Morton's interdigital neuroma: a comprehensive treatment protocol.

One hundred fifteen patients with signs and symptoms of Mortons' interdigital neuroma were studied in an attempt to evaluate the efficacy of a staged treatment program. The first stage consisted of patient education, footwear modifications, and metatarsal head relief. The second stage consisted of a steroid/local anesthetic injection into the affected interspace. The third stage was surgical excision of the inflamed interdigital nerve. Overall, 97 of 115 patients (85%) believed that they had improved with the treatment program. Twenty-four patients (21%) eventually required surgical excision of the nerve and 23 of 24 patients (96%) had satisfactory results. The results of the staged treatment protocol were very satisfactory and patient satisfaction was high.

Triple arthrodesis in adults.

Twenty-two adult patients who underwent a triple arthrodesis because of hindfoot pain and/or deformity were reviewed retrospectively with a minimum 3-year follow-up. All procedures were performed by the same surgeon using a two-incision technique and internal fixation. Objective results were good in eight (36%) patients, fair in 13 (59%), and poor in one (5%). There were two asymptomatic nonunions of the talonavicular joint, no infections, and no neuromas. Eleven patients had radiographic evidence of tibiotalar arthritis, and eleven patients had midfoot arthritic changes that had progressed after the operation. Patient satisfaction with the procedure was high, and 21 of 22 (95%) patients felt that they were improved overall and would have the surgery again if indicated. Although the procedure is technically demanding, patient satisfaction is high and complications can be kept to a minimum if proper surgical technique is utilized.

Correction of hallux valgus with metatarsocuneiform stabilization.

51 feet in 30 patients were evaluated clinically and radiographically an average of 27.6 months after undergoing a modified McBride bunionectomy with a metatarsocuneiform stabilization. An inlay block of bone was used after achieving corrected position of the first metatarsal. The retrospective review included an anteroposterior x-ray, in which definite trabecular bridging was present in only 25.5% of the cases. The metatarsocuneiform joint was asymptomatic regardless of its x-ray appearance. The average intermetatarsal angle was reduced from 14.6 degrees to 8.7 degrees. This procedure attempts to restore near-normal anatomy, thereby preventing transfer metatarsalgia from shortening or elevation of the first metatarsal. Acceptable correction is possible in both moderate and severe deformities.

Protrusio acetabuli in Marfan's syndrome.

In an unselected series of 14 patients with Marfan's syndrome, protrusio acetabuli was documented by both presence of a center edge (CE) angle of 40 degrees or more and crossing of the teardrop by the femoral head. The disorder was unilateral in 8 patients, bilateral in 6. Since most of the CE angles were measured on scoliosis roentgenograms, the measurements were made in a control group with an average CE angle of 33.1 degree, compared with an average of 43.4 degree in the Marfan's group. One of the hips with protrusio was associated with chondrolysis. Protrusio acetabuli is a common abnormality of persons with Marfan's syndrome. It may be related to the same mesenchymal tissue disorder that predisposes these persons to scoliosis, chest wall deformities, and other skeletal malformations.