By Louis-Samuel Barouk
For a very long time, forefoot surgical procedure had many risks together with a painful postoperative interval and recurrence of deformities. New options – significantly shawl, the 1st metatarsal osteotomy and the Weil osteotomy of the lesser metatarsal – offer an important development within the therapy of static forefoot issues. the good toe osteotomy has additionally been significantly enhanced. because 1991, the writer has brought those innovations in lots of nations, whereas constructing and learning the corresponding implants and the postoperative interval. He has additionally constructed surgical administration ideas that bridge those assorted osteotomies. greater than one thousand surgeons worldwide are utilizing those innovations, that are now greatly taught. during this moment variation of the booklet the overall presentation is clearer and extra friendly and lots of photographs were changed. numerous themes are emphasised, particularly the good toe proximal phalanx osteotomy, the joint preservative surgical procedure in serious forefoot issues, together with revision after failed bunionectomy and rheumatoid forefoot following the "ms” aspect for a correct and powerful metatarsal shortening. finally, new strategies are uncovered, rather in Claw toe and hammer with the PIP plantar unlock and the surgical procedure of the center phalanx and likewise the Weil osteotomy of the 1st metatarsal in hallux limitus.
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Extra info for Forefoot Reconstruction
Limit of lowering by scarf regarding the 4th ray metatarsalgia. Lowering by scarf can correct metatarsalgia on the 2nd ray, sometimes also on the 3rd one, but never on the 4th metatarsal. : M4 BRT osteotomy of the 4th metatarsal). Fig. 07c8. Insufficiency of Ml lowering by scarf. 1, 2. In an early experience, we did n ot make the longitudinal cut in a plantar direction which resulted in the lack of M l lowering (I) and therefore in remaining or transfer metatarsalgia on the 2nd ray. 3. In this case, the lesser metatarsals were too long comparatively to the l st one, so the solution was a secondary Wei!
Fig. 06b. Transverse cuts. The scarf is a hi-chevron osteotomy. So the transverse cuts form an angle of about 60° with the longitudinal cut (l ). Both cuts are directed backwards, but the proximal one is slightly more inclined in order to ensure the distal fragments good contact (2). -Proximal cut: (3, 4) direction and inclination of the saw blade. The proximal cut is easily performed and checked thanks to the ppe, which also allows protection of the soft tissue (5). -Distal cut: (6, 7) this cut is just proximal to the dorsal capsule (de), thus remaining extra articular.
Lowering by scarf can correct metatarsalgia on the 2nd ray, sometimes also on the 3rd one, but never on the 4th metatarsal. : M4 BRT osteotomy of the 4th metatarsal). Fig. 07c8. Insufficiency of Ml lowering by scarf. 1, 2. In an early experience, we did n ot make the longitudinal cut in a plantar direction which resulted in the lack of M l lowering (I) and therefore in remaining or transfer metatarsalgia on the 2nd ray. 3. In this case, the lesser metatarsals were too long comparatively to the l st one, so the solution was a secondary Wei!