Kim Hui Taek, Hong Sung Min, Kim In Hee
Department of Orthopaedic Surgery and Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea.
JB JS Open Access. 2018 Apr 19;3(2):e0046. doi: 10.2106/JBJS.OA.17.00046. eCollection 2018 Jun 28.
Brachymetatarsia is usually treated by lengthening the metatarsals, but excessive lengthening can be associated with complications. Our technique combines 1-stage step-cut lengthening of the first metatarsal with shortening and/or lengthening of the neighboring metatarsals and/or phalanges.
Twenty-four feet (15 patients) were treated for first-ray brachymetatarsia. Widely available commercial image-editing software was used to make a preoperative plan for each patient, with emphasis on the creation of a cosmetically satisfying toe-length arc with minimum shortening and lengthening of the affected metatarsals and proximal phalanges. Length gain and percentage increase were also recorded postoperatively. The American Orthopaedic Foot & Ankle Society (AOFAS) hallux metatarsophalangeal-interphalangeal scoring system was used for clinical evaluation.
In all 24 feet, smooth parabolas were created at the level of the metatarsal heads and at the toe tips. All patients showed osseous union, and no complications were noted. However, most patients showed mildly restricted range of motion of the first metatarsophalangeal joint. The mean AOFAS score of the hallux significantly improved from 88.3 preoperatively to 98.1 at the latest follow-up (p < 0.001).
One-stage step-cut lengthening of the first metatarsal combined with shortening and/or lengthening of the adjacent metatarsal and phalangeal bones provides excellent cosmetic and functional results.
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
短跖骨通常通过延长跖骨来治疗，但过度延长可能会引发并发症。我们的技术将第一跖骨的一期阶梯式截骨延长与相邻跖骨和/或趾骨的缩短和/或延长相结合。
对24足（15例患者）进行了第一跖骨短缩畸形的治疗。使用广泛应用的商业图像编辑软件为每位患者制定术前计划，重点是在尽量减少患侧跖骨和近端趾骨缩短和延长的情况下，创建一个美观满意的趾长弧度。术后还记录了长度增加量和增加百分比。采用美国矫形足踝协会（AOFAS）拇趾跖趾关节-趾间关节评分系统进行临床评估。
在所有24足中，在跖骨头水平和趾尖处均形成了平滑的抛物线。所有患者均实现骨愈合，未发现并发症。然而，大多数患者的第一跖趾关节活动范围有轻度受限。拇趾的AOFAS平均评分从术前的88.3显著提高到最近一次随访时的98.1（p<0.001）。
第一跖骨的一期阶梯式截骨延长联合相邻跖骨和趾骨的缩短和/或延长可提供优异的美容和功能效果。
治疗性四级。有关证据水平的完整描述，请参阅作者指南。
