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 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

This retrospective review was performed to determine results and to present a new operative method, a modified Mitchell procedure, used to treat 13 adolescents with a total of 21 bunions. The average age of the patients was 14 years, 6 months. The average clinical followup period was 31 months. The average preoperative valgus angle was 35 degrees (range, 21 degrees-65 degrees); the average preoperative intermetatarsal angle was 14 degrees (range, 7 degrees-22 degrees). The early operative result for 17 feet (81%) was satisfactory; deformity, pain, or stiffness recurred in 4 feet (19%). At the time of the last clinic visit, the average hallux valgus angle was 15 degrees (range, 3 degrees-43 degrees); the average intermetatarsal angle was 7 degrees (range, 2 degrees-18 degrees). No instances of malunion, nonunion, infection, avascular necrosis, or transfer metatarsalgia occurred. This modification of the Mitchell procedure is an effective management option for mild to moderate adolescent hallux valgus.
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PMID:Modified Mitchell bunionectomy for management of adolescent hallux valgus. 891 59

We retrospectively reviewed the records of thirty-two patients who had had an arthrodesis of the tarsometatarsal joints for intractable pain after a traumatic injury of the midfoot. The arthrodesis was performed at a mean of thirty-five months (range, six to 108 months) after the injury. All of the procedures were performed with use of rigid internal fixation, and twenty-four patients, in whom a defect had been created by debridement of the joints, were managed with an autogenous bone graft. Nine patients had at least one concomitant procedure, including a claw-toe procedure (eight patients), a reconstruction of the posterior tibial tendon (three patients), an excision of an interdigital neuroma (three patients), an arthrodesis of the calcaneocuboid joint (one patient), and an arthrodesis of the ankle (one patient). Complications included neuritis in three patients; metatarsalgia in two; malunion in two; and asymptomatic non-union, wound slough, superficial infection, and reflex sympathetic dystrophy in one each. The patients were evaluated at a mean of fifty months (range, twenty-four to 105 months) after the arthrodesis. The evaluation included a physical examination, radiographs, and use of the rating scale of the American Orthopaedic Foot and Ankle Society for the evaluation of the midfoot. The mean postoperative score of 78 (of a possible 100) points was significantly better than the mean preoperative score of 44 points (p = 0.02). With the numbers available, we could not show that the extent of the arthrodesis, the involvement of other joints in the hindfoot or the forefoot, the mechanism of injury, or whether the injury was work-related significantly affected the functional outcome.
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PMID:Results of arthrodesis of the tarsometatarsal joints after traumatic injury. 893 80

This study was undertaken to assess the efficacy of ketorolac compared with placebo when delivered by electromotive drug administration (EMDA) in patients with pain from rheumatic disease. In EMDA, or iontophoresis, a low-intensity electric current is applied over the skin to deliver medication into body tissues. Although EMDA has been used to treat patients with various diseases, controlled studies are lacking in patients with rheumatic disease. This double-masked study included 60 patients (43 women and 17 men) aged 31 to 80 years with the following conditions: 12, epicondylitis; 30, scapulohumeral periarthritis; 10, gonalgia; and 8, metatarsalgia. They were divided randomly by a physician into 2 groups of 30 patients each for 5 sessions of active treatment (30 mg of ketorolac) or placebo (5 mL of normal saline). Treatment took place every other day for 20 minutes. Immediately before and after the five treatment sessions and 7 days after treatment ended, both patient and physician measured the degree of pain using a categoric scale (no pain, slight pain, intermediate pain, strong pain, and very strong pain) and evaluated pain intensity using the Scott and Huskisson Visual Analogue Scale (VAS). Seven days after treatment ended, both physician and patient judged the result of treatment using a second categoric scale (no improvement or intermediate, good, or very good result). Both ketorolac and placebo provided immediate, significant pain relief when delivered by EMDA, but only those patients receiving ketorolac experienced a further reduction in pain 7 days after treatment; those receiving placebo experienced a slight increase in pain. VAS values differed significantly between the two groups. Poor results (no improvement) were significantly higher in the placebo-treated group, while good results were significantly higher in the ketorolac-treated group. No patient reported any adverse effects during treatment. This study demonstrates that ketorolac relieves pain when delivered by EMDA and offers longer-lasting pain relief than does placebo.
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PMID:Comparison of electromotive drug administration with ketorolac or with placebo in patients with pain from rheumatic disease: a double-masked study. 900 33

We present the short-term follow-up of 55 symptomatic hallux valgus deformities in 38 patients, treated operatively with a modification of the spike distal first metatarsal osteotomy, as described by Gibson and Piggott in 1962. The age range of the patients was 17 to 72 years at the time of surgery. The postoperative follow-up period was 12 to 55 months. Excellent and good clinical and radiographic results were recorded in 96.2% of our patients. Two of the patients (3.8%) were dissatisfied; one of them complained of metatarsalgia after the procedure, and the other had stiffness of the metatarsophalangeal joint and metatarsalgia that had been present before surgery. Three others (5.45%) required revision after early postoperative displacement but were asymptomatic subsequently. We concluded that our technique is an effective method of treating mild hallux valgus deformities with the advantages of simplicity, no shortening of the first metatarsal, and no risk of dorsal tilting of the distal fragment. Hallux valgus (lateral deviation of the great toe) is not a single disorder, as the name implies, but a complex deformity of the first ray that sometimes may involve the lesser toes. More than 130 procedures exist for the surgical correction of hallux valgus, which means that no treatment is unique. No single operation is effective for all bunions. The objectives of surgical treatment are to reduce pain, to restore articular congruency, and to narrow the forefoot without impairing function, by transferring weight to the lesser metatarsals either by shortening or by dorsal tilting of the first metatarsal. Patient selection is important for a satisfactory outcome after surgery of any kind, and our criteria were age, degree of deformity, presence of arthrosis, and subluxation of the first metatarsophalangeal joint. In this study, we present a new method of treating hallux valgus that has been used at Mayday University Hospital since 1990. The technique was first described at the British Orthopaedic Foot Surgery Society, Liverpool, November 1990, and we now present the short-term follow-up results. The procedure is essentially a modification of the spike osteotomy of the neck of the first metatarsal, as described by Gibson and Piggott. It has the advantages of simplicity, no shortening of the first metatarsal, and no risk of dorsal displacement of the distal fragment.
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PMID:The Mayday distal first metatarsal osteotomy for hallux valgus: a review after the introduction of a new instrument. 901 7

Static metatarsalgia involves pain of non-inflammatory origin in the region of the metatarsal heads. It is caused by a functional disorder or anatomic derangement of the architecture over the ball of the foot, whether congenital or acquired, evident or not. Clinical examination, including of the shoe and of the plantar orthosis, distinguishes five types of anomalies: 1. horizontal malalignment of the metatarsal heads with insufficiency at the first metatarsal-phalangeal joint, dominated by hallux valgus, and involvement of the second metatarsal bone, sometimes favouring Freiberg's disease; 2. vertical malalignment, with a hollow anterior foot, sometimes complicated by Morton's neuroma; 3. a combination of these two anomalies, easily diagnosed but less easily treated; 4. possible enlargement of the first metatarsal-phalangeal joint (hallux rigidus, sesamoid pathology); 5. no patent architectural anomalies, but stress fractures or bone insufficiency fractures of the metatarsals. Only clinical examination can orient complementary strategy and examinations.
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PMID:[Static metatarsalgia]. 903 41

Thirty patients (37 feet) with severe hallux rigidus underwent resection arthroplasty of the first metatarsophalangeal joint with our modification (reattachment of the extensor hood and extensor brevis to the flexor hallucis brevis as a capsular interposition arthroplasty, with minimal bone resection). Pain and function were significantly improved. Transfer metatarsalgia was not seen. All patients had at least 4/5 plantarflexion strength and averaged 50 degrees of dorsiflexion. In patients with severe hallux rigidus and nearly equal length of first and second metatarsals, capsular interposition arthroplasty offers a surgical option that relieves pain without sacrificing motion or strength.
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PMID:Roger Mann Award 1995. Capsular interposition arthroplasty for severe hallux rigidus. 904 76

The results for 18 patients (20 feet) in whom a hallux valgus procedure had failed were reviewed. Ten patients (11 feet), with a mean age of 63 years, had correction with Keller resection arthroplasty and were observed for an average of 10 years (range, 3-15 years). The hallux valgus angle improved an average of 11 degrees +/- 3 degrees, and the intermetatarsal angle improved an average of 2 degrees +/- 1.7 degrees. Results were good in six feet, fair in four, and poor in one. Eight patients (nine feet), with a mean age of 63 years, had correction with arthrodesis and were observed for an average of 5 years (range, 2-8 years). The hallux valgus angle improved an average of 23 degrees +/- 6.9 degrees, and the intermetatarsal angle improved an average of 2 degrees +/- 3 degrees. Results were good in six feet, fair in two, and poor in one. There were differences between the two operations in terms of patient satisfaction, pain relief, appearance, and footwear. The incidence of metatarsalgia was similar for the two groups. Complications, particularly malalignment, were more common in the resection group. None of the patients required additional revision operation. Resection arthroplasty is a simple procedure and does not require cast immobilization. Resection arthroplasty and arthrodesis are reasonable options for salvage treatment of failed hallux valgus operations in older patients because good results were achieved in six of nine (67%) feet after arthrodesis and in six of 11 (54%) feet after resection.
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PMID:Arthrodesis versus resection arthroplasty for failed hallux valgus operations. 952 Aug 92

We reviewed the results of 15 patients (16 feet) in whom a hallux valgus procedure had failed. Salvage was by proximal crescentic first metatarsal osteotomy with distal soft-tissue reconstruction. Results based on a clinical scale considering the level of pain, activity limitations, support requirement, footwear limitations, and alignment were good in 11, fair in two, and poor in three. Patients were satisfied with the results in 10 feet, satisfied with reservations in four feet, and dissatisfied in two feet. Complications were: transfer metatarsalgia in three, hallux varus in one, and osteotomy nonunion in one. One of the patients required reoperation to bone graft a proximal osteotomy. Metatarsal osteotomy was helpful in the salvage treatment of recurrent, symptomatic hallux valgus when the first metatarsophalangeal joint was functional and painless.
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PMID:Salvage treatment of failed hallux valgus operations with proximal first metatarsal osteotomy and distal soft-tissue reconstruction. 954 81

Two insoles designed to treat primary lesser metatarsalgia were compared in terms of their effect on plantar pressures and the subjective symptom relief. A prospective single blind randomized trial of 8 weeks' treatment in 46 feet in 33 patients was performed. Subjective outcome measures were visual analogue pain scores and estimated compliance. Objective outcome measures were dynamic plantar pressures using the Musgrave Footprint System. In group 1 (Viscoped), 6 of 18 patients rated themselves much improved or somewhat improved, and in group 2 (Langer) the proportion was 12 of 15 (P = 0.02). Reported mean compliance was 16% higher in the Langer group. Plantar forefoot pressure was lowered by the insoles in all cases. The reduction was significantly greater (P < 0.001) in group 2, both in absolute pressure and as a percentage of initial pressure. Group 2 (Langer) was significantly better in terms of reduction of peak metatarsal pressure. All the subjective outcome measures were better for the group 2 (Langer).
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PMID:Use of ready-made insoles in the treatment of lesser metatarsalgia: a prospective randomized controlled trial. 957 99

The effects of a custom moulded insole and a rockerbar on peak pressure and force impulse as well as on pain scores in subjects with a history of metatarsalgia were studied. In addition the subjects' preference for the type of intervention was determined. Forty-two subjects with a history of primary metatarsalgia were selected. They were all provided with the same brand of extra depth shoes with a ready made insole. The effect of custom moulded insoles, a rockerbar and the interaction between the two interventions were studied by testing the four possible combinations: ready made insole without a rockerbar, ready made insole with a rockerbar, custom moulded insole without a rockerbar and custom moulded insole with rockerbar. At the most important region, the central distal forefoot, a rockerbar caused a decrease in force impulse of 15.1% and a decrease in peak pressure of 15.7%. The custom moulded insole produced a decrease of 10.1% in force impulse and of 18.2% in peak pressure. Pain scores were significantly lower for interventions with a custom moulded insole, while the rockerbar showed no influence on pain scores. Subjects with pain preferred a custom moulded insole more often than subjects without pain. Decrease of peak pressure or force impulse was not correlated to pain scores. The use of either a custom moulded insole or a rockerbar produced an important decrease of peak pressure and force impulse at the central distal forefoot and, therefore, either is suitable in any situation which a decrease of pressure is vital.
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PMID:Primary metatarsalgia: the influence of a custom moulded insole and a rockerbar on plantar pressure. 960 74


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