Evans Calcaneal Osteotomy: Assessment of Multiplanar Correction.

Flatfoot deformity consists of collapse of the medial arch, forefoot abduction, increased talonavicular uncoverage, and hindfoot valgus. Although numerous soft tissue and bony procedures have been proposed to correct each plane of deformity, there is a lack of objective data in the literature quantifying the amount of structural correction. The purpose of this study was to quantify the multiplanar deformity correction of the lateral column lengthening osteotomy (Evans) on hindfoot alignment through objective, reproducible, radiographic measurements. We retrospectively reviewed 45 Evans calcaneal osteotomy procedures in 24 female (53%) and 21 male (47%) feet performed on 40 patients (5 bilateral). The mean follow-up was 53 weeks (range, 32-116). The mean age at the time of surgery was 35 years (range, 11-73). Statistically significant improvement in radiographic alignment was found in the calcaneal inclination angle, tibial-calcaneal angle, tibial-calcaneal position, and the anteroposterior talo-first metatarsal angle (p < .0001 for all). Although a direct correlation between graft size and degree of angular correction was not observed, it should be noted the calcaneal graft size (mean, 11.8 mm) and the amount of hindfoot valgus correction (mean, 12.6°) appear to be clinically related. The results of this study support that the Evans calcaneal osteotomy corrects the hindfoot alignment in 3 planes as evidenced by our multiplanar radiographic measurements.

Realignment Midfoot Osteotomy: A Preoperative Planning Method and Intraoperative Surgical Technique.

Deformities of the midfoot are often treated with midfoot osteotomies. The goal of the midfoot osteotomy is to create a plantigrade forefoot to hindfoot relationship. Many different techniques are described for performing midfoot osteotomies. Our goal is to present an objective pre-operative planning method and an intra-operative technique for accurate multiplanar realignment and discuss our short-term results. We retrospectively reviewed 18 patients, 10 female (56%) and 8 male (44%), that underwent realignment midfoot osteotomies. The mean follow-up was 25 months (range, 4-120). The mean age at the time of surgery was 53 years (range, 21-76). Statistically significant improvement in radiographic alignment was found in the anteroposterior talo-first metatarsal angle (p = .002) and the mechanical axis deviation of the foot (p = .02). This study proved that our pre-operative and intra-operative planning technique provides accurate multiplanar radiographic realignment with good clinical results.

Avascular Necrosis of the First Metatarsal: A Case of Second Metatarsal Bone Transport with External Fixation.

Avascular necrosis (AVN) after bunion surgery is an unfortunate complication which can be devastating and painful. We present a case report of gradual medializing transport of the second metatarsal with external fixation to repair a large bone defect caused by AVN affecting >50% of the first metatarsal. The procedure was performed on a 49-year-old female who suffered AVN after failed bunion surgery. At 12-month follow up, first ray position and length were maintained. With respect to the second ray, there were no clinically significant issues. The second digit was mildly elevated but there was no frank instability of the toe or of the Lisfranc complex. The patient was pain free and had returned to her desired daily activities.

Ilizarov External Fixation for Correcting Complex Postpolio Foot and Ankle Deformity: A Case Study.

Given their severity and resultant loss of function, postpoliomyelitic foot and ankle deformities require a unique correction method. Correction with dynamic Ilizarov external fixation is one such modality, although it is technically demanding and requires precise preoperative planning. In our case study, a 40-year-old male with a severe postpoliomyelitic equinocavovarus right foot and ankle deformity was treated with gradual correction using dynamic, hinged Ilizarov external fixation. The external fixation was in place for a total of 103 days, with gradual correction performed in 2 successive steps, achieving a functional, plantigrade foot. We maintained this position in a short leg cast for 30 days, followed by bracing and physiotherapy for 6 months. More than 2 years after the index surgery, the patient had achieved a painless and plantigrade foot, allowing for functional ambulation. This method does not require osteotomies, ankle arthrodesis, or tendon transfer.

Gabapentin-induced eczematous drug eruption of the bilateral foot.

Drug eruptions represent a wide spectrum of cutaneous reactions to various pharmaceutical agents. Given their complexity and varied patterns of presentation, these phenomena are the subject of study of many fields of medicine. Gabapentin is a widely prescribed medication, with numerous drug reactions previously reported. We present a unique case of a gabapentin-induced drug eruption primarily affecting the feet.