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Principles of foot and ankle orthoses
Published in Maneesh Bhatia, Essentials of Foot and Ankle Surgery, 2021
An FFO is an effective method of intervention for this patient group (20). The functional goal is to ensure appropriate loading through the medial column thereby reducing the damaging forces that aim to accelerate deformity. Patients with a large medial eminence and who are not suitable for surgical intervention may first try wider footwear to relieve pressure.
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
The medial eminence is resected in a plane parallel to the medial border of the foot, beginning at the sulcus. A lateral release is not routinely performed due to the increased risk of avascular necrosis. The chevron osteotomy is a V-shaped cut of approximately 60° with the apex at the centre of the metatarsal head (Figure 14.7a). Because the plane of the cuts is crucial, it can be useful to place a K-wire in this central point, running parallel to the sole of the foot and the distal articular surface of the metatarsal. This wire can then be used as a cutting guide to position the limbs of the chevron. The most crucial cut is the plantar limb, which must exit the plantar surface of the metatarsal in an extra-articular position to avoid damage to the sesamoid articulation. Several authors advocate a more horizontal plantar limb (see Figure 14.7b) to attempt to preserve the plantar blood supply (see ‘Scarf osteotomy’, p. 393). The dorsal limb is then cut at approximately 60° to the first cut. After completion of the cuts, the capital fragment can be translated laterally by up to 30% of its width to correct the hallux valgus.
Developing the theory of the extended amygdala with the use of the cupric-silver technique
Published in Journal of the History of the Neurosciences, 2023
Soledad de Olmos, Alfredo Lorenzo
Therefore, de Olmos decided to use his own skills with silver techniques by introducing variations from the Ramon y Cajal technique (Ramon y Cajal 1928). One of the versions he developed revealed the crystal-clear presence of degenerating fibers and terminal boutons in the pretectum two days after the transection of the optic tract. These degenerating fibers and axonal endings were heavily impregnated with dense, black silver grains that distinguished them from the normal argyrophilic elements reported by Knoche (1953, 1958). The characteristic features of these normal granular argyrophilic neurons were the impregnation of fine, dark-brown, dust-like silver grains in the perikaryon, which also extended through their axon and dendrites. Moreover, de Olmos realized that another difference that made his variant useful was that it demonstrated axonal fibers that formed the granular argyrophilic plexus along the medial eminence, the vascular organ of the lamina terminalis and the subfornical organ. None of the aforementioned techniques revealed this. de Olmos presented the advances of this work, titled “Modifications of the Nauta Gygax and Cajal Neurofibrillary Silver Staining Methods for the Study of Terminal Axonal Degeneration,” at a local meeting, with the ensuing article later printed in Spanish in the Neurology Bulletin of Cordoba (de Olmos 1960).
Proximal metatarsal wedge osteotomy for metatarsus primus elevatus associated with rheumatoid forefoot deformity: a case report
Published in Modern Rheumatology Case Reports, 2019
The right foot was treated with proximal plantar flexion wedge osteotomy of the first metatarsal [9,10] and distal oblique shortening osteotomies of the lesser metatarsals [11]. The size of the wedge to be removed from the base of the first metatarsal was determined preoperatively using the method of Niki et al. [12], in which the distal end of its head came in contact with the proximal end of the proximal phalanx. First, the adductor tendon was released from the lateral aspect of the lateral sesamoid and the base of the proximal phalanx. Next, the medial capsule of the first metatarsophalangeal joint was opened with a Y-shaped incision. The medial eminence was then resected. Next, the wedge was removed from the base of the first metatarsal. During the procedure, we adjusted the sagittal inclination of the osteotomy surface so that the first metatarsal head could touch the flat plate, which simulates the ground. Finally, the osteotomies were fixed with Kirschner (K-) wires, and the medial capsule was sutured in a V shape (Figure 2(B)). The first interphalangeal joint was not treated surgically because the transfer of the body weight load from the interphalangeal joint to the head of first metatarsal resulting from the first metatarsal wedge osteotomy was expected to reduce pain at the callosity. Postoperatively, the foot was placed in a bulky dressing with a short leg cast. The patient was allowed to walk with weight bearing on the heels. K-wires used for the lesser toes were removed 3 weeks after surgery. The patient was advised to wear shoes with arch support until 6 months after surgery. When bony fusion was obtained, K-wires used for the first metatarsal were removed.
Impact of combining medial capsule interposition with modified scarf osteotomy for hallux valgus
Published in Modern Rheumatology, 2020
Kosuke Ebina, Makoto Hirao, Hideki Tsuboi, Shoichi Kaneshiro, Masataka Nishikawa, Atsushi Goshima, Takaaki Noguchi, Hiroyuki Nakaya, Yuki Etani, Akira Miyama, Kenji Takami, Jun Hashimoto, Hideki Yoshikawa
Patients were treated by modified scarf osteotomy of the hallux with the medial longitudinal approach, as previously described [9,13]. A longitudinal incision was made in the medial aspect of the first metatarsal (Figure 2(a)), and the medial capsule was opened with a 10-mm-wide and 40-mm-long flap (Figure 2(b)). The osteotomy was parallel to the sole of the foot, and both distal and proximal bone fragments were partially resected owing to the measurements on pre-operative radiographs (Figure 2(c)). The distal bone fragment was laterally shifted and then fixed with 3 or 4 AcuTwist® Acutrak® 2.0-mm headless compression screws (Acumed USA, Hillsboro, OR) (Figure 2(d)). Next, a longitudinal dorsal incision (about 20 mm) was made between the first and second metatarsals. The adductor hallucis tendon was dissected from the base of the hallux proximal phalanx, and marked by 3-0 PDS suture to avoid its shortening (Figure 3(a)). The capsule between the first metatarsal and the lateral sesamoid was split longitudinally from the proximal phalanx to the middle of the first metatarsal shaft [9]. The medial eminence of the first metatarsal head was minimally excised, and a capsule hole was made in the lateral side of the hallux MTP joint (Figure 3(b)). Next, when performing interposition, the flap of the capsule was interposed into the hallux MTP joint (Figure 3(c)), and it was then sutured to the adductor hallucis tendon that was dissected from the hallux proximal phalanx (Figure 3(d)). Finally, the medial capsule was sutured after some shrinkage due to the interposition of the 10-mm-wide flap into the hallux MTP joint, with the expectation of producing the force needed for varus directions of the hallux [7–9]. When not performing interposition, the medial capsule flap was sutured to the remaining capsule or periosteum with appropriate traction, and the dissected adductor hallucis tendon was detached or sutured to the lateral capsule of the hallux.