Percutaneous Fifth Metatarsal Osteotomy for Bunionette Deformity Without Fixation or Strapping: A Retrospective Study.

BACKGROUND: Bunionette deformity (BD) is a painful condition of the fifth metatarsal characterized by an osseous prominence and fifth toe varus deformity. The purpose of this study is to assess the clinical, functional, and radiographic outcomes of percutaneous distal metatarsal metaphyseal osteotomy (DMMO) without fixation or postoperative strapping of the foot. METHODS: A retrospective case series was performed on 111 patients (132 feet) with symptomatic BD who underwent percutaneous DMMO of the fifth metatarsal from September 2020 to January 2022 by an experienced minimally invasive surgeon. According to the Shimobayashi classification, we treated 1 type I deformity, 37 type II deformities, 52 type III deformities, 42 feet with type IV deformity, and no patient with a type V deformity. Ninety patients (81%) underwent unilateral osteotomy, and 21 (19%) had bilateral osteotomies. Most cases included other procedures including treatment of 114 associated deformities of the same feet: 68 bunions, 12 lesser metatarsal osteotomies (2-3-4 metatarsals), and 34 hammertoes (20 second hammertoes, 10 third hammertoes, 1 fourth hammertoes, 2 fifth hammertoes). Patient-reported clinical outcome measures, including the Foot Function Index (FFI) questionnaire, the visual analog score (VAS), and overall satisfaction were collected. Fourth-to-fifth intermetatarsal angle (IMA) correction, time to bone union, and complication rates were assessed in all patients. RESULTS: Mean follow-up was 24.1 months (range, 14-39 months). Both radiographic parameters and patient-reported outcome measures significantly improved after DMMO procedure. The average fourth-to-fifth IMA improved from 12.2 degrees, preoperatively, to 4.4 degrees, postoperatively (P < .001). Patient outcomes reflect the overall outcomes of the combined surgeries on a per-patient basis. Preoperatively, patients had a mean VAS score of 7.6, which improved to 0.6 at the last follow-up (P < .001). Furthermore, the average FFI significantly decreased from pre- to postoperation from 19.2 to 4.4, respectively (P < .001). Overall, 108 of 111 patients reported being satisfied with the outcomes of the procedure. Average bone union was achieved at 12.6 weeks postoperation, with a minimum of 12 and a maximum of 25 weeks. The complication rate was 1.5%, including 1 case of an asymptomatic cock-up deformity and 1 case of lateral fifth metatarsal shaft bone overhang pain, which resolved with an exostectomy. CONCLUSION: The results of this study of patients who had minimally invasive surgery from an experienced surgeon suggest that percutaneous DMMO of the fifth metatarsal without internal fixation or postoperative immobilization or strapping can be effective at improving radiographic alignment, pain, function, and overall satisfaction with minimal rates of complication. LEVEL OF EVIDENCE: Level IV, case series.

Scarf osteotomy for reduction of tailors bunion deformities: Systematic review and meta-analysis.

BACKGROUND: Tailors bunions are common forefoot deformities affecting the fifth MPJ, with challenging symptomatology often resistant to conservative care. Currently no gold standard exists for the surgical management of tailor's bunions, although the scarf osteotomy has been described as a versatile option for reducing these deformities. METHODS: Relevant electronic databases were searched to collate all studies pertaining to tailors bunion correction using the scarf osteotomy between 2000 and 2021. Both surgeon and patient reported outcomes were required to be included in the systematic review. Methodological quality assessment and risk of bias was performed for each study. Statistical analysis of outcomes and complications was measured. Four small scale case series studies met the inclusion criteria. RESULTS: All studies demonstrated a statistically significant reduction of 4th inter-metatarsal angles, improvement in clinical and patient reported outcome measures. 15% complication rate was identified, however recurring plantar hyperkeratoses were the most frequent, with one study suggesting a relationship with Pes Cavus. All four studies demonstrated significant methodological short comings and high risk of bias. CONCLUSION: Scarf osteotomy provides good reduction of tailors' bunion deformities, demonstrates low complication rate and high patient satisfaction. Foot and Ankle surgeons should counsel patients' accordingly on risk of recurrence where hyperkeratosis is a key complaint.

Minimally Invasive Foot and Ankle Surgery: A Primer for Orthopaedic Surgeons.

There is rapidly growing interest in minimally invasive surgery (MIS) of the foot and ankle. Technological advances, specifically with the advent of low-speed high-torque burrs, have enabled the expansion of MIS techniques. Accordingly, there is growing literature reporting excellent outcomes of MIS surgery to address many different pathologies of the foot and ankle. MIS techniques are particularly useful for conducting percutaneous osteotomies and bony débridement. These can be used to address bunion deformity, hammertoes, metatarsalgia, bunionette deformity, bone spurs, and hindfoot deformity. A detailed understanding of the technology, equipment, and techniques is crucial to safely conduct MIS of the foot and ankle. When done safely, MIS provides favorable outcomes with an expedited recovery and limited complications.

Midterm Outcomes of Sliding Distal Metatarsal Minimally Invasive Osteotomy to Treat Bunionette Deformity.

BACKGROUND: Bunionette deformity is described as a painful bony prominence on the lateral aspect of the fifth metatarsal head. The present study prospectively assessed the clinical, functional, and radiographic outcomes of sliding distal metatarsal minimally invasive osteotomy (S-DMMO) used in a large series of patients with a midterm follow-up period. METHODS: From December 2015 to December 2018, we evaluated 74 feet (57 patients). Radiologic (4-to-5 intermetatarsal angle, fifth metatarsophalangeal angle, the fifth metatarsal head width, lateral deviation angle, fifth metatarsal length, medial displacement, and elevation), clinician-reported scores (AOFAS score, visual analog scale [VAS]) and patient-reported outcomes measure (Foot and Ankle Ability Measure [FAAM] activities of daily living [ADL], FAAM sports, Manchester-Oxford Foot Questionnaire [MOXFQ], and patient satisfaction survey) were included in the analysis. The time to bone union was also assessed. RESULTS: The average 4-to-5 intermetatarsal angle improved from 11.1 degrees preoperatively to 4.5 degrees postoperatively (P < .001), whereas the average fifth metatarsophalangeal angle improved from 15.7 degrees preoperatively to 4.8 degrees postoperatively (P < .001). The lateral deviation angle was found to be 2.2 degrees. The fifth metatarsal length decreased from 66.6 to 64.3 mm postoperatively. The average initial medial displacement was 4.67 mm preoperatively and 4.54 mm at final follow-up. The elevation of the fifth metatarsal head was 1.08 mm. The American Orthopaedic Foot & Ankle Society score improved from 54.3 ± 20.86 points preoperatively to 93.4 ± 17.3 (P < .001). VAS score decreased from 7.9 to 0.7 (P < .001). Also, FAAM ALD, FAAM Sport, and MOXFQ showed statistically significant differences (P < .001) between preoperative and postoperative periods. Patients found the procedure excellent in 89.1% of cases, very good in 5.4%, and good in 5.4%. Bone union was obtained at 8.1 weeks. CONCLUSION: The most important finding of the present study is that S-DMMO showed improvement in function and pain associated with a high satisfaction rate. Also, we found substantial capacity to correct deformities and a low incidence of complications. LEVEL OF EVIDENCE: Level IV, case series.

Clinical Outcomes of Scarf-Akin Osteotomy for Hallux Valgus With Simultaneous Bunionette Correction: A Propensity Score-Matched Cohort Analysis.

Hallux valgus and bunionette (Tailor's bunion) deformities are debilitating forefoot deformities that may occur together. Successful outcomes of surgery for either pathology have been well-described; however, the literature is sparce on outcomes of patients undergoing simultaneous surgery for both deformities. Between 2007 and 2018, 429 patients underwent a scarf-Akin osteotomy, and 20 patients underwent simultaneous bunionette surgery. Propensity score matching was used to match the scarf + bunionette group in a 1:2 ratio to a corresponding scarf only group using logistic regression. Their hallux and fifth metatarsal visual analogue scale (VAS), American Orthopaedic Foot & Ankle Society (AOFAS) Hallux Metatarsophalangeal-Interphalangeal Scale, Short Form-36 (SF-36), expectations and satisfaction scores were recorded at preoperative, 6-month and 2-year intervals. There were no differences in baseline characteristics between groups after matching (p > .05). At 6 months, the scarf + bunionette group had a significantly worse fifth metatarsal AOFAS (80.7 vs 92.9, p = .002) and VAS (1.5 vs 0.1, p = .008). However, at 2 years, greater improvements in the scarf + bunionette group resulted in no significant differences for fifth metatarsal AOFAS and VAS. The scarf + bunionette group had better SF-36 scores in the domains of physical functioning, bodily pain, general health and mental health (p < .05). Scarf + bunionette patients trended toward higher satisfaction (100.0% vs 85.0%, p = .165) and expectation fulfilment (95.0% vs 80.0%, p = .249) at 2 years, although not significant with the available numbers. In patients with similar baseline hallux and fifth metatarsal pain and function, simultaneous surgery and a scarf osteotomy alone result in similar improvements to pain and function at 2 years. However, patients who undergo both procedures have higher quality of life scores.

Percutaneous Bunionette Correction: Retrospective Case Series.

Introduction. Bunionette is a deformity of the fifth metatarsal in which there is a painful lateral bony prominence of the distal region of this bone caused by various anatomical and biomechanical changes. The aim of this study is to report on a minimally invasive technique without the use of hardware to treat these deformities. Methods. This is a case series of 18 patients, 25 feet, who underwent bunionette percutaneous surgical treatment. All patients answered the American Orthopaedic Foot and Ankle Society (AOFAS) scale and the visual analogue pain scale (VAS) preoperatively and at the last follow-up. Standard radiological evaluation included measurement of intermetatarsal (4-5 IMA) and fifth toe metatarsophalangeal (5-MTTP) angles. Time to radiographic consolidation, complications, and satisfaction rate were also documented. Results. The average follow-up was 15.9 months, the AOFAS increased from 49.6 to 92.4 and the VAS decreased from 7.7 to 1.2. It was observed that average 5-MTTP decreased from 15° to 2.7° and that 4-5-IMA decreased from 9.1° to 3.3°. These outcomes showed a statistically significant difference (P < .001). The most common observed complication was the formation of a hypertrophic bone callus in the third postoperative month in three operated feet (12%). One patient had algodystrophy, which improved after conservative treatment. There were no cases of infection, neuropraxis, or recurrences. Fifteen patients rated the result as excellent, 2 as good, and 2 as regular. Conclusion. Percutaneous osteotomy of the fifth metatarsal without the use of hardware is a safe, reproducible technique and presents good clinical and radiographic results for the treatment of bunionette.Levels of Evidence: Therapeutic studies, Level IV: Case series.

Bunionette: Is There a Minimally Invasive Solution?

A bunionette deformity is a painful prominence on the lateral aspect of the fifth metatarsal head. Surgical treatment can be considered if conservative treatment has failed to relieve the symptoms. The percutaneous approach consists of 2 steps: a condylectomy and an osteotomy of the fifth metatarsal. The learning curve is small and the final results are similar to the open techniques. The main advantages are the hardware-free technique and the minimally invasive approach. This percutaneous approach avoids complications related to hardware and soft tissue healing. Because of this low complication rate, the percutaneous technique may become the new gold standard.

Percutaneous Oblique Distal Osteotomy of the Fifth Metatarsal for Bunionette Correction.

BACKGROUND: Bunionette is a common foot disorder, and several types of corrective surgery have been described. With the popularization of minimally invasive surgeries, the forefoot region has become a suitable area for this type of technique. The aim of this study was to evaluate the results of oblique distal osteotomy of the fifth metatarsal adapted for a percutaneous approach. METHODS: We prospectively evaluated 31 consecutive tailor's bunion patients who underwent operative correction on a total of 42 feet between 2017 and 2019 after failure of conservative treatment. Clinical outcomes such as pain (visual analog scale [VAS]), function (American Orthopaedic Foot & Ankle Society [AOFAS] Lesser Toe Metatarsophalangeal-Interphalangeal Scale scoring system), personal satisfaction, and complications were evaluated. Radiographic aspects were also examined. Shapiro and Mann-Whitney statistical tests were conducted. The average age of the patients was 69.5 years, and the average follow-up was 13.1 months. RESULTS: After the operative procedure, there was a decrease of 6.6 points on the VAS for pain (P < .001) and an increase of 34.9 in the AOFAS score (P < .001). Radiographic correction was achieved for both the fifth metatarsophalangeal angle (P < .001) and the intermetatarsal angle (P < .001), which showed decreased values. There was 1 case of superficial infection and 2 cases of nonunion (asymptomatic). A large majority of patients regarded the procedure outcome as satisfactory. CONCLUSION: This percutaneous oblique distal osteotomy of the fifth metatarsal for bunionette deformity produced improvements in pain and function and a high rate of satisfaction, with a low incidence of complications and a high capacity for correcting the deformity. LEVEL OF EVIDENCE: Level II, prospective cohort study.

Bunionette deformity corrected with "shortening" scarf osteotomy of the fifth metatarsal: mid-term results of a 34-cases.

BACKGROUND: The aim of this study was to evaluate the clinical and radiological outcomes (in mid-term) after "shortening" scarf osteotomy of the fifth metatarsal for the treatment of bunionette deformity. METHODS: We retrospectively reviewed the functional score - American Orthopaedic Foot and Ankle Society (AOFAS) Lesser Toe Metatarsophalangeal-Interphalangeal Scale, radiographic results - 4th/5th intermetatarsal angle, varus angle of the 5th metatarsophalangeal joint and complications in a consecutive series of 34 feet (27 patients) with bunionette. Nine males and 18 females (mean age: 45 years) were included in the study. Three males and four females were operated bilaterally The patients were operated on between 2004 and 2015, and evaluated during 2017. RESULTS: The average AOFAS score improved from 59.4 to 93 at a mean follow-up of 7.2 years. The 4th/5th intermetatarsal angle and varus angle of the 5th metatarsophalangeal joint decreased from 13.9°/19.5° preoperatively to 6°/5.9° at final follow-up. No neurovascular damage was recorded. Complications arose in five feet (14.7%): delayed union (n=1), early infection (n=1), distal screw migration (n=1), asymptomatic non-union (n=1), transverse metatarsalgia (n=1). The osteotomy healed within less than three months except twoo (delayed union, non-union). Three feet needed additional surgery: screw removal (n=2), Weil osteotomy of 2nd-4th metatarsals (n=1). CONCLUSIONS: "Shortening" scarf osteotomy is an acceptable, but not complication-free, treatment option for the bunionette deformity and offers promising results in the mid-term.

Bone Reconstruction in the Diabetic Foot.

Surgical bone reconstructive procedures of the foot and ankle in diabetic patients must be considered when performing evaluation of a diabetic foot for patients with preulcerative lesions and preexisting wounds. Preventive deformity correction can reduce the potential risk of ulceration, infection, and possible amputation in a patient with an at-risk foot type. It can also expedite wound healing and prevent further breakdown in a patient with lower extremity ulcerations. This article discusses different types of surgical bone reconstructive procedures as preventive and prophylactic deformity corrections to reduce osseous deformity, minimize preulcerative lesions, and increase limb-salvage rates in the compromised patient.

Direction and location of the nutrient artery to the fifth metatarsal at risk in osteotomy for bunionette.

BACKGROUND: The aims of this study were to identify the artery feeding the fifth metatarsal and determine how bunionette osteotomy could injure this vessel. METHODS: The nutrient artery entering the fifth metatarsal was investigated in 10 adult cadaveric lower limbs by barium injection and enhanced computed tomography. RESULTS: The nutrient artery entered the medial aspect of the fifth metatarsal around the junction of the middle and proximal thirds obliquely from a distal direction (mean angle 36°) in the coronal plane in all cases; in the axial plane, the point of entry and direction of the artery was medial-plantar (mean angle 49°). CONCLUSIONS: This report revealed direction and location of the nutrient artery entering the fifth metatarsal.

Anatomical considerations for minimally invasive osteotomy of the fifth metatarsal for bunionette correction - A pilot study.

INTRODUCTION: Operative correction of symptomatic bunionette by means of minimally invasive (MI) osteotomies of the 5th metatarsal (M5) has gained popularity. This study aims to investigate the safe zones of commonly used techniques and the risk of injury to neurological structures. MATERIALS AND METHODS: Ten human fresh frozen cadaveric feet were dissected and branches of the sural nerve were identified. A frontal section of the feet was performed at the site of the skin incision described for M5 MI osteotomies (corresponding to distal and mid diaphyseal osteotomies). The location of the lateral dorsal cutaneous nerve (LDCN) of the sural nerve or its branches was documented using a goniometer and o'clock references placed on the frontal section of the M5. RESULTS: The LDCN showed variations in the distribution of its branches, forming the dorsolateral branch - a single terminal branch for the 5th toe - in 6/10 cases or two terminal branches - the dorsolateral and dorsomedial - in 4/10. At the point of osteotomies, the dorsolateral branch was identified at a mean of 22.7° from the extensor tendon around the M5 circumference and in all cases between 12 and 2 o'clock in a right foot or 10 o'clock to 12 o'clock in a left. CONCLUSION: The studied M5 osteotomies can place the dorsolateral branch of the fifth toe at risk and safe zones lie between 10 o'clock to 2 o'clock in any foot laterality. If these landmarks are considered, the risk of nerve damage is minimized when performing MI osteotomies of the M5.

Management of Bunionette Deformity.

Bunionette deformity, historically known as tailor's bunion, is a forefoot protuberance laterally, dorsolaterally, or plantarlaterally along the fifth metatarsal head. Although bunionette deformity has been compared to hallux valgus deformity, it is likely due to a multifactorial, anatomic interplay between fifth metatarsal bony morphology and forefoot soft-tissue imbalance. Friction generated between the bony prominence, soft tissue, and associated constrictive footwear can result in keratosis, inflammation, pain, and ulceration. Symptomatic bunionettes are usually responsive to nonsurgical management. Surgical options are available based on the underlying bony deformity when nonsurgical treatment fails.

Minimally invasive bunionette correction.

OBJECTIVE: Bunionette or 'tailor's bunion' is a deformity of the fifth ray, which comes along with a metatarsus quintus valgus and a varus deformity of the fifth toe with subluxation of the metatarsophalangeal joint. A minimally invasive osteotomy of the fifth metatarsal without internal fixation using burrs is an increasingly used alternative for symptomatic tailor's bunion deformity. Similar to open surgery procedures the type of osteotomy complies with the underlying pathology. Minimally invasive surgical (MIS) procedures allow comprehensive treatment of various types of tailor's bunion deformities. INDICATIONS: Symptomatic tailor's bunion deformity, failed conservative treatment, a closed epiphyseal gap. CONTRAINDICATIONS: Osteoporotic bone, poor patient compliance. SURGICAL TECHNIQUE: The technique comprises percutaneous resection of the lateral exostosis of the fifth metatarsal head with a straight burr and an osteotomy of the fifth metatarsal, either distally, diaphyseal or proximally with a conical burr due to the shape of the deformity, usually without internal fixation. POSTOPERATIVE MANAGEMENT: Redressive wrapping, partial pain-adapted weight bearing. Non-steroidal anti-inflammatory drugs for 3-5 days, lymphatic drainage, intermittent cooling. Radiographic assessment on postoperative day 1; radiographic follow-up 6 weeks postoperatively. Thromboembolic prophylaxis. RESULTS: The clinical outcome is comparable to standard surgical procedures with the advantages of MIS. Based on our results and the current literature, the minimally invasive distal metatarsal osteotomy without fixation is becoming a reliable treatment for tailor's bunion.

Clinical and radiographic outcomes of the Kramer osteotomy in the treatment of bunionette deformity.

BACKGROUND: Bunionette deformity is a painful bony prominence of the 5th metatarsal. We evaluated outcomes of using a Kramer osteotomy to treat this condition. METHODS: Retrospective study of patients treated with a Kramer osteotomy from 2003 and 2016. Outcome measures included Foot Functional Index (FFI) and radiographic measurements. RESULTS: 38 patients (43 feet) with an average follow-up of 55 months. Mean postoperative FFI1 was 19.4. Mean 4-5 IMA2 improved 3.9°, from 8.3° preoperatively to 4.4° on final postoperative films (p<0.01). Mean MTP-53 angle improved 13.2° from 13.6° preoperatively to 0.4° at final follow-up (p<0.01). There were 5 delayed unions (11.6%) and 1 non-union (2.3%). CONCLUSIONS: The Kramer osteotomy is an effective treatment option in patients with bunionette deformity, with significant correction of the 4-5 IM2 and MTP-53 angles and few complications.

Minimally Invasive Distal Metatarsal Metaphyseal Osteotomy (DMMO) of the Fifth Metatarsal for Bunionette Correction.

BACKGROUND: Different osteotomies have been proposed for the treatment of bunionette deformity. Minimally invasive surgery is now increasingly popular for a variety of forefoot conditions. The aim of this study was to evaluate the outcome following fifth minimally invasive distal metatarsal metaphyseal osteotomy (DMMO) for bunionette deformity. METHODS: Nineteen patients (21 feet) who had symptomatic bunionette deformity and failed conservative treatment between 2014 and 2016 were included in this retrospective study. Clinical data were recorded, and pre- and postoperative Manchester-Oxford Foot Questionnaire (MOXFQ) scores and visual analog scale (VAS) pain score were collected. The mean follow-up was 28 months (range, 12-47). RESULTS: The mean MOXFQ summary index score decreased from 71 (range, 59-81) preoperatively to 10 (range, 0-30) postoperatively. All 3 MOXFQ domains also improved. The average improvement in VAS score was 7. Forefoot swelling and some painful symptoms took an average of 3 months to settle. There were no wound or nerve complications. One patient required a dorsal cheilectomy for a symptomatic prominent dorsolateral callus formation. CONCLUSION: The minimally invasive fifth DMMO for bunionette deformity was a safe and effective technique. It had relatively few complications and led to good clinical results. We believe it is important to warn patients that the forefoot swelling will take months to settle compared to an osteotomy with fixation, and there is a 10% chance of a prominent callus over the osteotomy site. LEVEL OF EVIDENCE: Level IV, retrospective case series.

Fifth Metatarsal Osteotomies for Treatment of Bunionette Deformity: A Meta-Analysis of Angle Correction and Clinical Condition.

We assessed which type of osteotomy would be most suited for correcting an increased fourth to fifth intermetatarsal angle (IMA) and metatarsophalangeal angle (MPA) and would have the best results regarding the clinical condition and satisfaction. The study design was a systematic review and meta-analysis. The main outcome measures were the IMA, MPA, and American Orthopaedic Foot and Ankle Society Lesser Metatarsophalangeal-Interphalangeal scale and satisfaction scores. A systematic search was performed in Medline, Embase, Cochrane, SPORTdiscus, and CINAHL up to September 2016. Prospective and retrospective studies that had evaluated the outcomes of fifth metatarsal osteotomies to correct a bunionette deformity at all patient ages were included. The outcomes were determined from clinical or radiographic evaluations. The search yielded 28 studies suitable for inclusion in our meta-analysis. All groups of osteotomies achieved significant IMA changes, with proximal osteotomies resulting in significantly greater changes than diaphyseal or distal osteotomies. The overall effect of osteotomies on the MPA was of a significant reduction. Proximal and diaphyseal osteotomies both resulted in significant differences in MPA correction compared with distal osteotomies. The incidence of major complications was the least in the distal osteotomy group. The overall mean success rate of bunionette surgery was 93%. The patients were most satisfied with proximal osteotomies, followed by distal and diaphyseal osteotomies (100% and 92%, respectively). In conclusion, every type of osteotomy has the capability of significantly reducing the fourth to fifth IMA and MPA. The fewest complications occurred with distal osteotomies, and the greatest satisfaction score was achieved with proximal osteotomies. However, only 1 study evaluated these results for proximal osteotomies. Distal osteotomies resulted in a high satisfaction rate and were the most represented osteotomy in our meta-analysis. Thus, when major IMA and MPA reduction is not required, the distal osteotomy could be the treatment of choice owing to its low complication rate.

Bunionette.

PURPOSE: The purpose of this study is to review the most recent literature available on the treatment of bunionette (also named tailor's bunion) with percutaneous and minimally invasive techniques. Focusing especially on clinical outcomes, studies related to this type of techniques were examined in order to evaluate the success of this practice that is, fusion rate and complications. The hypothesis is that these techniques are safe and successful procedures. METHODS: In July 2015, a topical review of the PubMed/MEDLINE, EMBASE, and Google Scholar databases was conducted using the keywords percutaneous (OR mini-invasive OR minimally invasive) AND bunionette (OR tailor's bunion) AND treatment (OR surgery). Studies reporting the outcomes of the surgical treatment of bunionette were also included in our review. RESULTS: The search yielded a total of 111 publications from PubMed/MEDLINE, EMBASE, and Google Scholar. After evaluating abstracts and full-text reviews, 9 articles were included in this review. Treatment methods were divided into 2 main surgical treatment categories: with or without fixation of the osteotomy. The most commonly used technique was that with fixation. The scores of success for techniques with and without fixation were 93.5 and 97.8, respectively. CONCLUSION: The current evidence for the treatment of bunionette deformity is limited to retrospective case series. Therefore, no conclusion can be made regarding the gold standard technique for bunionette deformity. The results published are very satisfactory, but the literature is still poor. LEVELS OF EVIDENCE: IV: Topical review.

Percutaneous hardware free corrective osteotomy for bunionnette deformity.

When bunionette deformities are not responding to conservative treatment, several surgical procedures are available. Recently, minimal invasive techniques have been proposed with good results. We present our results of a strictly percutaneous 5th metatarsal osteotomy to correct the deformity with bandage after care. We present a retrospective review on 20 percutaneous distal oblique 5th metatarsal osteotomies for correction of bunionette deformity. Aftercare consisted of 5-6 weeks of corrective taping with full weight bearing using a post-op shoe. Patients were evaluated radiographically and clinically by the American Orthopaedic Foot & Ankle Society (AOFAS) Lesser Toe Metatarsophalangeal-Inter-phalangeal scale, Visual Analogue scale (VAS) and Coughlin classification. At a mean follow-up of 27.05 months, the AOFAS improved from a mean of 51 points to 91.6 points (max 100). 90% of patients had good or excellent clinical result and a mean pain score on the visual analog scale was 0.7 out of 10. Radiographic evaluation showed a good correction of the intermetatarsal and metatarsophalangeal angle. We did not encounter any complications such as infections, wound breakdown, neurovascular problems, non-union or recurrence. The percutaneous hardware free corrective osteotomy is an effective, reliable and safe procedure concerning the treatment of bunionette deformity. The results are comparable with previously published outcomes of open and minimal invasive procedures with considerable less soft tissue damage, shorter operating time and the lack of internal fixation.

[Modified Chevron osteotomy combined distal soft tissue reconstruction to treat high-grade bunionette deformity].

OBJECTIVE: To explore the surgical method of using the modified chevron osteotomy combined distal soft tissue reconstruction to treat high-grade bunionette deformity. METHODS: From June 2013 to June 2015, the modified chevron osteotomy combined distal soft tissue reconstruction was used for surgical treatment of high-grade bunionette deformity in the Department of Hand and Foot Microsurgery in Xuzhou Central Hospital.Twenty-six patients with 28 feet high-grade bunionette deformity were hospitalized for treatment, with 3 male (3 feet) and 23 female (25 feet) cases, aged 22-73 (mean 47.1) years old.The average fourth-fifth intermetatarsal angle, lateral deviation of the fifth metatarsal angle and metatarsophalangeal-fifth angle were measured on the pre-and post- operative anterior to posterior weight-beating X rays of treated feet.The American Orthopaedic Foot and Ankle Society (AOFAS) Lesser Toe Metatarsophalangeal-Interphalangeal Scale was used to evaluate the post-operative outcomes. RESULTS: All of 26 patients were followed, with a mean 15.7 months (range 8-25 months). Primarily healing of the wound was achieved in all cases.No postoperative infection and nonunion on the osteotomy site was found during the follow-up time.The fracture healing time was 6-15 (mean 12.2) weeks.All the patients had satisfactory appearance and sensory function without callosum and metastatic metatarsalgia at the final follow-up.The post-operative fourth-fifth intermetatarsal angle, lateral deviation of the fifth metatarsal angle and metatarsophalangeal-fifth angle were significantly lesser than the pre-operative at the 6th week after operation, respectively [(5.5±1.7)°, (2.1±0.8)°, (5.7±2.6)°vs (16.4±4.2)°, (6.0±2.2)°, (10.5±7.4)°; all P<0.01]. The post-operative AOFAS score was significantly greater than the pre-operative [(87.1±6.7) vs (62.3±9.8) points, P<0.001]. CONCLUSION: The modified chevron osteotomy combined distal soft tissue reconstruction is a safe and easy treatment option for the high-grade bunionette deformity and provides patient satisfaction results.