Department of Plastic, Reconstructive and Hand Surgery, Erasmus Medical Center, University Medical Center, Rotterdam, the Netherlands.
Department of Rehabilitation Medicine, Academic Medical Center, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands.
Foot Ankle Int. 2020 Dec;41(12):1553-1562. doi: 10.1177/1071100720943850. Epub 2020 Sep 3.
In preaxial polydactyly of the foot, the choice for excision of the lateral or medial hallux is not straightforward, in particular with proximal phalangeal (type IV) and metatarsal (type VI) duplication, because of anatomical characteristics. We evaluated whether medial or lateral hallux excision gives better outcomes in these duplication types, to help clinical decision making.
Children with type IV or type VI duplication (n=14, age: 4.4-17.2 years), who were operatively treated by excision of the lateral or medial hallux, were assessed for foot function using plantar pressure measurements and clinical examination. Foot aesthetics were scored by the child, an expert, and 10 laypersons, and additional patient-reported outcome questionnaires were obtained. Outcomes were compared between lateral and medial excision, per duplication type.
In type IV duplication (n=11), lateral excision showed a better distribution of peak pressure between the hallux and first metatarsal with significantly lower median first metatarsal peak pressure ( = .008). Lateral excision showed more medial hallux deviation ( = .017). Foot aesthetics were not different between excision sides. In type VI duplication (n=12), lateral excision showed a 59% higher hallux peak pressure, larger medial hallux deviation ( = .004), and more reoperations. Foot aesthetics were scored significantly better after lateral excision by experts and laypersons.
Foot function by virtue of plantar pressure was better after lateral hallux excision in type IV and after medial hallux excision in type VI duplication. Surgeons and laypersons perceived the foot as more normal after lateral excision in type VI, whereas children reported no differences. These outcomes can be used in clinical decision making.
Level III, therapeutic, comparative study.
在足的桡侧多趾畸形中，由于解剖学特点，对于切除外侧或内侧跖骨，特别是近端趾骨（IV 型）和跖骨（VI 型）重复，选择并不直接。我们评估了在这些重复类型中切除内侧或外侧跖骨是否会获得更好的结果，以帮助临床决策。
对接受外侧或内侧跖骨切除手术治疗的 IV 型或 VI 型重复畸形的儿童（年龄：4.4-17.2 岁，n=14）进行足部功能评估，采用足底压力测量和临床检查。足部美学由儿童、专家和 10 名非专业人士评分，并获得额外的患者报告结果问卷。按重复类型比较外侧和内侧切除的结果。
在 IV 型重复畸形（n=11）中，外侧切除显示跖骨和第一跖骨之间的峰值压力分布更好，第一跖骨峰值压力的中位数显著降低（=0.008）。外侧切除显示内侧跖骨偏差更大（=0.017）。切除侧的足部美学无差异。在 VI 型重复畸形（n=12）中，外侧切除显示跖骨峰值压力增加 59%，内侧跖骨偏差更大（=0.004），并且需要更多的再手术。专家和非专业人士认为外侧切除后的足部美学评分显著更好。
在 IV 型重复畸形中，外侧跖骨切除的足部功能更好，在 VI 型重复畸形中，内侧跖骨切除的足部功能更好。外科医生和非专业人士认为 VI 型外侧切除后的足部更正常，而儿童报告无差异。这些结果可用于临床决策。
III 级，治疗性，比较研究。
