1/7. Post-burn hallux varus: a case report and management of a rare deformity. Post-burn hallux varus is an extremely rare condition. A 22-year-old male, with a history of campfire burns in childhood, presented with secondary hallux varus of the left great toe. Surgical correction included medial soft tissue release, metatarsophalangeal joint arthrodesis, two-pin fixation of bones, metatarsophalangeal joint capsulorrhaphy, and coverage of the skin defect with a "Z" plasty of the skin and split thickness skin grafting. Follow up 20 months later showed satisfactory results. ( info) |
2/7. eye problem following foot surgery--abducens palsy as a complication of spinal anesthesia. BACKGROUND: paralysis of abducens nerve is a very rare complication of lumbar puncture, which is a common procedure most often used for diagnostic and anesthetic purposes. CASE REPORT: A 38-year-old man underwent surgery for a left hallux valgus while he was under spinal anesthesia. On the first postoperative day, the patient experienced a severe headache that did not respond to standard nonsteroidal anti-inflammatory medication and hydration. During the second postoperative day, nausea and vomiting occurred. On the fourth postoperative day, nausea ceased completely but the patient complained of diplopia. Examination revealed bilateral strabismus with bilateral abducens nerve palsy. His diplopia resolved completely after 9 weeks and strabismus after 6 months. CONCLUSION: Abducens palsy following spinal anesthesia is a rare and reversible complication. Spinal anesthesia is still a feasible procedure for both the orthopaedic surgeon and the patient. Other types of anesthesia or performing spinal anesthesia with smaller diameter or atraumatic spinal needles may help decrease the incidence of abducens palsy. Informing the patient about the reversibility of the complication is essential during the follow-up because the palsy may last for as long as 6 months. Special attention must be paid to patient positioning following the operation. Recumbency and lying flat should be accomplished as soon as possible to prevent cerebrospinal fluid leakage and resultant intracranial hypotension. This becomes much more important if the patient has postdural puncture headache. ( info) |
3/7. hallux varus: a step-wise approach for correction. Iatrogenic hallux varus can be an unfortunate complication of hallux abducto valgus surgery. The correction of hallux varus must be performed in a well planned, step-wise method. The authors present both soft tissue and osseous corrections for hallux varus, with two case reports. ( info) |
| The split tendon transfer is introduced as an additional procedure for the correction of hallux varus. More clinical and statistical evaluations are required to fully appreciate its potential benefits. ( info) |
| A case of hallux varus and extensus of unusual etiology and treatment is presented. Special emphasis is directed toward the angle formed between the first metatarsal base and medial cuneiform, which these investigators believe has not been previously described. The procedure performed is a reverse Austin bunionectomy with a step-by-step outline of soft tissue procedures attempted before osteotomy. The cartilage at the first metatarsal head was medially adapted and of normal structure and function preoperatively; therefore, the decision was made to perform a joint preservation procedure. ( info) |
6/7. Dynamic post-surgical hallux varus after lateral sesamoidectomy: treatment and prevention. hallux varus and clawing are occasionally seen after a McBride procedure, due to the severance of the flexor hallucis brevis, when the lateral sesamoid is removed. The present study includes six patients, (involving ten feet), who developed hallux varus and great toe clawing after McBride procedures were performed by various orthopedic surgeons. Treatment utilized partial proximal phalangeal resection, with and without silicone single-stem implants, extensor hallucis longus tendon transfer to the great toe metatarsal, and interphalangeal joint arthrodesis, or tenodesis of the great toe to correct clawing. One patient eventually required a great toe metatarsophalangeal joint fusion. This reconstructive surgery is generally effective by correcting capsular malalignment, the "bowstringing" tendency of the extensor hallucis longus, and great toe clawing that develops simultaneously with hallux varus. Lateral sesamoidectomy is risky, and believed unnecessary as adductor hallucis tenotomy is effective in relieving hallux valgus. Although, it can occur with excessive excision of the medial emminence and distal advancement of the abductor hallucis. The author is unaware of hallux varus developing after adductor hallucis tenotomies. ( info) |
| adult hallux varus is an uncommon clinical entity usually caused by an inflammatory arthropathy or overcorrection during bunion reconstruction. We present five cases of unexplained spontaneous hallux varus. Clinically, all patients initially were found to have flexible deformities, and no evidence of underlying inflammatory disease or history of trauma. Symptoms were easily relieved with shoe wear modifications. Two of the patients developed more rigid deformities and subsequent medial callusing of the first toe and varus deformities of the lesser toes. These two patients eventually required surgical intervention. A Keller arthroplasty was performed on the first metatarsophalangeal joint and valgus proximal phalangeal osteotomies were done on the lateral toes when indicated. The outcome for these patients was good. Possible etiologic mechanisms are discussed. It is postulated that in these cases, the abductor hallucis tendon inserts more medially on the phalanx and overpowers the adductor. This produces a medially directed moment and, with time, a varus deformity. ( info) |