Pedographic and Clinical Results of Percutaneous Metatarsal Osteotomies for Metatarsalgia

C. Kinast , M. Olos, A.Namazi Pedographic and clinical results of percutaneous metatarsal osteotomies for metatarsalgia

Surgical technique : Percutaneous metatarsal osteotomies PCMO 67 feet form dorsal distal to plantar proximal with a steep angle as possible < 45° same surgery: open hallux valgus reconstruction L-Austin ( Bevel ), Akin 52 feet Lapidus Akin 8 feet Other previous surgery 1st ray 7 feet M 2 3 OT n=12 feet M2 3 4 OT n=50 feet M3,4 n=1 feet M2 n=4 feet percutanous hammertoe correction ( dePrado ) n = 42 open PIP arthrodesis KW fixation 4 weeks n = 15 Prospectiv study design: patients with metatarsalgia, with and without hammertoes index minus elevated pedographic pressure of M 2 ( novel emed ) No plantar plate rupture No osteochondral lesions of MPJ 2 3 4 No clinical Morton´s syndrom

2009-F.B. M1 P 1 osteotomy Lactosorb fixation pc MOT 2 3; pc hammertoe correction M 5

pre pre post 1 year post 1 year

pedography: novel emed M2 P (pressure ) max kPA pre-post-difference M2 post less than als pre n=60 feet -403 kPa M2 all n=67 feet -313 kPa M2 post more than preop n=7 feet +262 kPa M 3 P max > M 2 P max n = 8 feet transfer-overload No clinical transfer metatarsalgia !!! so far P max M2 average preop 969 kPA post op 652 kPA Dynamic pedobarography was performed using the EMED-SF1 pressure platform (Novel GmbH, Munich, Germany) with a spatial resolution of four sensors per cm2. Measurements at 50-Hz sample frequency were used to obtain barefoot plantar pressures. Each subject was tested using the two-step method in which platform contact was made on the second step after initiation of gait

Clinical examination: 1 year minimum follow up metatarsalgia: none sensory disturbance : 5 feet at 1 year P 2 spontanous floor contact 61 feet P2 floor contact with active plantarflexion x-ray: healing without significant callus 24 feet healing with severe callus 41 feet incomplete healing visible osteotomy gap after 1 year 2

Summary: percutaneous osteotomies M 2 3 4 Pedography max pressure was decreased from P max M2 average preop 969 kPA post op 652 kPA in 60 feet 7 feet no decrease floorcontact of Z2 3 4 was positive in most of the feet subcapital osteotomies heal faster as more proximal osteotomies Metatarsalgia was successfully treated

Pedographic and Clinical Results of Percutaneous Metatarsal Osteotomies for Metatarsalgia

by Christian Arno Kinast on Jan 11, 2012

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Pedographic and Clinical Results of Percutaneous Metatarsal Osteotomies for Metatarsalgia — Presentation Transcript