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Jimenez Mosquea TR, Colasanti CA, Ubillus HA, Walls RJ. Revision Surgery for Failed Polyvinyl Alcohol Hydrogel Implant in the First MTP Joint: A Case Report and Comprehensive Review. FOOT & ANKLE ORTHOPAEDICS 2025; 10:24730114251330300. [PMID: 40297397 PMCID: PMC12033773 DOI: 10.1177/24730114251330300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2025] Open
Abstract
Background Hallux rigidus is a degenerative condition of the first metatarsophalangeal (MTP) joint that can significantly impair function and quality of life. The introduction of polyvinyl alcohol (PVA) hydrogel implants, such as Cartiva, offered an alternative to arthrodesis by preserving joint motion. However, failures of these implants, often resulting in bone loss and joint instability, present a challenge for revision surgery. Methods We report the case of a 43-year-old woman with persistent pain and functional limitations after a failed PVA hydrogel implant in the first MTP joint. The revision surgery involved a biologic resurfacing using the Osteochondral Autograft Transfer System (OATS) with a graft harvested from the ipsilateral femoral condyle, complemented by interpositional arthroplasty with a dermal graft and a proximal phalanx closing wedge osteotomy to correct residual hallux valgus. Results At the 3-year follow-up, the patient-reported complete resolution of pain and returned to full activity with improved range of motion (40 degrees dorsiflexion, 15 degrees plantarflexion). Radiographic evaluation demonstrated graft incorporation and restoration of joint space, confirming the success of the procedure. Conclusion This case highlights the potential of OATS combined with interpositional arthroplasty as a viable option for revision surgery in complex cases of failed synthetic cartilage implants in hallux rigidus. By addressing bone loss and preserving joint function, this approach provides a patient-specific alternative to traditional arthrodesis. Further studies are warranted to establish the long-term efficacy of this technique in similar cases. Level of Evidence Level V, case report.
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Affiliation(s)
| | | | - Hugo A. Ubillus
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
| | - Raymond J. Walls
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
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Barnes D, Matijasich P, Maxwell A, Yatsonsky D, Ballard A, Ebraheim N, Elattar O. From Etiology to Intervention: A Holistic Review of Bunion Pathophysiology and Care. Adv Orthop 2024; 2024:9910410. [PMID: 39429503 PMCID: PMC11489004 DOI: 10.1155/2024/9910410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Accepted: 09/23/2024] [Indexed: 10/22/2024] Open
Abstract
In this review paper, we present the common etiology, presentation, diagnosis, and management of the following three common bunion formations: dorsal bunion, tailor's bunion, and hallux valgus (HV). Bunions are common pathologies that present to a variety of clinics, so it is important for providers to have a base understanding of these in order to provide the best care to patients. Many of these bunion formations have a variety of causes which allow providers to manage them before surgical intervention is required. The aim of this review paper is to bring attention and expanded insight on these common bunion presentations in order to minimize morbidity early on. The information provided in this review will allow both primary care and subspecialty physicians with the knowledge to accurately diagnose and optimally manage these bony deformities of the lower extremity.
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Affiliation(s)
- Danielle Barnes
- University of Toledo, College of Medicine and Life Sciences, Toledo, Ohio, USA
| | - Paige Matijasich
- University of Toledo, College of Medicine and Life Sciences, Toledo, Ohio, USA
| | - Aidan Maxwell
- University of Toledo, College of Medicine and Life Sciences, Toledo, Ohio, USA
| | - David Yatsonsky
- University of Toledo, Orthopedic Surgery Department, Toledo, Ohio, USA
| | - Audrey Ballard
- University of Toledo, College of Medicine and Life Sciences, Toledo, Ohio, USA
| | - Nabil Ebraheim
- University of Toledo, Orthopedic Surgery Department, Toledo, Ohio, USA
| | - Osama Elattar
- University of Toledo, Orthopedic Surgery Department, Toledo, Ohio, USA
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Martinez-Rico M, Gijon-Nogueron G, Ortega-Avila AB, Roche-Seruendo LE, Climent-Pedrosa A, Sanchis-Sales E, Deschamps K. Effect of Custom-Made Foot Orthotics on Multi-Segment Foot Kinematics and Kinetics in Individuals with Structural Hallux Limitus. SENSORS (BASEL, SWITZERLAND) 2024; 24:6430. [PMID: 39409469 PMCID: PMC11479352 DOI: 10.3390/s24196430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2024] [Revised: 09/22/2024] [Accepted: 10/02/2024] [Indexed: 10/20/2024]
Abstract
The first metatarsophalangeal joint (MTPJ) and the first ray are crucial in walking, particularly during propulsion. Limitation in this joint's sagittal plane motion, known as hallux limitus, can cause compensatory movements in other joints. Some studies assessed the impact of various foot orthoses designs on the foot biomechanics; however, a comprehensive understanding is lacking. This study compared the effects of two custom-made foot orthoses (CFOs) on the foot joint kinematics and kinetics in patients with structural hallux limitus (SHL). In this quasi-experimental study, 24 patients with hallux limitus were assessed in three conditions: (i) barefoot, (ii) shod with a cut-out custom foot orthosis (cut-out CFO), and (iii) shod with an anterior forefoot-stabilized element custom foot orthosis (AFSE CFO), fitted into a minimalist neoprene shoe. Multi-segment foot kinematics and kinetics were assessed during the stance phase of the gait. A decrease in ankle and midfoot inversion, as well as in ankle plantarflexion, was found in both orthotic conditions. Regarding the first MTPJ, a greater dorsiflexion was observed with the patient being barefoot compared to both of the conditions under study. From the current finding, it should be concluded that neither of the custom foot orthoses produced the predefined functional effects.
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Affiliation(s)
- Magdalena Martinez-Rico
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga, 29016 Malaga, Spain; (M.M.-R.); (A.B.O.-A.)
- KU Leuven, Musculoskeletal Rehabilitation Research Group, Department of Rehabilitation Sciences, Campus Brugge, Spoorwegstraat 12, 8200 Bruges, Belgium;
| | - Gabriel Gijon-Nogueron
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga, 29016 Malaga, Spain; (M.M.-R.); (A.B.O.-A.)
- IBIMA Plataforma BIONAD, 29590 Malaga, Spain
| | - Ana Belen Ortega-Avila
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga, 29016 Malaga, Spain; (M.M.-R.); (A.B.O.-A.)
- IBIMA Plataforma BIONAD, 29590 Malaga, Spain
| | - Luis E. Roche-Seruendo
- Facultad de Ciencias de la Salud, Universidad San Jorge, 50830 Zaragoza, Spain; (L.E.R.-S.) (A.C.-P.)
| | - Ana Climent-Pedrosa
- Facultad de Ciencias de la Salud, Universidad San Jorge, 50830 Zaragoza, Spain; (L.E.R.-S.) (A.C.-P.)
| | - Enrique Sanchis-Sales
- Facultad de Enfermería y Podología, Universidad de Valencia, C/Jaume Roig s/n, 46010 Valencia, Spain;
| | - Kevin Deschamps
- KU Leuven, Musculoskeletal Rehabilitation Research Group, Department of Rehabilitation Sciences, Campus Brugge, Spoorwegstraat 12, 8200 Bruges, Belgium;
- Division of Podiatry, Haute Ecole Leonard De Vinci—Institut D’Enseignement Supérieur Parnasse Deux-Alice, 1200 Brussels, Belgium
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Zanchini F, Catani O, Sergio F, Boemio A, Sieczak A, Piscopo D, Risitano S, Colò G, Fusini F. Role of lateral soft tissues release in percutaneous hallux valgus correction: A medium term retrospective study. World J Orthop 2023; 14:843-852. [PMID: 38173806 PMCID: PMC10758593 DOI: 10.5312/wjo.v14.i12.843] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 10/12/2023] [Accepted: 11/17/2023] [Indexed: 12/15/2023] Open
Abstract
BACKGROUND In the field of minimally invasive surgery (MIS) for the treatment of hallux valgus (HV), different techniques have begun to emerge in the literature concerning the distal osteotomy of the first metatarsal bone, the synthesis or not of the metatarsal head, the possible association with lateral soft tissues release (LSTR) and osteotomy of the base of the first phalanx. AIM To evaluate the role of LSTR on percutaneous HV correction, evaluating functional and radiographical results. METHODS From January 2012 to May 2016 a total of 396 patients with mild to moderate symptomatic HV treated with the MIS technique were included in this retrospective study. The technique provides no internal fixation (WOS). Patients were divided into the LSTR group and no LSTR group (LSTR N). This surgical procedure (LSTR) was reserved for insufficient HV angle (HVA) correction during fluoroscopic control. Patients were evaluated at each follow-up by two other authors after appropriate training by senior authors (first practitioners). Clinical evaluation was performed before surgery, 6 mo after surgery, and 48 mo follow-up. American Orthopaedic Foot and Ankle Society (AOFAS) and visual analog scale (VAS) score was used to evaluate pain and function, and complications were recorded. In addition, the incidence of relapses and the degree of joint range of motion (ROM) with the association with the LSTR (capsule, adductor tendon, phalanx-sesamoid ligament, and the deep transverse metatarsal ligament) were evaluated. Radiological parameters included HVA and intermetatarsal angle (IMA). Patient satisfaction was assessed. Student t-test and Fisher exact test were used to assess statistical analysis. RESULTS From our study it is clear that no differences in term of HVA, VAS, IMA correction, rate of complications, and AOFAS score were found between groups, while a significant improvement of the same variables was found in each group between pre and postoperative values. A significant improvement in ROM at 6 mo (P = 0.018) and 48 mo (P = 0.02) of follow-up was found in LSTR N group. Complications were rare in both groups. CONCLUSION LSTR procedure on percutaneous HV correction seems to increase postoperative joint stiffness with a comparable incidence of relapse and a low incidence of complications.
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Affiliation(s)
- Fabio Zanchini
- Division of Orthopaedics and Traumatology, Multidisciplinary Department of Medical-Surgical and Dental Specialties, Clinical Orthopeadics, University of Campania “Luigi Vanvitelli”, Naples 80138, Italy
| | - Ottorino Catani
- Department of Foot Surgery, Casa di cura Santa Maria, Santa Maria Capua Vetere 81055, Italy
| | - Fabrizio Sergio
- Department of Foot an Ankle Surgery, Casa di cura Santa Maria, Santa Maria Capua Vetere 81055, Italy
| | - Alessia Boemio
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, Clinical Orthopeadics, AOU Luigi Vanvitelli, Napoli 80138, Italy
| | - Angelo Sieczak
- Clinical Orthopeadics, University of Campania Luigi Vanvitelli, Naples 80138, Italy
| | - Davide Piscopo
- Clinical Orthopeadics, University of Campania Luigi Vanvitelli, Naples 80138, Italy
| | - Salvatore Risitano
- Department of Orthopaedic and Traumatology, Orthopaedic and Trauma Centre, Città della Salute e della Scienza di Torino, Turin 10126, Italy
| | - Gabriele Colò
- Department of Orthopaedics and Traumatology, Regional Center for Joint Arthroplasty, ASO Alessandria, Alessandria 15121, Italy
| | - Federico Fusini
- Department of Orthopaedic and Traumatology, Regina Montis Regalis Hospital, Cuneo 12084, Italy
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Fusini F, Alessandro M, Rava A, Kristijan Z, Felli L, Colò G. Aetiology, diagnosis, and treatment of brachymetatarsia: a narrative review. Musculoskelet Surg 2021; 106:99-109. [PMID: 34268706 DOI: 10.1007/s12306-021-00720-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 06/27/2021] [Indexed: 11/28/2022]
Abstract
Brachymetatarsia (BM), or hypoplastic metatarsal, is an abnormal shortening of one or more metatarsal bones with a female-to-male ratio of 10.53:1. Different causes are described in the literature, such as congenital, acquired, or iatrogenic, associated with different conditions and syndromes. Its presence may develop deformity and pain; however, often feet are pain free and the major worries of patients are cosmetics. Non-operative treatments aim to improve the comfort of metatarsal heads and the possible dorsal conflict through comfortable shoes or the use of specific orthotics. The surgical treatment is anything but straightforward, with "one-stage" or "two stage" techniques, the latter better called "by gradual distraction". One-stage procedures are more rapid techniques but have limited ability to restore the desired length due to neurovascular compromise caused by acute lengthening. Insufficient correction is also possible. On the contrary, by gradual distraction procedures allow gradual distraction lengthening of more than 1.5 cm, but require the use of an external fixator, with a higher risk of complications in more than about 50% of surgeries. The adjacent metatarsal shortening should be considered in combination with other techniques, to diminish the excessive lengthening. In each case, surgeries should be always decided on each patient's concerns, deformities, and clinical needs.
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Affiliation(s)
- F Fusini
- Department of Orthopaedics and Traumatology, Regina Montis Regalis Hospital, ASL CN1, Via S. Rocchetto, 99, 12084, Mondovì, CN, Italy
| | - M Alessandro
- Department of Orthopaedics and Traumatology, Orthopaedic and Trauma Centre, Città della Salute e della Scienza di Torino, University of Turin, Via Zuretti 29, 10121, Turin, Italy
| | - A Rava
- Department of Orthopaedics and Traumatology, Orthopaedic and Trauma Centre, Città della Salute e della Scienza di Torino, University of Turin, Via Zuretti 29, 10121, Turin, Italy
| | - Z Kristijan
- Department of Orthopaedics and Traumatology, Regional Center for Joint Arthroplasty, ASO Alessandria, Via Venezia 16, 16121, Alessandria, Italy
| | - L Felli
- Orthopaedic Clinic, Department of Surgical Sciences (DISC), University of Genoa, Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, Italy
| | - G Colò
- Department of Orthopaedics and Traumatology, Regional Center for Joint Arthroplasty, ASO Alessandria, Via Venezia 16, 16121, Alessandria, Italy.
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