The Role of the Plantaris in Intramuscular Gastrocnemius Equinus Correction.

Equinus deformity is a common cause of foot and ankle pathology. The purpose of our study was to evaluate the role of the plantaris in equinus. Secondary aims were to describe the role of the plantaris in intramuscular gastrocnemius recession and to determine the prevalence of the plantaris in our patient population. We measured ankle dorsiflexion during the steps of a Baumann-type intramuscular gastrocnemius recession. Eighty-nine patients were enrolled in our study. Fourteen of 89 (15.7%) patients did not have a plantaris. A mean dorsiflexion of 9 (interquartile range 6-12)° was obtained after transection of the plantaris tendon and an additional mean 8 (interquartile range 5-10)° was obtained after recession of the gastrocnemius aponeurosis. There was a strong positive correlation (rs = 0.842) of dorsiflexion increase after plantaris transection and dorsiflexion increase after gastrocnemius recession (p < .00). Linear regression showed that for every one-degree of dorsiflexion increase with plantaris transection, there was a predicted dorsiflexion increase of 0.69° with gastrocnemius recession. These results indicate that the plantaris is a component of equinus deformity.

Deep Peroneal Neurectomy for Midfoot Arthritis.

Osteoarthrosis of the tarsometatarsal joint (TMTJ) and naviculocuneiform joint (NCJ) is a common pathology treated by foot and ankle specialists. Arthrodesis is the most widely accepted surgical treatment. Patients that are not candidates for arthrodesis are often left without surgical treatment options. Neurectomy has been described for treatment of upper extremity joint arthrosis but has not been well described in the foot. The deep peroneal nerve innervates the first, second, third TMTJs and NCJ. We present a retrospective case series on the outcomes of patients treated with deep peroneal neurectomy for TMTJ and NCJ arthrosis (N = 34 feet in 26 patients). The median postoperative American Orthopedic Foot and Ankle Society midfoot score was 53 (range 16-75) points. Twenty two (85%) of 26 patients stated that their expectations were met as a result of the deep peroneal neurectomy procedure, and 20 (77%) of 26 patients stated that they would have deep peroneal neurectomy for their symptoms again. There were recurrent symptoms prompting patients to seek additional treatment in 7 (21%) of 34 feet. Recurrent pain is also documented in hand denervation studies and the physiologic explanation remains unclear. Our results suggest that deep peroneal neurectomy is an effective treatment option for TMTJ and NCJ arthritis and may be particularly helpful in patients that are poor candidates for arthrodesis.

First Metatarsophalangeal Joint Distraction Arthrodesis With Bicortical Calcaneal Autograft.

First metatarsophalangeal joint (MTPJ) arthrodesis is a surgical treatment option for failed first MTPJ procedures. In cases of failed MTPJ arthroplasty, removal of failed implants and necrotic bone can cause shortening and biomechanical insufficiency of the first ray. Distraction arthrodesis with bone grafting can be used to maintain first ray length. We describe a technique of autograft harvest from the ipsilateral calcaneus. We present a retrospective case series of clinical and radiographic outcomes of distraction arthrodesis with bicortical calcaneal autograft in patients with failed procedures of the first MTPJ. We achieved a 100% osseous union rate. There was an insignificant change in first ray length from preoperative to postoperative (P = .2402). First ray length was maintained with a median autograft length of 10 (range 5 to 14) mm. We were able to correct first ray deformity with a significant reduction in preoperative to postoperative intermetatarsal angle and hallux abduction angle (P = .0156, P = .0068, respectively). Seven (88%) of 8 patients with available subjective follow-up were satisfied with the outcome of the procedure and would undergo the procedure again. Our results indicate that first MTPJ distraction arthrodesis with calcaneal autograft is a viable option for failed first MTPJ procedures. Surgeons who implement our techniques can expect high rates of osseous union, deformity correction, and patient satisfaction.

Outcomes Study of an Innovative Method of Direct Repair of Metatarsophalangeal Joint Instability With an Angiocatheter Needle.

Plantar plate tears are a common cause of forefoot pain and digital deformity. Repair of the plantar plate has been described from both a dorsal and plantar approach, each with its own benefits and drawbacks. Many of the approaches use costly devices. Our innovative repair method uses low-cost materials available in most operating room settings. We undertook a retrospective case series study to evaluate outcomes in patients who had undergone plantar plate repair with our method of repair. A review was performed to identify patients with plantar plate disruptions treated with this approach by a single surgeon. Clinical position and patient satisfaction of the involved joints were evaluated. Six patients (9 joints) underwent plantar plate repair using this innovative method and were evaluated at a median follow-up time of 19 (range 19 to 39) months. The mean visual analog scale pain score at final follow up was 0.8 ± 2.0. The median sagittal plane position of the toe was 2 mm (range 0 to 6) from the plantar skin of the digit to the ground. Five of the 6 patients (83%) stated that they would have the procedure again. We were able to obtain satisfactory outcomes with good alignment by repairing the plantar plate with this innovative method. Our data suggest that the described method of plantar plate repair can be used as an effective way to treat metatarsal phalangeal joint instability.