Tendon arthroplasty for basal fourth and fifth metatarsal arthritis
ABSTRACT Arthritis of the fourth and fifth tarsometatarsal joints, recalcitrant to nonoperative treatment, presents a difficult clinical situation. As part of the lateral rays, these joints have considerable motion, making fusion a very disabling operation. Between 1990 and 1998, 12 patients, who had failed nonoperative treatment, underwent resection arthroplasty of the base of the fifth or fourth and fifth metatarsals with tendon interposition. Preoperative differential injections had confirmed the source of pain in eight cases. Patients were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) midfoot scale; a visual analogue scale to assess perception of pain and disability; a satisfaction index; and, where possible, a comprehensive physical examination. At an average of 25 months follow-up, the average AOFAS score was 64.5. On the visual analogue scale, pain improved an average of 35% and disability improved 10%. Six of the eight patients who participated in this study were satisfied with the operation and would undergo the procedure again for similar symptoms. Patients with a higher postoperative score on the AOFAS midfoot rating scale were statistically more likely to have had a positive differential injection preoperatively. We believe a lateral column tarsometatarsal resection arthroplasty is an effective salvage operation when lateral column midfoot arthritis is confirmed by differential injection and nonoperative measures have provided inadequate relief.
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- "While some centres may be continuing to collate this information within their institution for future publication, treatment of lateral column arthralgia refractory to all attempted conservative management is probably most reliably treated by fusion. Evidence for this procedure is based on the largest patient group of all the discussed operative interventions, and achieves a higher postoperative VAS score than that reported following interpositional procedures    . It is widely agreed that careful attention to surgical technique and reduction of the columns are mandatory in achieving a good result   . "
ABSTRACT: Osteoarthritis of the lateral tarsometatarsal joints is less common than that which is seen in the 1st-3rd tarsometatarsal joints. Despite a suspected increase in incidence of tarsometatarsal arthritis and consequently the burden of disability and economic impact, guidelines for treatment and decision making remain scarce. When conservative treatment fails, lateral column osteoarthritis can severely limit a patient's mobility, lifestyle, and present a difficult management problem for the foot and ankle specialist. Evidence for the surgical techniques used in treatment of lateral column osteoarthritis is limited and sporadic within the literature. This article aims to summarise and compare the evidence for these surgical management options. This article looks at aetiology and epidemiology, with a summary of the biomechanics of the region and a comprehensive review of the literature regarding surgical treatment options.Foot and Ankle Surgery 12/2013; 19(4):207-211. DOI:10.1016/j.fas.2013.06.002
Article: Management of cuboid crush injuries[Show abstract] [Hide abstract]
ABSTRACT: Cuboid crush injuries are usually seen with forceful plantar flexion and abduction injuries of the foot. Shortening of the lateral column and disruption of the articular surfaces are often the result, requiring operative reconstruction and fixation to prevent subsequent pes planus deformity and disability. The indications for and techniques of operative intervention are reviewed for acute and late presentation of this injury.Foot and Ankle Clinics of North America 04/2006; 11(1):121-6, ix. DOI:10.1016/j.fcl.2005.11.001 · 0.84 Impact Factor
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ABSTRACT: Lisfranc joint injuries may be missed at the time of occurrence potentially leading to persistent instability, deformity, or arthritis. In the absence of significant residual arthritis or fixed deformity, delayed open reduction and internal fixation with or without reconstruction of the Lisfranc ligament may be performed. An alternative is reduction and primary arthrodesis of the relatively immobile medial tarsometatarsal (TMT) joints. In the presence of significant residual arthritis or fixed deformity that is recalcitrant to conservative treatment, arthrodesis, including correction of deformity, is the treatment of choice for the first, second, and third TMT joints. Resection arthroplasty of the fourth and fifth TMT joints may be preferable to arthrodesis in order to maintain physiologic motion.Foot and Ankle Clinics of North America 04/2006; 11(1):127-42, ix. DOI:10.1016/j.fcl.2005.12.005 · 0.84 Impact Factor