Orthotics for the Treatment of Lesser Toe Deformities
This study focuses on the conservative management of lesser toe deformities and will try to provide the reader with an overview on the portfolio of shoe modifications and orthotics available for the conservative treatment of lesser toe deformities, indication of each specific type of device, how they can impact on pain relief, and the rationale after considering conservative management as a first line of treatment and potentially avoiding surgery. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - April 21, 2024 Category: Orthopaedics Authors: Manuel Monteagudo, Ángel M. Orejana Source Type: research
Is It Necessary to Repair the Plantar Plate in the Management of Metatarsophalangeal Joint Instability?
Lesser metatarsophalangeal joint (MTPJ) instability is a common cause of metatarsalgia and is associated with plantar plate pathology. The instability is often due to chronic attenuation and attritional changes of the plantar plate and collateral ligaments, leading to eventual rupture. The plantar plate and collateral ligaments serve as the primary stabilizers of the MTPJ, and rupture or attenuation of these ligaments leads to instability. Surgical intervention is often necessary for plantar plate tears, with various approaches and techniques available. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - April 1, 2024 Category: Orthopaedics Authors: Neil K. McGroarty, Albert T. Anastasio, James A. Nunley Source Type: research
Hallux Rigidus Revisited
It ’s been nearly 9 years since we published an issue about hallux rigidus in Foot and Ankle Clinics of North America, and the incidence of hallux rigidus has increased as our population ages. Over this time period there has been significant progress made in theories of etiology, pathology, classific ation schemes, surgical treatment, and results, all of which we have highlighted in this issue. I know in my own practice I have had to rethink my treatment algorithm based on much of the information included in this issue. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - March 24, 2024 Category: Orthopaedics Authors: James A. Nunley Tags: Preface Source Type: research
Classical Surgical Alternatives for the Treatment of Lesser Toe Deformities
Lesser toe deformities are the second most common deformities around the foot and ankle. Early reports of procedures for lesser toe correction date back to the 1880s. Lesser toe deformities have a high variability of appearance. Thorough assessment of the joints involved in the deformity is necessary. Numerous techniques of soft tissue and osseous interventions are available and need to be included for individual correction. Osseous corrections are usually accompanied by soft tissue procedures. Kirschner-wire fixation is still an effective method of fixation, but internal fixation is probably the way to go for the future i...
Source: Foot and Ankle Clinics - March 23, 2024 Category: Orthopaedics Authors: Hans-J örg Trnka, Paul Trnka Source Type: research
Moberg and Moberg-Akin ( ‘Mo-Akin’) Osteotomies for Hallux Rigidus
Hallux rigidus represents the arthritis affecting the first metatarsophalangeal joint. It often leads to limited dorsiflexion, affecting gait and causing pain. Moberg osteotomy involves a dorsal closing wedge osteotomy on the proximal phalanx performed for early stages of hallux rigidus. This osteotomy shifts the load to the plantar aspect and compensates for the limited dorsiflexion. Moberg osteotomy can be combined with Akin osteotomy to create a biplanar correction for hallux interphalangeus. The procedure has favorable outcomes and high patient satisfaction rates with low complications. Larger high-quality studies are ...
Source: Foot and Ankle Clinics - March 23, 2024 Category: Orthopaedics Authors: Mohamad Issa, Conor O ’Neill, Karl Schweitzer Source Type: research
Arthrodesis for Hallux Rigidus
First metatarsophalangeal (MTP) joint fusion, or arthrodesis, has been a cornerstone treatment for advanced joint degeneration since the 1950s, benefiting not only older patients but also younger individuals. The procedure boasts favorable long-term outcomes and a low rate of revision when fusion is successful. However, complications such as interphalangeal arthritis may occur, and nonunion or malunion can necessitate revision. While the first MTP fusion provides significant relief, its applicability varies, underscoring the need for careful patient selection. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - March 23, 2024 Category: Orthopaedics Authors: Antoine S. Acker, Jeffrey Liles, Mark E. Easley Source Type: research
Minimally Invasive Cheilectomy for Hallux Rigidus
Hallux metatarsophalangeal joint cheilectomy is a joint-sparing technique that involves resection of the dorsal metatarsal head osteophytes; this may be achieved through minimally invasive and arthroscopic techniques. General indications for minimally invasive surgery (MIS) cheilectomy are mild-to-moderate hallux rigidus (Grades I –II) with symptomatic dorsal osteophytes causing dorsal impingement and/or shoe wear irritation in those who have failed extensive nonoperative management. The literature confirms equivalent outcomes to open cheilectomy; however, it is somewhat inconsistent regarding superiority. The theoretic ...
Source: Foot and Ankle Clinics - March 21, 2024 Category: Orthopaedics Authors: Amanda N. Fletcher, Vandan Patel, Rebecca Cerrato Source Type: research
Imaging Considerations in Differentiating Plantar Plate Pathology and Webspace Neuroma
Myriad pathologies affect the lesser toes. In this article, the focus is on the challenging radiological differential diagnosis of plantar plate (PP) degeneration and tear versus webspace neuroma. It is now understood that PP tear and even degeneration without tear is most accompanied by reactive pericapsular soft tissue thickening (pseudoneuroma), which contributes to neuritic symptoms that are often indistinguishable from webspace neuroma. In this article, the authors will review the differing clinical presentations and radiographic, sonographic, and MRI findings of these entities and the different acquired toe deformiti...
Source: Foot and Ankle Clinics - March 21, 2024 Category: Orthopaedics Authors: Rodrigo O.C. Aguiar, Hilary Umans Source Type: research
Rheumatoid Deformities of the Lesser Toes
Rheumatoid arthritis is a chronic heterogeneous autoimmune disease characterized by painful joint inflammation and causes destructive bone erosions. Most common deformities in the rheumatoid forefoot are hallux valgus and claw toes. Radiographs are helpful to show the deformity and the associated pathologies. Nonsurgical treatment is focused on pain reduction, function preservation, and prevention of further deformity, by relieving pressure and pain with shoe modification and use of insoles. Surgical procedures can address either soft tissue and bone deformities that can be performed by a percutaneous or open approach. (So...
Source: Foot and Ankle Clinics - March 21, 2024 Category: Orthopaedics Authors: Tania S. Mann, Gustavo Araujo Nunes Source Type: research
Lesser Metatarsophalangeal Joint Instability
Lesser metatarsophalangeal (MTP) joint instability can cause pain in the MTP joints with ambulation. The goal of nonsurgical treatment is to offload the metatarsal heads and stabilize the MTP joints. Achilles stretching can be effective by decreasing pressure in the forefoot with ambulation. Metatarsal offloading does not stabilize the lesser MTP joints but can alleviate pain in the plantar surface of the metatarsal heads. Crossover taping and strapping can stabilize the MTP joint and resist MTP hyperdorsiflexion. Steroid injections can alleviate inflammation but is also associated with further attenuation of the ligamento...
Source: Foot and Ankle Clinics - March 21, 2024 Category: Orthopaedics Authors: Paul G. Talusan Source Type: research
Lesser Metatarsophalangeal Joint Instability
This article provides an overview of the open surgical treatment alternatives and the most used techniques to solve instability of the metatarsophalangeal joints. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - March 21, 2024 Category: Orthopaedics Authors: Daniel Baumfeld, Caio Nery Source Type: research
Neuropathic Deformities of the Lesser Toes
Neuropathic deformities of the lesser toes refer to a variety of neuromuscular disorders in which a stiff lesser toe deformity is encountered. Claw toes, hammer toes, and mallet toes can be found. Each deformity is better described as which joint of a particular toe is in a flexed or extended position. This information guides the surgeon to which joint should be addressed and what additional soft tissue procedure may be needed. Interphalangeal joint fusions are the procedure of choice, together with extensor or flexor tenotomies. Good results can be expected, with low revision rates. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - March 9, 2024 Category: Orthopaedics Authors: Emilio Wagner, Pablo Wagner Source Type: research
Posttraumatic Avascular Necrosis of the Talus
Avascular necrosis (AVN) of the talus in a posttraumatic setting describes a condition of temporary or permanent bone death of a different extent, initiated by a circulatory disturbance. It is estimated that about 75% of all talar AVNs are caused by a prior trauma. The incidence of posttraumatic AVN rises with higher energy of injury, severity of talar body or neck displacement, fracture comminution, and injury to the soft tissues and major vessels in the lower leg and ankle region. These conditions are often seen in open fractures, fracture dislocations, and pure dislocations. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - March 4, 2024 Category: Orthopaedics Authors: Lubomir Kopp, Stefan Rammelt Source Type: research
Lesser Metatarsophalangeal Joint Instability
Instability of the lesser toes metatarsophalangeal (MTP) joints is a common forefoot problem and can present as metatarsalgia, synovitis, and lesser toe deformities. The plantar plate contributes to MTP joint stability through its interaction with the plantar aponeurosis, and plantar plate insufficiency is the primary cause of MTP joint instability. Conservative treatment options, including the use of nonsteroidal anti-inflammatory medications, intra-articular steroid injections, orthosis, and accommodative shoe modifications, generally provide only temporary relief and do not effectively halt the progression of deformity ...
Source: Foot and Ankle Clinics - February 20, 2024 Category: Orthopaedics Authors: Charles Churk Hang LI, Tun Hing LUI Source Type: research
Regeneration
Bone Marrow Stimulation of osteochondral lesions of the talus has been shown to be a successful way to treat cartilage injuries. Newer data suggest that Bone Marrow Stimulation is best reserved for osteochondral lesions of the talus Sizes Less Than 107.4 mm2 in area. Additionally, newer smaller and deeper techniques to perform bone marrow stimulation have resulted in less subchondral bone damage, less cancellous compaction, and superior bone marrow access with multiple trabecular access channels. Biologic adjuvants such as platelet-rich plasma (PR P), hyaluronic acid (HA), and bone marrow aspirate concentrate (BMAC) may ...
Source: Foot and Ankle Clinics - February 10, 2024 Category: Orthopaedics Authors: Jeff S. Kimball, Richard D. Ferkel, Eric I. Ferkel Source Type: research
