Chevron osteotomy and scarf osteotomy for hallux valgus angle and intermetatarsal angle correction: a systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: This systematic review and meta-analysis aimed to investigate the differences in hallux valgus angle (HVA), intermetatarsal angle (IMA), American Orthopedic Foot and Ankle Society (AOFAS) scores, and complication rates between chevron osteotomy and scarf osteotomy for correcting hallux valgus. METHODS: Two investigators independently searched for randomized controlled trials (RCTs) published from 2007 to 2018 on PubMed, Web of Science, and Cochrane Library databases. Next, chevron and scarf osteotomies were compared for their postoperative outcomes using HVA, IMA, and AOFAS scores and their complication rates. Meta-analysis was performed using Review Manager (version 5.3). RESULTS: Six RCTs-comprising 507 feet, of which 261 and 246 underwent chevron and scarf osteotomies, respectively-were included. The meta-analysis revealed that chevron osteotomy led to significantly smaller postoperative HVAs than scarf osteotomy (weighted mean difference [WMD] = -1.94, 95% CI = - 2.65 to - 1.29, P < .00001). However, the differences in postoperative IMA (WMD = - 0.44, 95% CI = - 1.10 to 0.22, P = .19), postoperative AOFAS scores (WMD = 0.75; 95% CI = - 5.32 to 6.82; P = .81), and complication rates (risk ratio = 1.22, 95% CI = 0.65-2.27, P = .53) between feet that underwent chevron and scarf osteotomies were nonsignificant. CONCLUSIONS: Compared with scarf osteotomy, chevron osteotomy had significantly more favorable postoperative outcomes in terms of HVA correction, but not in terms of IMA, AOFAS scores, or complication rates. LEVEL OF EVIDENCE: Level I, systemic review and meta-analysis.

Cross-sectional size, shape, and estimated strength of the tibia, fibula and second metatarsal in female collegiate-level cross-country runners and soccer players.

Bone stress injuries (BSIs) frequently occur in the leg and foot long bones of female distance runners. A potential means of preventing BSIs is to participate in multidirectional sports when younger to build a more robust skeleton. The current cross-sectional study compared differences in tibia, fibula, and second metatarsal diaphysis size, shape, and strength between female collegiate-level athletes specialized in cross-country running (RUN, n = 16) and soccer (SOC, n = 16). Assessments were performed using high-resolution peripheral quantitative computed tomography and outcomes corrected for measures at the radius diaphysis to control for selection bias and systemic differences between groups. The tibia in SOC had a 7.5 % larger total area than RUN, with a 29.4 % greater minimum second moment of area (IMIN) and 8.2 % greater estimated failure load (all p ≤ 0.02). Tibial values in SOC exceeded reference data indicating positive adaptation. In contrast, values in RUN were similar to reference data suggesting running induced limited tibial adaptation. RUN did have a larger ratio between their maximum second moment of area (IMAX) and IMIN than both SOC and reference values. This suggests the unidirectional loading associated with running altered tibial shape with material distributed more in the anteroposterior (IMAX) direction as opposed to the mediolateral (IMIN) direction. Comparatively, SOC had a similar IMAX/IMIN ratio to reference data suggesting the larger tibia in SOC resulted from multiplane adaptation. In addition to enhanced size and strength of their tibia, SOC had enhanced structure and strength of their fibula and second metatarsal. At both sites, polar moment of inertia was approximately 25 % larger in SOC compared to RUN (all p = 0.03). These data support calls for young female athletes to delay specialization in running and participate in multidirectional sports, like soccer, to build a more robust skeleton that is potentially more protected against BSIs.

Lateral plantar fasciopathy: An frequently overlooked cause of atraumatic pain at the fifth metatarsal base.

BACKGROUND: Lateral cord plantar fasciitis (LCPF) causes atraumatic pain at the fifth metatarsal base. This study assesses the outcomes of a conservative treatment (PRP + casting) on LCPF. METHODS: Medical history, clinical diagnosis, and ultrasound imaging were used to determine LPCF. All patients received a leucocyte-poor PRP injection at the proximal part of the fifth metatarsal base, followed by three weeks in a walking cast. Follow-up questionnaires, encompassing NRS, AOFAS, and Foot Functioning Index (FFI), were administered at 6 weeks, 12 weeks, and 2 years post-treatment. RESULTS: Ten patients were enrolled in the study. Ultrasound findings revealed hyposonant and thickened lateral fascia plantaris at the MT 5 insertion point with normal peronei tendons. There was a notable reduction in pain from pre-treatment (NRSrest 55.1 ± 29.6, NRSactivity 79.20 ± 15.5) to 6 weeks post-treatment (NRSrest: 22.4 ± 23.6, p = 0.03; NRSactivity: 38.6 ± 30.3, p = 0.005). FFI indicated an improvement between 12 weeks (25.7 ± 25.7) and 2 years (9.1 ± 8.5) compared to pre-treatment (42.6 ± 16.7). CONCLUSION: Ultrasound stands out as the preferred diagnostic method for identifying LCPF. A PRP injection followed by a walking cast proves effective in relieving LCPF symptoms within six weeks with sustained relief up to two years. LEVEL OF EVIDENCE: Level IV.

Management of zone 2 fifth metatarsal fractures varies based on treating specialty.

Aims: This study evaluated the effect of treating clinician speciality on management of zone 2 fifth metatarsal fractures. Methods: This was a retrospective cohort study of patients with acute zone 2 fifth metatarsal fractures who presented to a single large, urban, academic medical centre between December 2012 and April 2022. Zone 2 was the region of the fifth metatarsal base bordered by the fourth and fifth metatarsal articulation on the oblique radiograph. The proportion of patients allowed to bear weight as tolerated immediately after injury was compared between patients treated by orthopaedic surgeons and podiatrists. The effects of unrestricted weightbearing and foot and/or ankle immobilization on clinical healing were assessed. A total of 487 patients with zone 2 fractures were included (mean age 53.5 years (SD 16.9), mean BMI 27.2 kg/m2 (SD 6.0)) with a mean follow-up duration of 2.57 years (SD 2.64). Results: Overall, 281 patients (57.7%) were treated by orthopaedic surgeons, and 206 patients (42.3%) by podiatrists. When controlling for age, sex, and time between symptom onset and presentation, the likelihood of undergoing operative treatment was significantly greater when treated by a podiatrist (odds ratio (OR) 2.9 (95% CI 1.2 to 8.2); p = 0.029). A greater proportion of patients treated by orthopaedic surgeons were allowed to immediately bear weight on the injured foot (70.9% (178/251) vs 47.3% (71/150); p < 0.001). Patients treated by podiatrists were immobilized for significantly longer (mean 8.4 weeks (SD 5.7) vs 6.8 weeks (SD 4.3); p = 0.002) and experienced a significantly longer mean time to clinical healing (12.1 (SD 10.6) vs 9.0 weeks (SD 7.3), p = 0.003). Conclusion: Although there was considerable heterogeneity among zone 2 fracture management, orthopaedic surgeons were less likely to treat patients operatively and more likely to allow early full weightbearing compared to podiatrists.

Juvenile hallux valgus: Comparison of three types of osteotomy and medium-term postoperative results.

BACKGROUND: There is no consensus on the treatment of juvenile hallux valgus (JHV). Numerous surgical techniques have been described, none of which has been proven to be superior and the mid-term results of these methods are not well known. Our objective was to compare the mid-term clinical, radiographic, and functional results of three metatarsal osteotomy techniques. METHODS: Patients under 18 years of age operated on for JHV between January 2010 and December 2019 were included in this multicenter retrospective study. Patients were excluded if they had non-idiopathic hallux valgus or if their postoperative follow-up was less than 3 years. The surgical techniques used were metatarsal osteotomies: basimetatarsal, scarf, or distal. During follow-up visits, we collected HMIS-AOFAS (Hallux Metatarsophalangeal Interphalangeal Scale-American Orthopedic Foot and Ankle Society) and Visual Analogue Scale (VAS) scores, acquired radiographs, and recorded complications and recurrences. Secondarily, the study population was stratified according to physis status (open vs. closed). RESULTS: During the study period, 18 patients (26 feet) met the inclusion criteria. The median postoperative follow-up was 6.5 (4.1) years. At the end of follow-up, the median HMIS score was 79.0 (20.0), the mean hallux valgus angle (HVA) improvement was 13.2° (16.8), and the complication and recurrence rates were 31 % and 23 %, respectively. There was no significant difference in the outcome measures between the three techniques or any difference according to physis status at the time of surgery. DISCUSSION AND CONCLUSION: The functional and radiographic results of metatarsal osteotomies are good in the medium term, regardless of the osteotomy site. Our results are comparable to those published in the literature. As our sample size was limited, it did not lead to the identification of statistically significant differences.

First metatarsal shortening after hallux valgus surgery: Benefits of treatment with distraction osteogenesis.

INTRODUCTION: Iatrogenic shortening and elevation of the first metatarsal (MT1) is a common complication of hallux valgus surgery, inducing metatarsalgia underneath the lesser rays, a reason for patient dissatisfaction. For resolving this problem, different types of revision surgery are described, of which lengthening MT1 by distraction osteogenesis is underreported and therefore undervalued. MATERIALS AND METHODS: We present three cases with iatrogenic shortening after hallux valgus surgery treated by distraction osteogenesis of MT1 using a custom-made frame, made of Ilizarov equipment. To evaluate the amount of lengthening, the length of the first and second metatarsal (MT2) and the parabolic distribution of the metatarsal heads were compared before and after distraction. To evaluate correction in the sagittal plane, Meary's angle was measured pre- and post-lengthening. Pain was noted by a visual analogic score during follow-up. RESULTS: In our series of three cases, lengthening of MT1 between 7 mm and 18 mm, resulted in an improved parabolic distribution of the MT heads. The average difference between the second and first MT-head, relative to the SM4 axis (M2-M1) improved from 9.4 mm (± 0.9 mm) to 2.8 mm (± 0.7 mm) resolving corresponding pain in all patients. Meary's angle was normalized in one case. The average duration of treatment was 116 days (± 9 days). Minimal follow up was 11 years. CONCLUSION: Using Ilizarov equipment for distraction osteogenesis of MT1 is a low-cost and effective method. Over time, this technique has proven its utility in pronounced iatrogenic shortening of MT1. The possibility to lengthen more than 1 cm, to correct in multiple planes, as well as early mobilization and weight bearing are additional advantages, but one must be careful to avoid overcorrection. The need for strict follow-up with multiple radiographs and rigorous patient selection is mandatory.

Radiomorphometric analysis of the metapodial bones in the Scottish fold cats.

Scottish Fold cats (Felis catus, Linnaeus 1758) are one of the most well-known and popular cat breeds in the world, characterized by their folded ears attached to the head. Very frequently, cats fall prey of different trauma and accidents that can cause bone fractures especially in the metapodial bones. The method of radiometry is used in veterinary practice to visualize and measure different parts of the animal skeleton. The aim of this study was to assess the linear parameters derived from radiographic images of the metacarpals and metatarsals in Scottish Fold cats and additionally detecting potential sexual dimorphism. Radiographic images of 24 adult Scottish Fold cats (12 male and 12 females) of different ages and weights were analysed. Six linear measurements of the metapodial bones were evaluated to investigate any differences between the sexes. The linear radiometric measurements of the five metacarpals (MC1-5) and the four metatarsals (MT2-5) bones were larger in male metapodial bones than that of female cats. The maximum length (Ml) of the MC1 and MC2 was statistically different between sex, respectively, (p = 0.001) and (p = 0.05). The others metacarpal bones were different in mostly all linear parameters but not statistically significant. The most significant differences between sexes were observed in the parameter of width proximal end (Wp) of MC1-3 (p = 0.001) and MC4 (p = 0.05). More statistical different was MT2 and less MT3. The linear parameter of Bd of the MT4 was the most different statistically between sex (p = 0.001). The results of the study will be useful in function of comparative anatomy, in veterinary clinical practice, in zoo archaeology and in the veterinary forensic investigation.

The vertical mobility of the first tarsometatarsal joint during demi-plié with forced turnout in ballet dancers.

The forced turnout has a perceived risk of development of hallux valgus (HV) in ballet dancers. We determined how the forced turnout affects the sagittal mobility of the first tarsometatarsal (TMT) joint, which is one of the pathogenic factors of HV development. Seventeen female ballet dancers (body mass index: 18.2 ± 1.8 kg/m2) were included and performed demi-plié in control, functional turnout, and forced turnout conditions. Ultrasound imaging synchronized with a three-dimensional motion analysis system was used for measuring the vertical locations of the first metatarsal and medial cuneiform (MC) to evaluate the first TMT joint mobility. Plantar displacement of MC and the first TMT joint mobility in the forced turnout were the greatest among the 3 conditions. Multiple regression analysis indicated that the greater extent of the forcing angle might increase the displacement of MC and the first TMT joint mobility. Evaluating the sagittal mobility of the first TMT joint in the forced turnout can assist in understanding the association between inappropriate techniques including the forced turnout and HV development in ballet dancers. Since the excessive mobility of the first TMT joint is a factor in HV development, the acquirement of adequate active turnout may have the potential to prevent HV development in ballet dancers.

Biomechanical comparison of reverse offset-L osteotomy and chevron osteotomy in cadaveric hallux valgus surgery.

OBJECTIVE: Chevron osteotomy offers near-excellent clinical results and adequate stability at lower shift percentages, among the techniques used to correct hallux valgus deformity. This cadaveric study aimed to compare the Chevron osteotomy with the reverse offset-L osteotomy, which may provide a greater surface area and a more stable geometry to withstand higher cantilever forces at higher shift percentages. METHODS: Metatarsal bones obtained from 20 human cadavers with similar bone quality were divided into two groups: Chevron osteotomy was applied to the 1st group and reverse offset-L osteotomy was applied to the 2nd group. The load-to-failure, displacement in the y-axis, and total displacement values of both groups were compared statistically. Furthermore, bone densities were compared between the groups with computed tomography imaging. RESULTS: When outliers in both groups were excluded, a statistically significant difference was found in favor of reverse offset-L (143 ± 42 vs. 204 ± 51.2 N, p = 0.02) in terms of failure load. The groups were similar in terms of displacement on the y-axis and total displacement values. Bone densities were similar. CONCLUSION: The reverse offset-L osteotomy has been shown to withstand greater loads before failure compared to the standard Chevron osteotomy. This significant difference in load-to-failure may enable reverse offset-L to provide reliable stability in osteotomies performed in advanced HV cases requiring higher shifts.

Correlation of Clinical Outcomes and Relative Position of the First Metatarsal After the Modified Lapidus Procedure.

BACKGROUND: Hallux valgus is a complex 3-dimensional deformity, and the modified Lapidus is a commonly used procedure to correct moderate to severe cases. Shortening and elevation of the first ray can occur with this procedure, which may result in increased pressure on the lesser metatarsal heads. However, there is currently no consensus regarding an accepted length and elevation of the first ray following the modified Lapidus. Therefore, the purpose of this study is to evaluate the impact of the position of the first ray on patient-reported outcome measures. METHODS: This retrospective study identified 68 patients (72 feet) who underwent the modified Lapidus bunionectomy over a 4-year period at a single institution with a median follow-up of 24 months (range, 11-35.6 months). Patients were included if they were over 18 years of age, had pre- and postoperative weightbearing computed tomography (WBCT) scans, and preoperative and minimum 1-year postoperative Patient-Reported Outcome Measurement Information System (PROMIS) scores. PROMIS scores from 6 domains including physical function, pain interference, pain intensity, global physical health, global mental health, and depression were evaluated and compared pre- and postoperatively. Radiographic parameters were measured and compared before and after surgery. Paired t tests were used to evaluate the significance of pre- to postoperative changes. Differences between cohorts were compared using Mann-Whitney U test for continuous variables or Fisher exact test for categorical variables. Correlation between radiographic measurements and patient-reported outcomes were assessed using the Spearman rank rho estimate and visualized with scatterplots with a linear regression. RESULTS: PROMIS physical function, pain interference, pain intensity, and global physical health improved significantly following the modified Lapidus (all P < .001); however, scores did not show any significant correlation with shortening of the first ray up to a maximum shortening of 4.8 mm. The length of the first metatarsal relative to the second decreased by an average of 2.7 mm following the procedure when measured on WBCT (P < .001), and 2.6 mm when measured on plain radiographs (P < .001). No significant elevation of the first ray was observed postoperatively. CONCLUSION: This study revealed that the Lapidus bunionectomy resulted in significantly improved pain and physical function at short-term follow-up. The amount of first ray shortening and elevation that occurred in this cohort did not adversely affect patient-reported outcomes.

Foot radiologic morphology as a predictor of pseudo-jones fractures: A retrospective case-control study.

BACKGROUND: Fifth metatarsal basis fractures are common injuries. Zone 1 fractures are also known as pseudo-jones fractures. This study aimed to elucidate the impact of foot radiologic morphology on pseudo-Jones fractures. METHODS: Patients with pseudo-Jones fractures formed the case group and individuals with ankle sprains but no fractures formed control group. Weight-bearing anteroposterior and lateral radiographs were evaluated for pre-determined measurements: metatarsus adductus angle (MAA), intermetatarsal angles (1-2, 4-5), calcaneal inclination (CI) angle, and fifth metatarsal base angle. All measurements were performed by a single investigator using digital PACS tools. Statistical analysis compared these radiographic parameters between the groups. RESULTS: The fracture group demonstrated a significantly lower 4-5 intermetatarsal and calcaneal inclination angles than the control group (p < 0.05). Notably, no statistically significant difference was found in the metatarsus adductus angle. CONCLUSION: This study demonstrates a potential association between foot radiographic morphology and pseudo-Jones fractures. Patients with a lower 4-5 IMA and calcaneal inclination angle may be at a higher risk for developing pseudo-Jones fractures. However, these requires future prospective studies. LEVEL OF EVIDENCE: Level III case control study.

Sagittal Plane Alignment for First Metatarsal Phalangeal Arthrodesis Correlated with Postoperative Function: What is the Optimal Position?

There have been many reports describing the proposed alignment of a first metatarsal phalangeal arthrodesis to obtain optimum function. Most of these recommendations are based upon historical and anecdotal evidence. Furthermore, there are few reports directly comparing alignment to patient reported function. We studied radiographic sagittal plane alignment in a group of 60 patients (80 feet) who had undergone a first metatarsal phalangeal joint arthrodesis (20 of the 60 had bilateral arthrodesis) to better understand how this component of the arthrodesis position translates to real world function. The patients in this study had completed a functional survey in 2022 at a mean of 28.4 (median 27.8; range 13.2-45.7) months with very high satisfaction for return to activities of daily living and recreational sports. We measured the sagittal plane position of the first metatarsal relative to the proximal phalanx in this cohort with known post operative activity data. We found that a mean (standard of deviation) sagittal plane angle (angle between the anatomic axis of the first metatarsal and the proximal phalanx) of 15.4 (SD 7.4) degrees and a proximal phalanx head to ground height of 12.7 (SD 3.3) mm was present in this group. Comparing the functional and positional results we conclude that this sagittal plane position provides a good recommendation for alignment.

Congenital Generalized Lipodystrophy in a Division 1 Female Sprinter.

ABSTRACT: A 21-year-old African American Division 1 female sprinter presented with 3-weeks history of right great toe and forefoot pain, fatigue, and a 30-day continuous menstrual cycle despite implanted etonogestrel (Nexplanon) inserted 3 years prior. An magnetic resonance imagine (MRI) identified likely stress fracture of the second metatarsal base with a diffusely low T1 signal indicating hyperactive red marrow. Due to persistent pain, a follow-up MRI was ordered 6 months later and indicated serous atrophy of the bone marrow, prompting a further metabolic workup notable for triglycerides exceeding 4000 mg/dL and a hemoglobin A1c of 10.9%. This case highlights the manifestation of a rare congenital lipodystrophy that initially presented as a relatively classic stress fracture and metrorrhagia in a female athlete.

Shaft structure of the first metatarsal contains a strong phylogenetic signal in apes and humans.

OBJECTIVES: Metatarsal bones constitute a key functional unit of the foot in primates. While the form-function relationships of metatarsals have been extensively studied, particularly in relation to the loss of the grasping ability of the foot in humans in contrast to apes, the effect of phyletic history on the metatarsal morphology and its variability remains largely unknown. MATERIALS AND METHODS: Here, we evaluate how the strength of the phylogenetic signal varies from the first to the fifth metatarsal in humans, chimpanzees, gorillas, orangutans, gibbons, and Japanese macaques. We use computed tomography imaging and morphometric mapping to quantify the second moment of area around and along the metatarsal shaft and evaluate the strength of the phylogenetic signal with multivariate K-statistics. RESULTS: The shaft structure of the first metatarsal, but not the others, correlates well with the phylogeny of apes and humans. DISCUSSION: Given the importance of the first metatarsal for grasping and bipedal/quadrupedal locomotion, the strong phylogenetic but weak functional signal in its structure is unexpected. These findings suggest that the evolutionary diversification of hominoid locomotor behaviors, including human bipedality, is only partly reflected in form-function relationships of key skeletal elements, and that phylogenetic history acted as a major evolutionary constraint.

[Epiphyseal fracture of the second metatarsal in adolescents: report of two cases]. / Fractura epifisaria del segundo metatarsiano en adolescentes: reporte de dos casos.

Epiphyseal fractures of the metatarsal head are a rare entity specially as an isolated injury and is rarely seen in patients with skeletal immaturity. Due lack of documentation for this type of fracture, the treatment of choice is uncertain. The purpose of the present study is to present two cases and treatment of epiphyseal fracture of the second metatarsal head, to our knowledge there are no publications for this injury.

Las fracturas epifisarias de la cabeza metatarsiana son una entidad poco frecuente, principalmente cuando se presentan de forma aislada y en raras ocasiones se ven en pacientes con inmadurez esquelética. Debido a la escasez de documentación para este tipo de fractura, el tratamiento de elección es incierto. El motivo del presente estudio es presentar dos casos de fractura epifisaria de la cabeza del segundo metatarsiano y su tratamiento, ya que para nuestro conocimiento no hay publicaciones al respecto.

Preoperative increased pronation angle of the first metatarsus associated with correction loss after hallux valgus surgery: A semi-weight-bearing computed tomography study.

BACKGROUND: The effect of preoperative first metatarsal pronation on postoperative prognosis of hallux valgus (HV) surgery is under investigation. Utilizing semi-weight-bearing computed tomography, the preoperative pronation angle was assessed to quantify its impact on postoperative prognosis. METHODS: In a retrospective analysis of 31 feet, those with re-increased hallux valgus angle postoperatively were classified as the non-maintained group, and the remainder as the maintained group. Preoperative pronation angles were compared to establish a threshold. Subsequently, feet were re-classified into high or low-pronation categories. The relative risk of non-maintenance in high-pronation category was calculated. RESULTS: The non-maintained group exhibited a significantly higher preoperative pronation angle (p = 0.021), with a 28.4º threshold. The high-pronation category had a relative risk of 2.34 for non-maintenance. CONCLUSIONS: Increased preoperative first metatarsal pronation angle is associated with correction loss after HV surgery. Utilizing sWBCT to measure the pronation angle provides valuable insights into postoperative prognosis. LEVEL OF EVIDENCE: III.

Radiologic and Clinical Outcomes of the Dovetailed Notch Scarf Osteotomy for Correcting the First Metatarsal Pronation in Moderate to Severe Hallux Valgus Deformity: A Comparative Study.

BACKGROUND: The traditional scarf osteotomy (TSO) has limited ability to correct the first metatarsal pronation. A novel modification that we refer to as a "dovetailed notch scarf osteotomy" (DNSO) has been developed to enhance the ability to correct coronal plane pronation. The study aimed to observe and compare TSO to DNSO in the treatment of moderate to severe hallux valgus deformity. METHODS: This retrospective study included 78 feet that had a TSO and 105 feet that had a DNSO. Minimum follow-up was 24 months. Weightbearing computed tomography (WBCT) and weightbearing anterior-posterior (AP) radiographs were taken preoperatively and at the last follow-up. We measured the intermetatarsal angle (IMA), hallux valgus angle, distal metatarsal articular surface angle on AP radiographs and first metatarsal coronal pronation angle (α angle), tibial sesamoid coronal grading, and first metatarsal length on WBCT. Clinical assessment was done using visual analog scale (VAS), American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot scale, Foot and Ankle Ability Measure (FAAM), and the 36-Item Short Form Health Survey (SF-36). The occurrence of postoperative complications was also documented. RESULTS: The DNSO group exhibited a significantly higher correction amount of α angle and IMA (14.3 ± 9.9 and 10.3 ± 4.6 degrees) than the TSO group (8.6 ± 5.9 and 5.4 ± 5.9 degrees) during the final follow-up assessment (P < .05).The DNSO group (10.1 [8.0-12.0] degrees and 4.8 [3.9-5.6] degrees) demonstrated significantly smaller α angle and IMA compared with the TSO group (4.8 [3.9-5.6] degrees and 9.5 [7.5-11.5] degrees) at 24 months postsurgery (P < .05). The postoperative FAAM activities of daily living and SF-36 physical functioning scores were significantly higher in the DNSO group (97.2 ± 3.3 and 95.7 ± 4.4 points) compared with the TSO group (92.3 ± 3.3 and 87.7 ± 8.7 points) (P < .05). Additionally, hallux varus occurred in 1 case in the DNSO group, whereas 4 cases were observed in the TSO group. CONCLUSION: Two osteotomy methods can effectively correct moderate to severe hallux valgus deformity. Compared with the TSO, the DNSO has stronger correction ability. The most crucial aspect lies in its controllability when correcting first metatarsal pronation and addressing IMA. LEVEL OF EVIDENCE: Level III, retrospective comparative study.

Ultrasound ability in early diagnosis of metatarsal stress fractures.

Stress fractures are common in young and active individuals, associated with aggressive or repetitive physical activity and their early detection is fundamental to optimise patient care, decrease complications and avoid unnecessary exams. Currently, magnetic resonance imaging is the standard of care for detecting these lesions. Recently, ultrasound has been getting an increasing interest for the detection of stress fractures. In this article, we describe a clinical case that involved a second metatarsal stress fracture diagnosed by ultrasound and review the literature regarding the use of ultrasound in the diagnosis of stress fractures, particularly of the metatarsals.

Functional outcome and risk of non-union for 5th metatarsal base fractures.

OBJECTIVES: Treatment of 5th metatarsal fractures via direct discharge from virtual fracture clinic (VFC) has become common practice in the NHS. We aim to assess the functional outcome and incidence of non-union in a series of 5th metatarsal base fractures, exposed to 1-year of follow-up. METHODS: 194 patients who sustained a fracture between the period February 2019 to April 2020 were included, referred via the VFC pathway. Radiographs were reviewed to classify in which zone, the fracture occurred along with union on subsequent follow-up. Telephone follow-up was used to measure patient functional outcomes (EQ-5D & FAAM survey) and satisfaction with the VFC service. RESULTS: Off 194 patients, 53 (27.3%) had zone 1, 99 (51%) had zone 2, and 42 (21.6%) had zone 3 fractures. 80 were discharged directly from VFC, with 114 patients being offered at least one face to face clinic follow-up. Six (3.1%) patients had clinical and radiological evidence of non-union; 4 in zone 2, and 2 in zone 3. No zone 1 injuries were identified as a non-union. Only 2 patients had surgery, 1 of which was for symptomatic non-union. Of the 6 non-union patients, 1 had surgery, 4 did not wish to have surgery and the final non-union patient was deemed unsuitable for surgery. CONCLUSION: The VFC is an effective way of managing 5th metatarsal fractures, with high patient satisfaction. Conservative management has excellent outcomes, with a low percentage of zone 2 and 3 injuries developing a symptomatic non-union. Functional outcome surveys provide further reassurance.

Distal Rotational Metatarsal Osteotomy (DROMO) for the treatment of hallux valgus associated with first metatarsal pronation: Surgical technique and initial results.

BACKGROUND: Hallux valgus (HV) is a very common deformity worldwide. Most of the surgical techniques used in the treatment of HV only correct these deformities in two planes, that is sagittal and transverse planes. The importance of the first metatarsal pronation as an etiological factor of hallux valgus is validated by numerous authors and it is usually unaddressed. Few surgical techniques have focused on the correction of rotational deformity of the hallux valgus. We aim to first report a detailed technique and a case series using the Distal Rotational Metatarsal Osteotomy (DROMO) surgical technique, which is less invasive and can address the pronation deformation. METHODS: The inclusion period was 6 months finishing in April 2021. The study analyzed the following x-ray parameters: preoperative and postoperative intermetatarsal angle (IMA), preoperative and postoperative hallux valgus angle (HVA), preoperative and postoperative coronal rotation of the first metatarsal according Hardy and Clapham's classification as described by Kim et al., preoperative and postoperative shape of the first metatarsal head as described by Ono et al. RESULTS: 33 patients matched our inclusion and exclusion criteria. Most patients underwent the surgery for the left foot (n = 18), compared to the right foot (n = 15). We found statistically significant differences between preoperative and postoperative IMA (p < 0.001), preoperative and postoperative HVA (p < 0.001). Preoperative and postoperative coronal rotation of the first metatarsal as classified by Hardy and Clapham was significantly different (p < 0.001), as well as preoperative and postoperative shape of the first metatarsal head (p < 0.01). CONCLUSIONS: DROMO can correct the metatarsal rotation through minimal invasive surgery. From our perspective, DROMO technique should be another alternative for HV correction technique which in time can be associated as a local anesthetic technique, DROMO results are attractive for an ambulatory procedure.