This study investigated the results of first metatarsophalangeal (MTP) arthrodesis in terms of clinical outcome measures, plantar pressure distribution, and gait patterns. Ten feet in nine patients with severe hallux rigidus (HR) who underwent first MTP arthrodesis were studied. The preoperative evaluation included a subjective questionnaire, physical exam, AOFAS hallux score, radiographs and dynamic pedobarography (EMED). At follow-up (average 34 months) these were repeated, and gait analysis studies were obtained. Patients showed significant clinical improvement based on the subjective criteria. The mean AOFAS score improved from 38 preoperatively to 90 postoperatively. Postoperative EMED analysis showed restoration of the weightbearing function of the first ray, with greater maximum force carried by the distal hallux at toe-off. Kinematic and kinetic gait analysis from each patient's operative limb were compared to the unaffected contralateral limb and to age- and sex-matched healthy subjects. The kinematic data indicated a significantly shorter step length with some loss in ankle plantar flexion at toe-off on the fused side. The kinetic data indicated a reduction in both ankle torque and ankle power at push-off. Clinical results indicated effective pain relief and a high level of patient satisfaction, consistent with previous reports in patients with symptomatic Hallux Rigidus.

MM is an effective tool for aiding in the provision and retention of information during the informed consent process.

We prospectively evaluated the results of plantar pressure measurement in 32 patients (43 feet) who had a proximal crescentic osteotomy of the first metatarsal with a modified McBride procedure. The procedure's effectiveness in increasing weightbearing under the first ray, decreasing pressure under the second metatarsal head, and the relationship of radiographic measurements of first metatarsal length and position to postoperative pressure measurements were evaluated. Mean followup was 29 months. Average peak pressure increased postoperatively under the second metatarsal head. Almost identical numbers of feet had first metatarsal elevation (12) or depression (11) greater than 2 mm. Radiographic evidence of first metatarsal elevation, but not shortening, was associated with diminishing peak pressure and pressure-time integral under the first metatarsal head and hallux. Five feet that had first metatarsal elevation greater than 2 mm had new second metatarsal transfer lesions develop. Eleven feet preoperatively and nine feet postoperatively had symptomatic second metatarsal pressure lesions. One lesion persisted, 10 resolved, and eight new lesions developed. Control of the crescentic osteotomy in the sagittal plane was unpredictable despite modification of the surgical technique to plantarly displace the distal segment of the first meta-tarsal. Although average second metatarsal pressure increased postoperatively, there was variability in the correlation of radiographic change and pedobarographic measurements.

Our study found a strong association with transient bone marrow edema in the foot and ankle and low systemic bone mineral density, which appears to be due to a vitamin D deficiency. We recommend that, when TBME is diagnosed, patients should be referred for assessment and treatment of their bone mineral density.

Midfoot osteoarthritis (OA) is a degenerative condition of the foot that can be treated nonoperatively by the use of orthotics. This prospective study was conducted to determine the effects of custom-made semi-rigid foot orthoses (FOs) and rigid carbon fibre (CF) footplates for the treatment of midfoot OA evaluated using specifically designed questionnaires. Fifty-seven subjects diagnosed with midfoot OA were recruited through a private clinic for inclusion in the study. Subjects were required to complete pre-treatment questionnaires prior to receiving orthotic treatment. All subjects received a pair of custom-made full-length semi-rigid FOs and 36 subjects also received CF footplates that were incorporated into the soles of the shoes worn on the symptomatic feet. Subjects completed post-treatment questionnaires at six weeks, three months and six months after receiving the orthotic treatment. The results demonstrated that there were no significant differences between the results of the subjects who received CF footplates and those who did not. The results of the questionnaires demonstrated that subjects experienced significant improvements in pain, activity levels, walking ability and footwear comfort at all intervals following the orthotic treatment (p 5 0.01). Subjects' satisfaction with the appearance of their footwear did not decrease with the orthotic treatment despite needing shoes to fit the FOs and CF footplates. The questionnaires also demonstrated that subjects were generally satisfied with the orthotic treatment for the management of their midfoot OA.

Distal TA tendinosis is a condition that seems to predominantly affect overweight elderly women. It often presents with nocturnal burning medial midfoot pain.

Debridement and repair of DTAT, with EHL augmentation for greater than 50% tendon involvement, provided a high level of patient satisfaction after nonoperative management failed in this series.

This study demonstrated that incorporation of a computer-based, multimedia education tool into to the surgical consent process improved patient understanding of the risks, benefits and usual postoperative course following first MTPJ arthrodesis surgery.