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The rheumatoid foot
Published in Maneesh Bhatia, Essentials of Foot and Ankle Surgery, 2021
Patricia Allen, Jasdeep Giddie
Over the years, several different approaches have been advocated for metatarsal head or proximal phalangeal resection, utilising both dorsal and plantar incisions. Metatarsal head excision is performed either via a plantar incision, commonly excising an ellipse of plantar skin in an attempt to bring the plantar fat pad back proximally so that it lies under the metatarsal necks or, via dorsal longitudinal incisions in the 2nd and 4th web spaces. Proximal phalangeal resection can only be achieved through dorsal incisions. Stainsby described a technique utilising four separate Chevron-shaped incisions, apex medial, over the individual rays, so as to allow exposure for resection of the proximal three quarters of the proximal phalanx and harvest of the individual extensor tendons for interposition arthroplasty. The plantar plates (and thus plantar fat pad) are repositioned under the metatarsal heads, and the toes are then stabilised with a k-wire into the metatarsal shaft (12). Meticulous attention to the soft tissues is required to avoid wound complications. The metatarsal heads are part of the weight-bearing system of the foot and retaining them helps restore a more normal weight-bearing function of the foot as well as re-establishing the transverse tie-bar system.
Surgery of the Foot
Published in Timothy W R Briggs, Jonathan Miles, William Aston, Heledd Havard, Daud TS Chou, Operative Orthopaedics, 2020
Yaser Ghani, Simon Clint, Nicholas Cullen
Facing the blade away from the neurovascular bundles, the collateral ligaments are divided, allowing deliverance of the condyles of the proximal phalanx into the wound. Using a bone cutter, the condyles are excised at the metaphyseal flair. Sufficient bone must be removed to allow the toe to be straightened without undue tension on the tissues, especially the neurovascular bundles. The plantar plate is released from the middle phalanx allowing its base to be delivered. The articular surface is then decorticated using a nibbler. A double-ended K-wire is advanced in an antegrade direction through the middle and distal phalanges, aiming to come out just below the nail bed. The joint is then reduced and the wire advanced into the proximal phalanx to secure the joint.
Diagnosis and conservative management of great toe pathologies: a review
Published in Postgraduate Medicine, 2021
Nicholas A. Andrews, Jessyca Ray, Aseel Dib, Whitt M. Harrelson, Ankit Khurana, Maninder Shah Singh, Ashish Shah
Grade 3 injuries necessitate orthopedic referral, as many of these injuries will require surgical repair. Depending on severity, surgery may be indicated to repair the plantar plate, including the capsule and ligament support of metatarsal. Partial sesamoidectomy with capsular repair may be warranted in cases with additional sesamoid injury [20]. In the event of surgical repair, patients may be placed on DVT prophylaxis while weight-bearing ambulation is interrupted.
The dysmorphic metatarsal parabola in diabetes—clinical examination and management: a narrative review
Published in Journal of Endocrinology, Metabolism and Diabetes of South Africa, 2021
AT Thompson, B Zipfel, C Aldous
A high risk (2–5 times) of plantar plate pathology of the second metatarsophalangeal joint has been associated with shortness of the first metatarsal greater than 4 mm relative to the length of the second metatarsal.14