Introduction Improving the approaches to treating patients with hammer toe deformity is a relevant task. The problems of its management are a lack of uniform approaches to treatment, a significant number of complications and low patient satisfaction with the results of treatment. A frequent complication of its surgical treatment is a residual abduction deformity of the second toe. However, the available literature does not adequately cover the treatment of this pathology, and the methods of surgical correction have serious shortcomings. In this regard, the aim of the study was to evaluate the efficiency of the original method for correcting the abduction deformity of the second toe. The proposed approach is based on strengthening the medial capsuloligamentous structures of the metatarsophalangeal joint with the tendon of the brevis extensor digitorum muscle. Material and methods Treatment of 26 (100 %) patients operated for abduction deformity of the second toe at the Novosibirsk Research Institute of Traumatology and Orthopedics in 2016 and 2017 was analyzed. The index group included 15 (58 %) patients in whom the residual deformity was corrected according to the method proposed. In the comparison group of 11 (42 %) patients, the capsulotomy method of the second metatarsophalangeal joint with transarticular Kirschner wire fixation was used. The study utilised clinical, radiological, surgical, functional and statistical methods. Final treatment results were evaluated one year after the operations. Results The use of the traditional method of abduction deformity correction in the comparison group demonstrated its extremely low efficiency. On the other hand, in the index group there were 13 (86.6 %) good results, one (6.7 %) was fair and one (6.7 %) was poor. Discussion Many authors state the importance of restoring the capsulo-ligamentous complex of the metatarsophalangeal joint while correcting the toe deformity in the plantar plane. The method proposed by us enables to avoid residual deformities due to a number of technical merits with good clinical and functional results.
Background. Surgical treatment of patients with talus posttraumatic aseptic necrosis and its consequences usually includes tibiotalocalcaneal arthrodesis with various foot joints according to additional indications. This type of surgical treatment has number of significant disadvantages: traumatic surgical technique, permanent loss of movement in functionally significant joints, high risk of non-union, high frequency of residual deformities, the need for long periods of limb immobilization. The question arises: how to overcome the existing disadvantages and improve the results of talus posttraumatic aseptic necrosis treatment? A potential solution to this problem is the total talus endoprosthetics. Clinical case. A 64-year-old patient came to the clinic complaining of pain and deformity of the right foot and ankle area. After the examination, talus posttraumatic aseptic necrosis was diagnosed. The patient underwent ankle joint arthroplasty using total talus ceramic endoprosthesis in combination with the tibial component of the ankle joint endoprosthesis, a course of rehabilitation treatment was performed. Results. The VAS and AOFAS scales indicators showed a significant improvement both in the pain decrease (from 75 mm before surgery to 10 mm after), and in the functional state according to AOFAS by 2.2 times (from 36 to 80 points 20 months after surgery). By the last follow-up the patient could take more than 8000 steps a day. Conclusion. Considering the good clinical result achieved, the ankle joint arthroplasty using total talus ceramic endoprosthesis in combination with the tibial component of the ankle joint endoprosthesis can be considered a promising method of treatment of this severe pathology.
Treatment of patients has been accumulated with deformity of the first ray of the foot has a long history and vast experience in this area of orthopedics. The clinical histories of the review of the treatment’s evolution of patients are presented with Hallux valgus. The ways of development and improvement of the basic methods are described in the historical plan with an estimation of their advantages and lacks.
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