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.

Operative Management of Y-Shaped Metatarsal with Biphalangeal Sixth Toe.

BACKGROUND: In the literature, there is no consensus regarding the surgical management of postaxial polydactyly, and few cases of polymetatarsia with polydactyly have been reported. Treatment of the complete deformity will prevent further foot and gait disorders. OBJECTIVE: To identify literature relevant to the operative management of Y-shaped metatarsal with biphalangeal sixth toe and related skin and wound care to improve surgical treatment protocols from a clinical experience perspective. DATA SOURCES: The authors searched several electronic databases in December 2022 for articles related to postaxial polysyndactyly in the feet and polymetatarsia. Databases searched included PubMed, SciELO, ScienceDirect, Cochrane Database of Systematic Reviews, and Google Scholar gray literature. STUDY SELECTION: Two independent researchers conducted the searches and read the article titles and abstracts. Studies were included if they were narrative reviews, case studies, or observational studies; written in English or Spanish; and published between 2012 and 2022. Nonhuman studies were excluded. Studies that met the inclusion criteria were fully evaluated. Disagreements between reviewers were resolved by consensus, and when there was no consensus, a senior researcher was consulted. DATA EXTRACTION: The following data were extracted from the included studies using a standardized form: author and year of publication, study type, number of participants, sex, polydactyly location, polymetatarsia, type of polydactyly, participants' history of hereditary associated diseases or malformations, treatment, removal criteria, and timing of surgery. DATA SYNTHESIS: Authors evaluated 11 studies of postaxial polydactyly that included a total of 153 participants (64 men, 89 women). They also document their clinical experience with a surgical technique used in cases of bilateral postaxial polydactyly of the foot with a Y-shaped metatarsal with biphalangeal sixth toe. CONCLUSIONS: Surgical correction with lateral removal of the sixth toe is a resolutive treatment to improve the functionality of the foot, its aesthetic appearance, and the patient's quality of life. Case-specific treatment should be applied and tailored to meet the individual needs. The biomechanics of gait and shoe problems in these patients improve with surgical treatment, without presenting secondary aesthetic problems in skin care.

Metatarsal lengthening by distraction osteogenesis for brachymetatarsia in paediatric patients: is it safe and effective?

PURPOSE: The primary aim is to assess the efficacy of the surgical callus distraction technique of the metatarsus in paediatric patients. Secondary objectives are to assess complications and treatment duration. We have also described the details of our surgical technique. MATERIALS AND METHODS: A case series review of paediatric patients who had metatarsal lengthening at our unit between 2014 and 2022. Patient demographics, duration of time in frame, complications and metatarsal length achieved were recorded. The AOFAS Midfoot and the MOXFQ were taken pre-operatively and at final follow-up. RESULTS: Sixteen metatarsals in 8 patients (14 feet) underwent lengthening between 2014 and 2022 using the MiniRail OrthoFix 100 (Orthofix Medical Inc, Lewisville, TX, USA). The mean age was 13.3 (12-17) years. The average duration between surgery and implant removal was 5.2 months. According to Paley's classification, there was one obstacle encountered in a patient who required a revision of their osteotomy and one problem in another patient who had an infected metatarsophalangeal joint stabilising k-wire treated with oral antibiotics. The Mean AOFAS Midfoot score improved from 53.10 to 86.40 (p < 0.0001) and the Mean MOXFQ improved from 32.5000 to 12.1250 (p < 0.05); these were statistically significant. CONCLUSION: Gradual metatarsal lengthening using the MiniRail external fixator is a safe and effective method to treat brachymetatarsia in paediatric patients. This preliminary report describes and supports metatarsal lengthening in appropriate patients. Holistic care in terms of a pre-operative assessment, psychological support and preparation for the extended rehabilitation period are vital.

Os Intermetatarseum: A Rare Variation of Great Relevance / Os Intermetatarseum: Una Rara Variación de Gran Relevancia

SUMMARY: The os intermetatarseum is an accessory bone located in the foot, usually between the first 2 metatarsals and the cuneiform bone. It can be presented as free, articulated or in a fused fashion. It is a very unusual variation found in less than 13 % of the population. A 27-year-old patient presented to the emergency service due to an ankle lesion. Physical exam showed pain and limited range of motion while supporting partial load. Radiographic imaging showed a bony trace near the base of the first and second metatarsals, diagnosed as the os intermetatarseum. Formation of this supernumerary bone begins as a separate ossification center. Most cases are asymptomatic; however, compression of the deep peroneal nerve branches by the os intermetatarseum can lead to pain. Some authors suggest that the presence of this bone may cause hallux valgus. The intermetatarseum can lead to diagnostic confusion, mainly related to Lisfranc fracture. Its origin is still little understood.

El os intermetatarseum es un hueso accesorio ubicado en el pie, generalmente entre los 2 primeros metatarsianos y el hueso cuneiforme. Puede presentarse de forma libre, articulada o fusionada. Es una variación muy inusual que se encuentra en menos del 13 % de la población. Paciente de 27 años que acude a urgencias por lesión en tobillo. El examen físico mostró dolor y rango de movimiento limitado mientras soportaba una carga parcial. Las imágenes radiológicas mostraron un rastro óseo cerca de la base del primer y segundo metatarsianos, diagnosticado como os intermetatarseum. La formación de este hueso supernumerario comienza como un centro de osificación separado. La mayoría de los casos son asintomáticos; sin embargo, la compresión de las ramas profundas del nervio fibular en el espacio intermetatarsiano puede provocar dolor. Algunos autores sugieren que la presencia de este hueso puede provocar hallux valgus. El hueso intermetatarsiano puede llevar a confusión diagnóstica, principalmente relacionada con la fractura de Lisfranc. Su origen aún es poco comprendido.

Braquimetatarsia: propuesta de tratamiento en base a técnicas de alargamiento: a propósito de dos casos / Brachymetatarsia: treatment proposal based on lengthening techniques: about two cases / Braquimetatarsia: proposta de tratamento baseada em técnicas de alongamento: sobre dois casos

Braquimetatarsia es el acortamiento anormal de uno o más metatarsianos. Tiene una incidencia de 0.02%-0.05% predominando en mujeres de 25 a 1. En un 72% puede ser bilateral. La etiología no es clara pero se plantea el cierre prematuro de la fisis dando un retardo en el crecimiento. La mayoría de las veces presenta síntomas causados por alteración en la mecánica de la parábola metatarsal como dolor e hiperqueratosis. Puede existir metatarsalgia y agregar en la evolución desviaciones digitales adicionales. El principal motivo de consulta es estético. El objetivo del reporte es mostrar dos técnicas quirúrgicas y los resultados clínicos correspondientes usando el score AOFAS, además de los resultados imágenológicos con hasta 5 años de seguimiento. Se describen dos pacientes y se analizan dos técnicas quirúrgicas diferentes para alargar los metatarsianos. Se trata de alargamientos agudos con interposición de injerto intercalar, en un caso mediante el procedimiento de Sandro Gianini con injerto de cresta ilíaca y en el otro con injerto de metatarsiano adyacente con modificación de la longitud del segundo y tercer metatarsiano restituyendo en ambos casos la parábola metatarsal. Obtuvimos buenos resultados al igual que series numerosas pudiendo recomendarse en casos similares.

Brachymetarsal is the abnormal shortening of one or more metatarsals. It has an incidence of 0.02%-0.05%, predominantly in women from 25 to 1. In 72% it can be bilateral. The etiology is not clear, but premature closure of the physis is suggested, giving growth retardation. Most of the time it presents symptoms caused by an alteration in the mechanics of the metatarsal parabola, such as pain and hyperkeratosis. There may be metatarsalgia and add additional digital deviations in the evolution. The main reason for consultation is aesthetic. The objective of the work is to show the surgical technique and the clinical results using the AOFAS score, in addition to the imaging results with up to 5 years of follow-up. Two patients are described and two different surgical techniques to lengthen the metatarsals are analyzed. These are acute lengthenings with intercalary graft interposition, in one case using the S.Gianini procedure with an iliac crest graft and in the other with an adjacent metatarsal graft with modification of the length of the second and third metatarsals, restoring in both cases the metatarsal parabola. We obtained good results. results as well as numerous series and can be recommended in similar cases.

Braquimetatarsal é o encurtamento anormal de um ou mais metatarsos. Tem incidência de 0,02%-0,05%, predominantemente em mulheres de 25 a 1 ano. Em 72% pode ser bilateral. A etiologia não é clara, mas sugere-se o fechamento prematuro da fise, causando retardo de crescimento. Na maioria das vezes apresenta sintomas decorrentes de uma alteração na mecânica da parábola metatarsal, como dor e hiperqueratose. Pode haver metatarsalgia e adicionar desvios digitais adicionais na evolução. O principal motivo da consulta é a estética. O objetivo do trabalho é mostrar a técnica cirúrgica e os resultados clínicos utilizando o escore AOFAS, além dos resultados de imagem com até 5 anos de seguimento. Materiais e métodos: São incluídos dois pacientes e analisadas duas técnicas cirúrgicas diferentes para alongar os metatarsos. São alongamentos agudos com interposição de enxerto intercalar, em um caso utilizando a técnica de S. Gianini com enxerto de crista ilíaca e no outro com enxerto de metatarso adjacente com modificação do comprimento do segundo e terceiro metatarsos, restaurando em ambos os casos o metatarso parábola. Obtivemos bons resultados, bem como inúmeras séries, podendo ser recomendados em casos semelhantes.

Influencia de la práctica deportiva sobre la huella plantar en atletas españoles / Influence of sport practice on the footprint in Spanish athletes

El objetivo de este estudio fue conocer la asociación entre el entrenamiento de atletas con las características de cada pie. Se midieron y compararon las huellas plantares de tres grupos de deportistas (28 velocistas, 29 fondistas, 47 nadadores) y de 67 sujetos no entrenados (GC). Para la captura de parámetros plantares se empleó una plataforma de escaneado podálico Podoscanalycer®. El índice podálico, metatarsal, medio podálico, y calcáneo fue inferior en GC respecto a corredores de velocidad, fondo, y nadadores (p<0.001). El riesgo relativo de tener un pie cavo o un tipo de pié específico por pertenecer a una determinada modalidad atlética no resulto significativo (todos p>0.05). Se concluye que los años de entrenamiento y la edad en atletas españoles no se asocian significativamente con la curvatura y tipología del pie ni sobre ningún índice plantar específico. Sin embargo, sexo e IMC se asocia significativamente con los índices plantares según la modalidad atlética (AU)

The aim of the present study was to determine the association between athletic training and characteristics of each foot. Plantar foot print of three groups of athletes (28 sprinters, 29 distance runners, 47 swimmers) and 67 sedentary subjects (CG) were measured and compared. A scanning platform breech Podoscanalyzer was employed to obtain plantar pressure measurements. The breech, metatarsal, middle breech, and calcaneus index, were lower in CG compared to sprinters, long-distance runners, and swimmers (p<0.001). The relative risk of having a cavus foot or any specific type of foot as a result of practicing a particular athletic discipline was not significant (all p>0.05). We conclude that the years of training and the age are not significantly associated neither with the curvature and the type of the foot nor with any specific plantar arch index in Spanish athletes. Nevertheless, sex and BMI are significantly associated with the plantar arch indexes according to the athletic discipline (AU)

Estudio comparativo de manejo de braquimetatarsia congénita mediante elongación por callotaxis / Comparative study of the management of congenital brachymetatarsia with elongation with callotaxis

La braquimetatarsia consiste en el acortamiento de 5 mm o más del arco parabólico metatarsal del pie, de uno o más de los metatarsianos; se relaciona directamente con el cierre prematuro del cartílago epifisario, o una prematura fusión de la línea epifisaria del extremo distal del metatarsiano, habitualmente el cuarto metatarsiano es el más afectado, predominio en el sexo femenino en relación de 25:1, afección bilateral 72%. Las causas pueden ser congénitas, post traumáticas o como parte de enfermedades específicas. Se realiza estudio prospectivo, comparativo de pacientes con diagnóstico de braquimetatarsia congénita, en el período comprendido de 2007-2008 y 2008-2012; el primer grupo consistió en siete pacientes de los cuales fueron seis niñas, un niño y en el segundo grupo: ocho pacientes, cinco niñas y tres niños. En el primer grupo se obtuvo un alargamiento de 21.1 mm en promedio, en el segundo grupo se obtuvo un alargamiento de 18 mm en promedio sin regresión, distrayendo 0.5 mm por día en ambos grupos. La elongación de los metatarsianos por callotaxis con minifijadores externos es un procedimiento satisfactorio para pacientes adolescentes próximos al cierre epifisario, teniendo mejores resultados con la distracción gradual a 0.5 mm por día.

Brachymetatarsia is the > 5 mm shortening of the metatarsal parabolic arc of the foot, in one or more metatarsals. It is directly related with the early closure of the epiphyseal cartilage or with early fusion of the epiphyseal line of the distal end of the metatarsal. The fourth metatarsal is usually the most affected one. Females are more commonly affected, with a female to male ratio of 25:1; 72% of cases have bilateral involvement. The causes may be congenital, posttraumatic or result from specific conditions. A prospective, comparative study was conducted of patients with a diagnosis of congenital brachymetatarsia seen in 2007-2008 and 2008-2012. Seven patients were included in the former period: six girls and one boy. Eight patients were included in the latter period: five girls and three boys. The mean shortening achieved in the first group was 21.1 mm; in the second one, 18 mm, without regression. The daily distraction in both groups was 0.5 mm. Metatarsal elongation by means of callotaxis with external fixators is an appropriate procedure for adolescent patients about to achieve epiphyseal closure. The best results are obtained with gradual distraction at a rate of 0.5 mm per day.

Pie en espejo / Mirror foot

Paciente masculino de 79 años de edad, el cual presenta en el miembro inferior izquierdo a nivel del pie una malformación congénita que corresponde a un pie en espejo, representado por 9 artejos, articulados en 8 metatarsianos, pie zambo, seudoartrosis alta de la tibia y luxación congénita alta del peroné. Es inusual encontrar esta deformidad en el momento actual.

Here is a 79 years-old patient who had in his left foot a congenital malformation called mirror foot, which is represented by 9 knuckles articulated in 8 metatarsals, knock-kneed foot, upper pseudoarthrosis of the shinbone and upper congenital luxation of the fibula. The presentation of this type of deformity is unusual today.

Pie en espejo / Mirror foot

Paciente masculino de 79 años de edad, el cual presenta en el miembro inferior izquierdo a nivel del pie una malformación congénita que corresponde a un pie en espejo, representado por 9 artejos, articulados en 8 metatarsianos, pie zambo, seudoartrosis alta de la tibia y luxación congénita alta del peroné. Es inusual encontrar esta deformidad en el momento actual(AU)

Here is a 79 years-old patient who had in his left foot a congenital malformation called mirror foot, which is represented by 9 knuckles articulated in 8 metatarsals, knock-kneed foot, upper pseudoarthrosis of the shinbone and upper congenital luxation of the fibula. The presentation of this type of deformity is unusual today(AU)

Metatarso aducto congénito: clasificación clínica y actitud terapéutica / Congenital metatarsus adductus: a clinical classification and therapeutic attitude

Objetivo. En este estudio se propone una clasificación clínico-terapéutica para el metatarso aducto congénito, con el objetivo de aunar criterios de diagnóstico y tratamiento, así como anticipar un pronóstico. Material y métodos. Seleccionamos 87 pacientes (144 pies) que se clasifican según su gravedad: •- Grado 1: antepié en aducción. Corrección total de la deformidad. •- Grado 2: antepié en aducción e inversión. Borde externo convexo (base del quinto metatarsiano palpable). Borde interno cóncavo. Arco longitudinal normal. Corrección parcial. •- Grado 3: grado 2 asociado a surcos transversales. No corregible. Tratamos el grado 1 con estimulación y manipulación. Para el grado 2 y 3 se realiza estimulación, manipulación y vendaje corrector, añadiendo férulas y botas de horma recta (opcional en el grado 2). Se ha realizado un estudio estadístico para determinar los casos que necesitan tratamiento, su duración y su eficacia. Resultados. Los 73 pies grado 1, 55 grado 2 y 16 grado 3 de nuestra serie se trataron de la forma indicada. Se consiguió la corrección total de 137 pies. La duración global del tratamiento fue de 4,65 meses, el período de corrección de 2,98 y el de seguimiento fue de 8,57 meses. Estos parámetros se asocian de manera significativa (p<0,05) con el grado de afectación. Conclusiones. Ninguno de nuestros pacientes precisó el uso de yesos ni intervención quirúrgica, lo que unido al porcentaje de correcciones totales nos hace pensar que nuestro protocolo es aceptable (AU)

Objective. This study proposes to make a clinical and therapeutic classification for congenital metatarsus adductus in order to unify criteria for diagnosis and treatment as well as to anticipate a prognosis. Material and methods. We selected 87 patients (144 feet) that were classified according to their severity: Grade 1: forefoot adduction. Total correction of the deformity. Grade 2: forefoot adduction and inversion. Convex outer edge (palpable first metatarsal base). Concave inner edge. Normal longitudinal arch. Partial correction. Grade 3: Grade 2 associated with transverse grooves. Uncorrectable. We treated level 1 with stimulation and manipulation. For grade 2 and 3 we applied stimulation, manipulation and corrective dressing, adding braces and straight-last boots (optional in grade 2). We performed a statistical study to identify cases that needed treatment, its duration and efficacy. Results. The 73 feet of grade 1, 55 grade 2 and 16 grade 3 of our series were treated as indicated. Total correction was achieved in 137 feet. Overall duration of treatment was 4.65 months, correction period 2.98 and monitoring was 8.57 months. These parameters were significantly associated (P<.05) with the degree of impairment. Conclusions. The percentage of total corrections and the fact that none of our patients required the use of casts or surgery makes us consider that our protocol is acceptable (AU)

Enfermedad de Charcot-Marie-Tooth: consideraciones ortopédicas / Charcot-Marie-Tooth syndrome: orthopaedic considerations

La enfermedad de Charcot-Marie-Tooth es una enfermedad heredodegenerativa del sistema nervioso periférico. La alteración es progresiva, y provoca deformidades en pies y manos. La musculatura de la pierna y el pie es la más afectada. La forma de presentación es muy diversa debido a que la afectación muscular es diferente en cada paciente. El pie cavo-varo es la forma de presentación habitual. El tratamiento conservador consiste en férulas correctoras, plantillas y rehabilitación. La indicación quirúrgica se plantea cuando fracasa el tratamiento conservador. La deformidad y el dolor son los problemas principales. En las deformidades flexibles se plantean cirugías para preservar las articulaciones. Los dedos en garra se tratarán con transferencias tendinosas o artroplastias. La deformidad en garra del dedo gordo se produce por el descenso del primer metatarsiano y la hiperactividad del músculo extensor hallucis longus. El tratamiento de esta deformidad del dedo gordo se realiza mediante la técnica de Jones. El descenso del primer metatarsiano necesitará una osteotomía dorsiflexora en la base del primer metatarsiano. Para el varo de retropié se utiliza la osteotomía valguizante de calcáneo. La retracción de la fascia plantar, gastrocnemio y Aquiles se trata con elongación de las estructuras retraídas. Cuando las deformidades son rígidas, será necesario realizar una artrodesis de las articulaciones afectadas. La artrodesis más utilizada es la triple artrodesis (AU)

Charcot-Marie-Tooth disease is a degenerative hereditary disease of the peripheral nervous system. The change is progressive and causes deformities in the feet and hands. The musculature of the leg and foot are most affected. The form of presentation is very diverse owing to the muscle involvement being different in each patient. The high-arched foot is the most common form of presentation. Conservative treatment consists of correction splints, insoles and rehabilitation. Surgery may be indicated when conservative treatment fails. The deformity and pain are the main problems. In flexion deformities surgery is indicated to conserve the joints. Claw hammer toes should be treated with tendon transfers and arthroplasty. The claw deformity in the big toe is caused by the descent of the first metatarsal and hyperactivity of the hallucis longus extensor muscle. The Jones technique is performed as treatment for this deformity of the big toe. The descent of the first metatarsal requires a dorsiflexion osteotomy in the base of the first metatarsal. For the hind foot varus a calcaneal vagus osteotomy is used. The tightening of the plantar fascia, gastrocnemius and Achilles is treated with an extension of the muscle contractures. When the deformities are rigid, it will be necessary to perform an arthrodesis of the affected joints. The arthrodesis most used is the triple arthrodesis (AU)

Criterios de selección de tratamiento en el síndrome de predislocación / Treatment selection criteria in predislocation syndrome

En la actualidad, la entidad clínica clasificada como síndrome de predislocación, es uno de los principales motivos de consulta referenciado a nivel de dolor en el pie. Se define como un proceso agudo, subagudo o crónico, inflamatorio, que afecta a las articulaciones metatarsofalángicas menores. Se produce como resultado de la insuficiencia de la placa plantar y los ligamentos colaterales, los cuales estabilizan las articulaciones metatarsofalángicas, asociándose a patrones anormales de carga en el antepié. Si la patología sigue su curso natural de evolución sin tratamiento, puede llegar a la ruptura de la placa plantar y a una inestabilidad crónica de la articulación metatarsofalángica que conlleva la dislocación o subluxación de la misma. El objetivo principal de la revisión bibliográfica es la actualización en los criterios de actuación mediante terapia física en el tratamiento del síndrome de predislocación. Se exponen las vías de tratamiento que se usan en la actualidad, los procedimientos y las técnicas físicas y se realiza una valoración basada en la evidencia sobre si la terapia física debe ser usada como tratamiento de elección o como coadyuvante. La revisión bibliográfica ha sido realizada en PubMed, ENFISPO y Tesauro. Las palabras clave de búsqueda han sido: síndrome predislocación, tratamiento físico, vendajes, metatarsalgia, bursitis antecapital, predislocation syndrome, antecapital pain, lesser subluxation metatarsophalangeal joint. Seleccionando los artículos con mayor evidencia científica y que presentaban mayor número de citaciones o referencias entre los artículos revisado(AU)

Nowadays, the clinical entity classified as predislocation syndrome is one of the principal reasons of consultation for foot pain. It is defined as acute, subacute or chronic inflammatory condition, affecting lesser metatarsophalangeal joint instability. The disorder is caused by failure of the plantar plate and collateral ligaments to stabilize the metatarsophalangeal joints. It is typically associated with abnormal forefoot loading patterns. If this condition is left untreated, it can lead to plantar plate and capsular attenuation and metatarsophalangeal joint instability associated dislocation or subluxation of the same. The purpose of this review is the update in the criteria of action by means of physical therapy in the treatment of predislocation syndrome. The currently used treatment, procedures and physical techniques used are presented and an evidence-based evaluation is made on whether physical therapy should be used as treatment of choice or as a coadjuvant one. The review of the literature review was conducted in PubMed, ENFISPO and Thesaurus, using search words in English and Spanish: síndrome predislocación, tratamiento físico, vendajes, metatarsalgia, bursitis antecapital, predislocation syndrome, physical therapy, dressings, metatarsalgia, antecapital pain, lesser subluxation metatarsophalangeal joint. The most scientific articles with the highest number of citations or references in the articles reviewed were selected(AU)

Corrección quirúrgica del puente epifi sario longitudinal en metatarsianos y falanges del pie / No disponble

El puente epifi sario longitudinal es un trastorno congénito infrecuentede la osifi cación encondral que afecta a pacientes esqueléticamenteinmaduros. Se presenta la revisión retrospectiva de los resultados deltratamiento quirúrgico en 4 pacientes (6 pies) entre los años 1999-2004. El puente epifi sario longitudinal, se localizó de forma bilateralen las falanges proximales del primer dedo del pie en 2 pacientes (4pies) y unilateralmente en los primeros metatarsianos de 2 pacientes(2 pies). El objetivo fue analizar los resultados obtenidos en nuestrocentro tras el tratamiento quirúrgico de esta patología. La técnicaquirúrgica, consistió en resección de la región central del puente deforma aislada en 1 caso y resección central de la lesión asociada aosteotomía en cuña de adición correctora de la deformidad angular ydel acortamiento óseo en los 5 casos restantes. El seguimiento mediofue de 6 años (4-8 años). Los resultados se valoraron en función dela mejoría postoperatoria de la desviación angular en varo del primerdedo y el aumento postoperatorio del crecimiento longitudinal delhueso. Todos los pacientes presentaron una evolución satisfactoria yno se registraron compliciones secundarias a la cirugía realizada. Eltratamiento del puente epifi sario longitudinal es siempre quirúrgico yla técnica ha de individualizarse para cada paciente(AU)

The longitudinal epiphyseal bracket is a rare ossifi cation defect in immaturepatients. We report our results in the surgical treatment of 4 patients(6 feet) from 1999 to 2004. The longitudinal epiphyseal bracket wasbilateral in the proximal phalanx of the toe in 2 patients (4 feet) andunilateral in the fi rst metatarsal in 2 patients (2 feet).The aim was toconsider the results of surgical treatment for this deformity. The surgicaltechnique consisted of excision of the central area of the longitudinalepiphyseal bracket in one case and central physiolysis associated withcorrective addition osteotomy of angular and shortening deformity in theother 5 cases. The average follow-up was 6 years (range 4-8 years).The results were assessed considering correction of angular deviationof the toe and increase in longitudinal bone growth. All patients presentsatisfactory evolution with no complications of surgical treatmentreported. Surgical treatment is always indicated in such cases, and theapproach should be individualized(AU)

The postoperative stability of the first metatarsal

The hallux valgus deformity is characterised by an increased first intermetatarsal angle, which can be reduced by osteotomies on the first metatarsal bone, such as the Proximal osteotomy and the Scarf shaft osteotomy. Osteotomy and subsequent screw fixations were performed on 18 matched pairs of cadaveric specimens to compare the postoperative stability of these two common types of operative correction. Biomechanical testing with plantar force was carried out and failure load was measured for each specimen. The results indicate that the threaded bones provide a high postoperative loading capacity. When maximal strain was exceeded, the specimens failed in the proximal third, irrespective of the type of osteotomy. Moreover, we found that in contrast to the living age the mineral density and the individual geometry of the bone have a marked influence on the postoperative loading capacity. Finally, static biomechanical studies demonstrated that the Scarf osteotomy is significantly more stable than the commonly used Proximal osteotomy. Regarding the early postoperative mobilization of the patients concerned, the Scarf osteotomy proved to be superior, but the Proximal osteotomy requires a more cautious rehabilitation program (AU)

No disponible

Metatarso varo congênito: seguimento a longo prazo / Congenital varus metatarsus: long term follow-up

Os autores fazem uma análise de 46 pacientes com 69 pés afetados com o diagnóstico de metatarso varo congênito. O seguimento foi a longo prazo, com mínimo de dois anos e máximo de 19 anos e média de oito anos e nove meses. A duraçäo média de tratamento foi de três meses. Fazem uma análise dos resultados, comparando os pés no início e no fim do tratamento e mais tarde, num último exame. Utilizam a medida do ângulo entre o eixo do calcâneo e o eixo do quarto metatarsiano na radiografia ântero-posterior do pé e constatam que a dificuldade do tratamento näo dependeu da intensidade da deformidade