Hallux extensus is a persistent dorsiflexion of the first metatarsophalangeal joint. Apart from many other causes, it can also be caused by contracture of the extensor hallucis longus muscle, in our case resulting from surgical treatment of crural fracture. The authors present the case of a 17-year-old soccer player who sustained a fracture of both shin and calf bone during a soccer match and underwent surgical treatment with intramedullary nailing. While compartment syndrome wasn't observed, a postoperative complication in the form of progressive development of a dynamic type of hallux extensus was reported. The reason behind this complication was later found to be the interaction of the osteosynthesis material with the extensor hallucis longus muscle, which led to its scarring and shortening. A Z-lengthening of the musculus extensor hallucis longus tendon was indicated and performed with a good clinical outcome. During surgery, an anatomical variation in the course of the extensor hallucis longus was observed, which had to be taken into account to achieve a successful surgical outcome. Key words: cock-up big toe deformity, musculus extensor hallucis longus contracture, Z-lengthening tenotomy, crural fracture complication.
- MeSH
- fotbal zranění MeSH
- fraktury kostí chirurgie komplikace MeSH
- intramedulární fixace fraktury škodlivé účinky metody MeSH
- lidé MeSH
- mladiství MeSH
- palec nohy * chirurgie MeSH
- pooperační komplikace etiologie MeSH
- Check Tag
- lidé MeSH
- mladiství MeSH
- mužské pohlaví MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- kazuistiky MeSH
PURPOSE OF THE STUDY Total arthroplasty of the first metatarsophalangeal joint is one of the surgical treatment options for patients with advanced hallux rigidus. This study evaluates the pressure changes in the propulsion phase of the gait cycle using dynamic pedobarography after the total arthroplasty of the first metatarsophalangeal joint by Medin PH-Flex and their comparison with the control groups of patients with hallux rigidus and with asymptomatic patients. MATERIAL AND METHODS Dynamic pedobarograph was used to evaluate 15 first MTP joint replacements by Medin PH-Flex implants in 12 female patients, the average time since joint replacement was 3.5 years (1.5 to 5.5 years). The control group consisted of 13 forefeet in 12 patients with hallux rigidus of Grade 3 and Grade 4 according to the Coughlin classification and 17 healthy patients with no clear foot deformity, i.e. of a total of 34 forefeet. A zone for each metatarsal (M1-M5) and the big toe area (T1) were defined with the use of an integrated software. The difference between the pressure under the big toe area and the first metatarsal bone - hallux stiffness (T1-M1) and the forefoot balance parameter, i.e. the difference between the pressures under the medial and lateral half of the forefoot ((M1+M2)-(M3+M4+M5)), was obtained. The parameters were evaluated for each group during the propulsion phase of the gait, i.e. from 55% to 100% of the stance phase and from 75% to 100% of the stance phase, i.e. that part of propulsion when the greatest pressure is exerted on the big toe. RESULTS For the HS parameter (T1-M1) in 55% to 100% of the stance phase, the median value was -0.66 ± 1.22 (-1.90 to 1.45) in the control group, -0.85 ± 1.94 (-1.40 to 3.80) in patients with hallux rigidus, and -0.10 ± 1.48 (-1.30 to 2.40) in patients after the first MTP joint replacement. The median forefoot balance parameter from 55% of the stance phase was -3.48 ± 2.45 (-6.90 to 0.68) in healthy patients and -4.43 ± 2.72 (-6.98 to 0.23) in hallux rigidus patients. In patients after the joint replacement, the value was -3.00 ± 2.46 (-6.20 to 0.40). The data were statistically analysed by the Dunnett's and Tukey's multiple comparison tests. The hallux stiffness parameter showed a significant improvement after the joint replacement compared to patients with hallux rigidus (p<0.0001). No statistical significance was confirmed when comparing the joint replacement cases and the healthy patients from the control group (p=0.0007 and p=0.0010, respectively). As concerns the forefoot balance parameter, a significant difference was reported in patients with joint replacement compared to healthy patients from the control group and patients with hallux rigidus (p <0.0001). DISCUSSION The published pedobarographic studies differ in terms of the methodology used, the patient population and the parameters examined. The pedobarographic studies after the replacement of the first MTP joint or after its arthrodesis present inconclusive outcomes. According to the available literature, the joint replacement has the potential to improve mediolateral forefoot loading and to partially restore the weight-bearing function of the first ray. Our analysis of the HS parameter suggests that the MTP joint replacement can improve the big toe function compared to patients with hallux rigidus but fails to achieve the functional outcomes of healthy patients. When evaluating the forefoot balance (FB) parameter, we can observe less loading on the lateral half of the forefoot in the propulsion phase compared to hallux rigidus. Nonetheless, the joint replacement is unable to restore the physiological loading of the foot. CONCLUSIONS The first MTP joint replacement has the potential to improve forefoot function and to bring it closer to that of a healthy person, even though achieving physiological loading of the forefoot is unrealistic. Additional studies will be needed to confirm that the indication for the first MTP joint replacement is justified in hallux rigidus in terms of the effect on forefoot biomechanics. Key words: hallux rigidus, total replacement of the first MTP joint, dynamic pedobarography, footscan.
- MeSH
- biomechanika MeSH
- chůze (způsob) MeSH
- hallux rigidus * chirurgie MeSH
- lidé MeSH
- noha (od hlezna dolů) MeSH
- palec nohy * MeSH
- Check Tag
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- MeSH
- ablace škodlivé účinky MeSH
- acitretin aplikace a dávkování MeSH
- amputace MeSH
- angioplastika MeSH
- antiflogistika nesteroidní terapeutické užití MeSH
- biologická terapie * MeSH
- cyklosporin aplikace a dávkování MeSH
- dermatologické látky aplikace a dávkování MeSH
- dospělí MeSH
- etanercept aplikace a dávkování MeSH
- fototerapie MeSH
- gangréna chirurgie MeSH
- humanizované monoklonální protilátky aplikace a dávkování MeSH
- inhibitory agregace trombocytů terapeutické užití MeSH
- klindamycin terapeutické užití MeSH
- komorbidita MeSH
- lidé MeSH
- methotrexát aplikace a dávkování škodlivé účinky MeSH
- neúspěšná terapie MeSH
- obezita komplikace MeSH
- palec nohy chirurgie patologie MeSH
- progrese nemoci MeSH
- psoriáza * farmakoterapie komplikace terapie MeSH
- rizikové faktory MeSH
- sympatektomie chemická MeSH
- výsledek terapie MeSH
- zarostlé nehty chirurgie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- Publikační typ
- kazuistiky MeSH
Úvod: Traumatická ztráta palce ruky je vážné zranění ovlivňující schopnost pacienta pracovat a účastnit se každodenních činností. Hlavním cílem plastického chirurga je obnovit úchop ruky, často mikrochirurgickými metodami. Pacienti by však měli být informováni o všech následcích odběru tkáně. Cílem studie bylo posoudit dopad na došlap donorské nohy a na chůzi u pacientů, kteří podstoupili rekonstrukci palce ruky technikou twisted-toe modifikovanou Kempným. Materiál a metody: Studie se zúčastnilo 12 pacientů: všichni utrpěli ztrátu palce ruky mezi lety 2003 a 2011 a pro rekonstrukci byla použita technika twisted-toe. Byly hodnoceny změny v rozložení tlaku na chodidla a zatížení kloubů dolních končetin. Výsledky: Rozdíly mezi celkovým maximálním plantárním tlakem, integrálem tlakového času, kontaktní plochou a maximální silou mezi postiženou a nepostiženou končetinou; byly však zjištěny statisticky významné rozdíly v kinetických parametrech a momenteh předního kotníků a kolene. Závěr: Funkčnost donorské končetiny a anatomické postižení byly hodnoceny pomocí pedobarografických systémů a 3D analýzy chůze. Nejvýznamnější nálezy byly zaznamenány v rozdílné distribuci plantárního tlaku (zvýšený tlak v I., IV. a V. metatarzální oblasti) a přetížení mediálního kompartmentu kolenního kloubu. Proto by pro pacienty po rekonstrukci palce technikou twisted-toe mohlo být jako prevence osteoartrózy prospěšné nošení individuálně přizpůsobených vložek do bot.
Background: Traumatic thumb loss is a serious injury affecting patient´s ability to work and participate in activities of daily life. The main goal for a plastic surgeon is to restore hand grip, often by microsurgical methods. However, patients should be informed of all effects associated with tissue harvesting. The aim of the study was to assess the impact on donor foot and gait cycle in patients who have undergone thumb reconstruction using twisted-toe technique modified by Kempný. Material and methods: Twelve patients participated in the study: all suffered a thumb loss between the years 2003 and 2011 and the twisted-toe technique for thumb reconstruction was utilized. The changes in foot pressure distribution and lower extremity joint loading were evaluated. Results: The differences in total maximal plantar pressure, pressure time integral, contact area, and maximum force between the affected and non-affected foot were statistically significant (P ≤ 0.1). No significant differences of temporal gait parameters between the affected and non-affected extremity were observed; however, statistically significant differences in kinetics parameters, frontal ankle and knee moments were detected. Conclusion: Donor limb functionality and anatomical disability were assessed using pedobarography systems and 3D-gait analysis. The recorded differences in plantar pressure distribution (increased pressure in I., IV. and V. metatarsal areas) and overload of the medial compartment of the knee joint were the most significant findings. Therefore, wearing individually adapted shoe insoles as prevention of osteoarthrosis might be beneficial for patients after thumb reconstruction by a twisted-toe technique.
- Klíčová slova
- pedobarografie,
- MeSH
- analýza chůze přístrojové vybavení MeSH
- lidé MeSH
- palec nohy * transplantace MeSH
- palec ruky * transplantace MeSH
- pooperační komplikace MeSH
- pooperační období MeSH
- posturální rovnováha MeSH
- traumatická amputace chirurgie MeSH
- zákroky plastické chirurgie MeSH
- zatížení muskuloskeletálního systému MeSH
- zobrazování trojrozměrné metody MeSH
- Check Tag
- lidé MeSH
PURPOSE OF THE STUDY In this study, we retrospectively reviewed a consecutive case series of first metatarsophalangeal (MTP) joint arthroscopies performed in our department over a span of six years. This study aimed to evaluate the efficacy and safety of arthroscopic treatment for various first MTP joint pathologies. MATERIAL AND METHODS A total of 36 patients that underwent first MTP joint arthroscopy between January 2014 and December 2019 were reviewed. The mean age at the time of surgery was 38.3 years (range, 14-65), with no gender predominance (19 males). All arthroscopies were performed by a single surgeon using a 2.7 mm arthroscope with a 30° viewing angle as well as other standard instruments with a diameter equal to or smaller than 3.5 mm. Postoperative results were assessed by a satisfaction questionnaire obtained during the telephone interview. For patients with sesamoid bone pathology ability to return to sports activities was also evaluated. RESULTS The far most common indication, in even twenty-nine patients, was hallux rigidus, five patients were treated for nonunion of sesamoid bone fracture, one patient had an osteochondral defect of the first metatarsal head and one was treated due to the development of arthrofibrosis following the open corrective procedure of hallux valgus. The mean follow-up was 31.2 months. Thirty-four patients responded to the satisfaction questionnaire. Thirty patients (88.2%) were either satisfied or very satisfied with the procedure and thirty-one (91.2%) of them stated that they would undergo the same procedure again. The satisfaction rate for patients with early stages of hallux rigidus (grade 1 and 2) was 90.4%. Only one patient in this group (2.8%) required open revision surgery due to recurrence of pain and joint stiffness. All patients with nonunion of sesamoid bone fracture were very satisfied with the procedure, and three out of four patients (75%) who were also competitive athletes resumed their sports activity at the same or improved level after the arthroscopy. Regarding arthroscopy-related complications we observed four cases (11.1%) of iatrogenic injury to dorsal sensory nerves of the great toe, resulting in only one permanent sensory impairment. DISCUSSION Considering the high satisfaction rate and low rate of complications in our study, as well as those published in the literature, we can suggest that arthroscopy of the first MTP joint is a safe and effective procedure. CONCLUSIONS Arthroscopy of the first MTP joint certainly has a place in the treatment of some pathological conditions of the first MTP joint, and in our opinion, it should be first-line surgical therapy for the initial stages of hallux rigidus and sesamoid bone pathology. Key words: arthroscopy, metatarsophalangeal joint, great toe, hallux rigidus, cheilectomy, sesamoid bone, sesamoidectomy.
- MeSH
- lidé středního věku MeSH
- lidé MeSH
- palec nohy MeSH
- zarostlé nehty * terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
- Klíčová slova
- špony drátkové - Podofix,
- MeSH
- lidé středního věku MeSH
- lidé MeSH
- palec nohy MeSH
- zarostlé nehty * terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
- Klíčová slova
- špony drátkové, špony plastové,
- MeSH
- lidé MeSH
- palec nohy MeSH
- zarostlé nehty * etiologie prevence a kontrola terapie MeSH
- Check Tag
- lidé MeSH
This work concerns a biomechanical study aiming to ascertain the optimal type of joint resection when performing a joint arthrodesis. A 3-dimensional digital model of the first metatarsophalangeal joint including the entire first metatarsal bone and proximal phalanx using CT scans of the forefoot was created. Using this computer model, 4 types of resections; ball-and-socket, flat-on-flat, wedge 90°, and wedge 100° were simulated. Parameters measured using this model were the force necessary to separate the 2 fused surfaces, the surface area of the resected surfaces and the shortening of the first ray. By measuring the reactive force necessary to separate the phalanx from the first metatarsal, the 90° wedge resection was found to be the most stable, with comparable results in the case of the 100° wedge resection. Wedge resections are also more favorable when comparing the shortening of the first ray. Wedge resections, though being more technically difficult to perform prove to be the most stable for metatarsophalangeal joint-1 arthrodesis using this model.
