BOOK
Management of Metatarsalgia and Painful Lesser Toe Deformities , An issue of Foot and Ankle Clinics of North America, E-Book
(2018)
Additional Information
Book Details
Abstract
This issue of Foot and Ankle Clinics, edited by Dr. Todd Irwin, will cover Management of Metatarsalgia and Painful Lesser Toe Deformities. Topics covered in this volume include, but are not limited to: Conservative Treatment of Metatarsalgia and Lesser Toe Deformities; Treatment of Metatarsalgia with Distal Osteotomies; Treatment of Metatarsalgia with Proximal Osteotomies; Complications of Metatarsal Osteotomies; Gastrocnemius Recession for Metatarsalgia, Hammertoes and Clawtoes; Treatment of Rigid Hammertoe Deformity; Lesser Metatarsophalangeal Joint Instability; Managing Complications of Lesser Toe and Metatarsophalangeal Joint Surgery; and Treatment of Freiberg's Disease.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| Management of Metatarsalgia and Painful Lesser Toe Deformities\r | i | ||
| Copyright\r | ii | ||
| Contributors | iii | ||
| CONSULTING EDITOR | iii | ||
| EDITOR | iii | ||
| AUTHORS | iii | ||
| Editorial Advisory Board | vii | ||
| Contents | ix | ||
| Preface: Management of Metatarsalgia and Lesser Toe Deformities | ix | ||
| Anatomy and Physiology of the Lesser Metatarsophalangeal Joints | ix | ||
| Conservative Management of Metatarsalgia and Lesser Toe Deformities | ix | ||
| Treatment of Metatarsalgia with Distal Osteotomies | ix | ||
| Treatment of Metatarsalgia with Proximal Osteotomies | ix | ||
| Metatarsal Osteotomies: Complications | x | ||
| Gastrocnemius Recession for Metatarsalgia | x | ||
| Treatment of Flexible Lesser Toe Deformities | x | ||
| Treatment of Rigid Hammer-Toe Deformity: Permanent Versus Removable Implant Selection | xi | ||
| Lesser Metatarsophalangeal Joint Instability: Treatment with Tendon Transfers | xi | ||
| Lesser Metatarsophalangeal Joint Instability: Advancements in Plantar Plate Reconstruction | xi | ||
| Managing Complications of Lesser Toe and Metatarsophalangeal Joint Surgery | xi | ||
| Treatment of Freiberg Disease | xii | ||
| FOOT AND ANKLE CLINICS\r | xiii | ||
| FORTHCOMING ISSUES | xiii | ||
| June 2018 | xiii | ||
| September 2018 | xiii | ||
| December 2018 | xiii | ||
| RECENT ISSUES | xiii | ||
| December 2017 | xiii | ||
| September 2017 | xiii | ||
| June 2017 | xiii | ||
| Preface:\rManagement of Metatarsalgia and Lesser Toe Deformities | xv | ||
| Anatomy and Physiology of the Lesser Metatarsophalangeal Joints | 1 | ||
| Key points | 1 | ||
| INTRODUCTION | 1 | ||
| OSTEOLOGY | 2 | ||
| PLANTAR PLATE | 3 | ||
| PROPER AND ACCESSORY COLLATERAL LIGAMENTS | 4 | ||
| EXTENSOR TENDONS | 4 | ||
| LUMBRICALS AND INTEROSSEI | 5 | ||
| FLEXOR TENDONS | 5 | ||
| DEEP TRANSVERSE INTERMETATARSAL LIGAMENT | 6 | ||
| SUMMARY | 6 | ||
| REFERENCES | 6 | ||
| Conservative Management of Metatarsalgia and Lesser Toe Deformities | 9 | ||
| Key points | 9 | ||
| INTRODUCTION | 9 | ||
| METATARSALGIA PATHOPHYSIOLOGY | 9 | ||
| Metatarsalgia Throughout Gait Cycle | 10 | ||
| Primary Metatarsalgia | 10 | ||
| Secondary Metatarsalgia | 10 | ||
| Iatrogenic Metatarsalgia | 13 | ||
| NONOPERATIVE MANAGEMENT OF METATARSALGIA | 14 | ||
| Shoewear and Orthotics | 14 | ||
| Callus Shaving | 15 | ||
| Physical Therapy | 16 | ||
| Injections | 16 | ||
| Protected Weight Bearing | 16 | ||
| PATHOPHYSIOLOGY OF OTHER LESSER TOE ABNORMALITIES | 17 | ||
| Mallet Toes | 17 | ||
| Hammer Toes | 17 | ||
| Claw Toes | 17 | ||
| CONSERVATIVE MANAGEMENT OF MALLET, HAMMER, AND CLAW TOES | 17 | ||
| SUMMARY | 19 | ||
| REFERENCES | 19 | ||
| Treatment of Metatarsalgia with Distal Osteotomies | 21 | ||
| Key points | 21 | ||
| INTRODUCTION | 21 | ||
| CAUSES OF METATARSALGIA | 22 | ||
| MEDIATORS OF METATARSALGIA | 22 | ||
| BIOMECHANICAL CAUSES OF METATARSALGIA | 22 | ||
| CLINICAL EVALUATION | 22 | ||
| First Rocker (Heel Strike Progressing to Foot Flat on Floor) | 23 | ||
| Second Rocker (Progression of the Body over the Foot with Progressive Dorsiflexion of the Ankle) | 23 | ||
| Third Rocker (The Foot Pivots over the Metatarsal Heads) | 23 | ||
| TYPES OF DISTAL METATARSAL OSTEOTOMY TECHNIQUES | 23 | ||
| Open Techniques | 24 | ||
| Weil osteotomy | 24 | ||
| Distal metatarsal “V” osteotomy | 25 | ||
| Distal chevron osteotomy | 26 | ||
| Other open osteotomies | 26 | ||
| Percutaneous Techniques | 27 | ||
| Distal metatarsal metaphyseal osteotomies | 27 | ||
| Surgical technique | 27 | ||
| Postoperative management | 28 | ||
| Indications and contraindications | 28 | ||
| Results | 29 | ||
| Complications | 29 | ||
| Distal incomplete metatarsal metaphyseal oblique osteotomy | 29 | ||
| CLINICAL EXAMPLES EMPLOYING PERCUTANEOUS TECHNIQUES | 30 | ||
| Example 1 | 30 | ||
| Example 2 | 30 | ||
| SUMMARY | 31 | ||
| REFERENCES | 31 | ||
| Treatment of Metatarsalgia with Proximal Osteotomies | 35 | ||
| Key points | 35 | ||
| INTRODUCTION | 35 | ||
| CLINICAL EVALUATION | 36 | ||
| SURGICAL TREATMENT | 36 | ||
| STEP-CUT OSTEOTOMY | 38 | ||
| MIDSHAFT SEGMENTAL OSTEOTOMY | 39 | ||
| DORSAL OBLIQUE METATARSAL OSTEOTOMY | 40 | ||
| PROXIMAL METATARSAL OSTEOTOMY | 42 | ||
| SUMMARY | 45 | ||
| REFERENCES | 45 | ||
| Metatarsal Osteotomies | 47 | ||
| Key points | 47 | ||
| INTRODUCTION | 47 | ||
| ANATOMY | 47 | ||
| CLINICAL EVALUATION | 48 | ||
| PROXIMAL OSTEOTOMIES | 48 | ||
| STEP-CUT OSTEOTOMY | 48 | ||
| PROXIMAL SEGMENTAL OSTEOTOMY | 48 | ||
| OBLIQUE DIAPHYSEAL METATARSAL OSTEOTOMY | 50 | ||
| PROXIMAL V OSTEOTOMY | 50 | ||
| BAROUK–RIPPSTEIN–TOULLEC OSTEOTOMY | 51 | ||
| DISTAL METATARSAL OSTEOTOMIES | 51 | ||
| DISTAL CHEVRON OSTEOTOMY | 51 | ||
| DISTAL OBLIQUE OSTEOTOMY | 51 | ||
| WEIL OSTEOTOMY | 52 | ||
| SUMMARY | 54 | ||
| REFERENCES | 54 | ||
| Gastrocnemius Recession for Metatarsalgia | 57 | ||
| Key points | 57 | ||
| INTRODUCTION | 57 | ||
| Primary Metatarsalgia | 58 | ||
| Secondary Metatarsalgia | 58 | ||
| Iatrogenic Metatarsalgia | 58 | ||
| CLINICAL EXAMINATION | 58 | ||
| NONOPERATIVE TREATMENT | 60 | ||
| SURGICAL DECISION-MAKING PRINCIPLES | 61 | ||
| Open Surgical Treatment | 62 | ||
| Endoscopic Treatment | 63 | ||
| POSTOPERATIVE PROTOCOL | 64 | ||
| OUTCOMES | 64 | ||
| Complications | 66 | ||
| SUMMARY | 66 | ||
| REFERENCES | 66 | ||
| Treatment of Flexible Lesser Toe Deformities | 69 | ||
| Key points | 69 | ||
| INTRODUCTION | 69 | ||
| CLASSIFICATION | 70 | ||
| Morphologic Criteria | 71 | ||
| Optional Criteria | 73 | ||
| TREATMENTS | 73 | ||
| Conservative Treatment | 73 | ||
| Surgical Treatment | 76 | ||
| Open surgery | 78 | ||
| Percutaneous surgery | 80 | ||
| Soft tissues procedures | 80 | ||
| Osteotomies | 82 | ||
| Proximal phalanx | 82 | ||
| Middle phalanx | 83 | ||
| Condylectomy | 85 | ||
| Postoperative care | 86 | ||
| SURGICAL DECISION MAKING BASED ON DEFORMITY | 86 | ||
| Morphologic Criteria | 87 | ||
| Flexibility Criteria | 88 | ||
| Causal Criteria | 88 | ||
| AUTHORS’ EXPERIENCE | 88 | ||
| CONTRAINDICATIONS FOR PERCUTANEOUS TOE SURGERY | 88 | ||
| MIXED SURGERY CONCEPT | 89 | ||
| SUMMARY | 89 | ||
| REFERENCES | 89 | ||
| Treatment of Rigid Hammer-Toe Deformity | 91 | ||
| Key points | 91 | ||
| INTRODUCTION | 91 | ||
| PREOPERATIVE EVALUATION | 92 | ||
| SURGICAL INDICATIONS | 94 | ||
| PREOPERATIVE PLANNING | 94 | ||
| SURGICAL TREATMENT | 95 | ||
| POSTOPERATIVE CARE | 96 | ||
| OUTCOMES | 96 | ||
| COMPLICATIONS | 97 | ||
| ALTERNATIVE FIXATION METHODS | 98 | ||
| SUMMARY | 100 | ||
| REFERENCES | 100 | ||
| Lesser Metatarsophalangeal Joint Instability | 103 | ||
| Key points | 103 | ||
| INTRODUCTION | 103 | ||
| PATIENT ASSESSMENT | 104 | ||
| CLASSIFICATION | 106 | ||
| DECISION MAKING | 107 | ||
| SURGICAL TREATMENT | 107 | ||
| Preoperative Discussion | 107 | ||
| PATIENT POSITION AND INCISIONS | 107 | ||
| METATARSAL OSTEOTOMY | 108 | ||
| Technique | 109 | ||
| TENDON TRANSFER | 109 | ||
| Basic Principles of Successful Tendon Transfer | 110 | ||
| FLEXOR DIGITORUM LONGUS TENDON TRANSFER | 110 | ||
| Technique | 111 | ||
| Two-Incision Technique | 111 | ||
| One-Incision Technique | 111 | ||
| Alternative Transfer Method and Tendon Fixation | 113 | ||
| EXTENSOR DIGITORUM TENDONS TRANSFER | 114 | ||
| EXTENSOR DIGITORUM LONGUS TENDON TRANSFER | 114 | ||
| Technique | 114 | ||
| EXTENSOR DIGITORUM BREVIS TENDON TRANSFER | 116 | ||
| Technique | 116 | ||
| Alternative Extensor Digitorum Brevis Tendon Transfer | 117 | ||
| OTHERS TYPES OF TENDON TRANSFERS | 119 | ||
| Synthetic Implants as Substitutes to Tendon Transfers for Metatarsophalangeal Joint Instability | 119 | ||
| Technique | 119 | ||
| POSTOPERATIVE CARE | 120 | ||
| COMPLICATIONS | 120 | ||
| CLINICAL RESULTS IN THE LITERATURE | 121 | ||
| SUMMARY | 123 | ||
| REFERENCES | 123 | ||
| Appendix 1. APPENDIX 1 COMBINATION OF CLINICAL AND ANATOMIC GRADING SYSTEMS FOR LESSER TOES PLANTAR PLATE TEARS WAS POSSIBLE BECAUSE OF ... | 126 | ||
| Lesser Metatarsophalangeal Joint Instability | 127 | ||
| Key points | 127 | ||
| INTRODUCTION | 127 | ||
| ANATOMY AND BIOMECHANICS | 128 | ||
| Plantar Plate | 128 | ||
| Collateral Ligaments | 129 | ||
| Mechanics: Plantar Plate and Collateral Ligaments | 130 | ||
| CLINICAL EVALUATION | 130 | ||
| Presentation and Examination | 130 | ||
| Imaging: Radiographs | 132 | ||
| Imaging: MRI | 132 | ||
| Imaging: Arthrography | 134 | ||
| SURGICAL TREATMENT AND OUTCOMES | 135 | ||
| Plantar Plate Repair: Plantar Approach | 135 | ||
| Plantar Plate Repair: Dorsal Approach | 136 | ||
| Authors’ Preferred Technique | 138 | ||
| SUMMARY | 141 | ||
| REFERENCES | 141 | ||
| Managing Complications of Lesser Toe and Metatarsophalangeal Joint Surgery | 145 | ||
| Key points | 145 | ||
| INTRODUCTION | 145 | ||
| WOUND AND SOFT TISSUE | 146 | ||
| Toe Gangrene | 146 | ||
| Wound Infection | 147 | ||
| Stiffness | 147 | ||
| MALALIGNMENT | 148 | ||
| Floating Toe | 148 | ||
| Extension Contracture | 148 | ||
| Joint Subluxation or Dislocation | 148 | ||
| Transfer Metatarsalgia | 150 | ||
| Coronal Plane Deformity | 150 | ||
| NEUROLOGIC | 152 | ||
| Postsurgical Neuroma | 152 | ||
| Complex Regional Pain Syndrome Type 1 | 152 | ||
| FIXATION OR HARDWARE | 153 | ||
| Nonunion | 153 | ||
| Kirschner-Wire Breakage | 154 | ||
| SUMMARY | 154 | ||
| REFERENCES | 154 | ||
| Treatment of Freiberg Disease | 157 | ||
| Key points | 157 | ||
| INTRODUCTION | 157 | ||
| CLINICAL AND RADIOGRAPHIC EVALUATION | 158 | ||
| Clinical Evaluation | 158 | ||
| Radiographic Evaluation | 158 | ||
| STAGING | 158 | ||
| NONOPERATIVE MANAGEMENT | 158 | ||
| OPERATIVE MANAGEMENT | 159 | ||
| Joint-Sparing Procedures | 159 | ||
| Joint debridement | 159 | ||
| Core decompression | 160 | ||
| Grafting procedures | 161 | ||
| Metatarsal osteotomies | 161 | ||
| Joint-Reconstructing Procedures | 164 | ||
| Metatarsal head resection | 164 | ||
| Interpositional tissue arthroplasty | 164 | ||
| Osteochondral distal metatarsal allograft replacement | 165 | ||
| Synthetic implants | 165 | ||
| SUMMARY | 166 | ||
| REFERENCES | 167 |