Clinics in podiatric medicine and surgery最新文献

Closing wedge distal tibial periarticular osteotomy (DTPO) is a surgical technique used to correct deformities of the ankle caused by conditions such as post-traumatic misalignment, congenital abnormalities, or early-stage arthritis. It realigns the tibiotalar joint to restore function and delay or avoid more invasive procedures like arthrodesis or ankle replacement. DTPO is particularly beneficial for younger patients and can be used as a staged procedure for future arthroplasty. Surgical planning involves accurate identification of the center of rotation of angulation, and the medial closing wedge approach is preferred due to its stability, predictable healing, and minimally invasive execution.

Early surgical intervention utilizing a fibular osteotomy to restore the fibular length results in restoration of ankle-joint congruency and stability. This can delay the need for an ankle arthrodesis or implant. The type of osteotomy performed depends on the amount of fibular rotation that has occurred and whether or not the syndesmosis is involved.

Metatarsus adductus (MA) is an isolated, transverse-plane dominant deformity occurring primarily at the tarsometatarsal joints. The deformity is commonly associated with increased rates of fifth metatarsal base fractures, hallux valgus deformities, lesser metatarsophalangeal joint deformities, and multiplanar deformities of the hindfoot. Periarticular osteotomies of the metatarsals, cuboid, and cuneiforms have been discussed thoroughly in the literature, both isolated and in combination. Recent techniques have described intraarticular osteotomies with realignment arthrodesis of the tarsometatarsal joints, however often reserved for older patients. This article reviews surgical approach to the correction of MA deformities via periarticular osteotomies in both pediatric and adult populations.

Calcaneal osteotomies are surgical procedures performed to correct a hindfoot deformity or realign the calcaneus in conditions that include pes planus and pes cavus. These joint-sparing procedures offer the ability to realign the calcaneus, enhancing foot biomechanics, redistributing forces, and reducing pain and dysfunction. Among the most common types of calcaneal osteotomies are the medial slide, lateral slide, and Dwyer calcaneal osteotomy, each with distinct indications, advantages, and surgical considerations.

Since its original description in 1936, the Cotton osteotomy has been used in treatment of many different pathologies of the forefoot. This article aims to review the Cotton osteotomy. We discuss a brief history, indications and contraindications, grafting options, technique, and current clinical points necessary to provide optimal correction of pathology seen in the forefoot.

Pes planovalgus is a prevalent deformity treated globally by foot and ankle surgeons. Surgical correction is indicated when a patient has failed conservative therapy or the deformity is unsuitable for conservative treatment. While correction of pes planovalgus often requires multiple procedures, the Evans osteotomy is widely utilized due to the robust triplanar correction it offers. This article aims to review the indications and surgical technique of the Evans osteotomy, while expanding on its indications that are not traditionally considered.

Understanding rotational deformities is complex in both the diagnosis and treatment. Rotational deformities can present in isolation or in combination with angular and translational malalignment, with/without limb length discrepancy. We present the clinical, radiographic, and advanced imaging evaluation for preoperative rotational examination. In addition, we describe techniques for osteotomy and fixation of derotational supramalleolar osteotomies.

The Zadek closing-wedge calcaneal osteotomy is an alternative to the way we have traditionally approached the surgical management of Haglund's triad. Although percutaneous approaches have recently gained popularity, the open approach remains the gold-standard incisional approach. Surgical technique, including use of an osteotomy guide, is critical to avoid soft-tissue and osseous complications. Internal fixation selection can have a significant impact on patient outcomes. When properly performed, the Zadek calcaneal osteotomy has been demonstrated through systematic review and meta-analysis to consistently resolve symptoms with few complications.

Dorsiflexory wedge first metatarsal osteotomies play a pivotal role in the structural correction of a symptomatic plantarflexed first ray often in the setting of a forefoot driven hindfoot varus deformity. Restoration of Meary's angle can provide surgeons intraoperative radiographic visualization of correction in addition to clinical correction of forefoot valgus deformity. This procedure is performed at the proximal metaphysis of the first metatarsal distal to the first tarsometatarsal joint. It typically is performed in conjunction with additional hindfoot osseous and soft tissue procedures. There exists a plethora of fixation options with high reported union rates.

Focal dome tibial osteotomy (FDTO) is a crucial joint-preserving procedure that addresses tibial deformities contributing to ankle osteoarthritis and malalignment. By using the principles of center of rotation and angulation, this technique allows for precise angular correction without significant translation, thereby maintaining biomechanical integrity. Various osteotomy techniques, including dome, opening wedge, and closing wedge osteotomies, provide different benefits and limitations based on individual patient needs. Despite its advantages, FDTO presents challenges such as prolonged recovery, technical complexity, and risks of complications. Future advancements in CT-guided assistance, patient-specific instrumentation, and biological enhancements hold promise for improving surgical precision and patient outcomes.