angle, while preserving correct MTP range motio n; in this case, combination of W ei/ M 2 shortening.