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- Long first ray
- Metatarsus Primus Elevatus - dorsiflexed 1st MT (controversial)
- Pes Planus
- high heels
- Previous gout, Hallux valgus
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- XR - toe, dorsal osteophyte, extent of joint narrowing
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- Coughlin and Shurnas (clinical and radiological)
- Grade 1 = Mild
- Grade 2 = XR < 50% narrowing
- Grade 3 = XR > 50% narrowing (no pain during ROM; only terminal)
- Grade 4 = pain at mid ROM (severe arthritis)
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- Stiff soled shoe/ Morton extension
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- Cheilectomy KIV moberg vs Osteotomies vs Fusion vs Arthroplasty
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- Excision of 30% of dorsal joint surface ➔ if insufficient correction ➔ moberg P1 dorsiflexion (dorsal closing wedge) osteotomy
- ~ 10% need fusion in 10 years.
- Option of MIS ➔ risk of EHL rupture
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- These osteotomies aim to obtain longitudinal decompression of the joint by proximal translation of the MT head and plantar flexing as desired.
- Shortening - allows the surrounding soft tissues to relax and remodel.
- Plantar flexion reduces the dorsal impingement between the metatarsal head and the base of the phalanx, which limits the hallux dorsiflexion and produces the dorsal chondral lesion of the head itself.
- This address Metatasus Primus Elevatus
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- Weil's shortening Osteotomy
- Cerccarini et al. 2015 FAI - case series of 40 Weil's shortening ostetomy ➔ good results with preservation of motion.
- Youngswick osteotomy
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- Ensure IPJ is flexible
- Approach – medial or dorsal incision; protect the dorsomedial cutaneous nerve
- Technique
- Remove subchondral bone. Avoid excessive shortening. If shortened ➔ bone graft (shortening leads to violation of parabola and transfer metatarsalgia)
- Hardware: screw + dorsal low profile plate
- Position = Dorsiflexion 10 ° for females high heel, neutral rotation.
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- Cartiva resurfacing arthroplasty – synthetic polyvinyl alcohol
- Pros – joint preserving
- 2017 RCT FAI – Outcomes – no difference from union
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- Bone block arthrodesis to prevent shortening of 1MT and resulting transfer metatarsalgia
- ✘ Keller resection arthroplasty (low function)
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- “Dorsal plate + screw combo” has been found to be the most stable construct
- Joel Politi et al. compared screw only, K-wires, Plate only and plate + screw combo
politi2003.pdf120.3KB
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- Use a flat surface intraop, press on the foot ➔ pulp should be lifted up 5mm
- 20 ° dorsiflexion with reference from the 1st MT.
