Open AccessTreatment of Brachymetatarsia Involving the Great Toe
Author(s) -
Hui Taek Kim,
Sung Min Hong,
In Hee Kim
Publication year - 2018
Publication title -
jb and js open access
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.786
H-Index - 3
ISSN - 2472-7245
DOI - 10.2106/jbjs.oa.17.00046
Subject(s) - phalanx , first metatarsal , medicine , ankle , metatarsal bones , interphalangeal joint , surgery , metatarsophalangeal joints , proximal phalanx , toe , osteotomy , physics , thermodynamics
Background: Brachymetatarsia is usually treated by lengthening the metatarsals, but excessive lengthening can be associated with complications. Our technique combines 1-stage step-cut lengthening of the first metatarsal with shortening and/or lengthening of the neighboring metatarsals and/or phalanges. Methods: Twenty-four feet (15 patients) were treated for first-ray brachymetatarsia. Widely available commercial image-editing software was used to make a preoperative plan for each patient, with emphasis on the creation of a cosmetically satisfying toe-length arc with minimum shortening and lengthening of the affected metatarsals and proximal phalanges. Length gain and percentage increase were also recorded postoperatively. The American Orthopaedic Foot & Ankle Society (AOFAS) hallux metatarsophalangeal-interphalangeal scoring system was used for clinical evaluation. Results: In all 24 feet, smooth parabolas were created at the level of the metatarsal heads and at the toe tips. All patients showed osseous union, and no complications were noted. However, most patients showed mildly restricted range of motion of the first metatarsophalangeal joint. The mean AOFAS score of the hallux significantly improved from 88.3 preoperatively to 98.1 at the latest follow-up (p < 0.001). Conclusions: One-stage step-cut lengthening of the first metatarsal combined with shortening and/or lengthening of the adjacent metatarsal and phalangeal bones provides excellent cosmetic and functional results. Level of Evidence: Therapeutic Level IV . See Instructions for Authors for a complete description of levels of evidence.