Reconstructive Foot and Ankle Surgery: Management of Complications E-Book , livre ebook

Reconstructive Foot and Ankle Surgery
Management of Complications
Second Edition

Mark S. Myerson, M.D.
Director, Institute for Foot and Ankle Reconstruction, Mercy Medical Center, Baltimore, Maryland
Saunders
Front Matter

Reconstructive Foot and Ankle Surgery
Management of Complications
S econd E dition
M ark S. M yerson , M.D.
Director, Institute for Foot and Ankle Reconstruction, Mercy Medical Center, Baltimore, Maryland
Copyright

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RECONSTRUCTIVE FOOT AND ANKLE SURGERY ISBN: 978-1-4377-0923-0
Management of Complications
Copyright © 2010 by Saunders, an imprint of Elsevier Inc.
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Notice
Knowledge and best practice in this field are constantly changing. As new research and experience broaden our understanding, changes in research methods, professional practices, or medical treatment may become necessary.
Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds, or experiments described herein. In using such information or methods they should be mindful of their own safety and the safety of others, including parties for whom they have a professional responsibility.
With respect to any drug or pharmaceutical products identified, readers are advised to check the most current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered, to verify the recommended dose or formula, the method and duration of administration, and contraindications. It is the responsibility of practitioners, relying on their own experience and knowledge of their patients, to make diagnoses, to determine dosages and the best treatment for each individual patient, and to take all appropriate safety precautions.
To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume any liability for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein.
Library of Congress Cataloging-in-Publication Data or Control Number
Myerson, Mark.
Reconstructive foot and ankle surgery/Mark S. Myerson. -- 2nd ed.
p.; cm.
Includes bibliographical references and index.
ISBN 978-1-4377-0923-0 (hardcover: alk. paper) 1. Foot--Diseases--Surgery.
2. Ankle--Diseases--Surgery. 3. Foot--Abnormalities--Surgery.
4. Ankle--Abnormalities--Surgery. I. Title.
[DNLM: 1. Ankle--surgery. 2. Foot--surgery. 3. Reconstructive Surgical
Procedures--methods. WE 880 M996r 2010]
RD563.M96 2010
617.5'85059--dc22
Acquisitions Editor: Daniel Pepper
Developmental Editor: Taylor Ball
Publishing Services Manager: Anne Altepeter
Team Manager: Radhika Pallamparthy
Senior Project Manager: Beth Hayes
Project Manager: Preethi Kerala Varma
Design Direction: Lou Forgione
Printed in Canada.
Last digit is the print number: 9 8 7 6 5 4 3 2 1
Dedication
To my beloved family
This work could not have been possible without your sacrifice.
You have my enduring love, affection, and gratitude.
Preface
Where do new ideas come from? What is original thought, and what can or should be attributed to someone else? The techniques presented in this text are an amalgamation of ideas and approaches that are not all original and certainly not necessarily novel. Some of my procedures have not changed at all over the decades, and indeed it is gratifying to know that although methods of fixation may have improved, the principles of surgical reconstruction remain similar. Certainly, surgical approaches change, but these are driven primarily by the technological advances that abound in our daily practice of medicine.
I have been blessed by those around me. To be an educator is a gift and a wonderful opportunity, and to be a teacher without continuing to learn from others is impossible. The ideas expressed in this book therefore represent the thoughts and techniques that I have accrued from my mentors, my colleagues, and my wonderful fellows. I owe my gratitude to my fellows for constantly challenging me to set the standards in foot and ankle surgery that are essential for our progress.

Mark S. Myerson, M.D.
Table of Contents
Front Matter
Copyright
Dedication
Preface
Section I: THE HALLUX AND SESAMOIDS
Chapter 1: Chevron Osteotomy
Chapter 2: The Modified Ludloff Metatarsal Osteotomy
Chapter 3: The Modified Lapidus Procedure
Chapter 4: Proximal Phalangeal Osteotomy (Akin Osteotomy)
Chapter 5: Management of Complications After Correction of Hallux Valgus
Chapter 6: Hallux Varus
Chapter 7: Claw Hallux Deformity
Chapter 8: Hallux Rigidus
Chapter 9: Disorders of the Sesamoids
Section II: LESSER TOE CORRECTION
Chapter 10: Correction of Lesser Toe Deformity
Chapter 11: Correction of Crossover Toe Deformity
Chapter 12: Management of Metatarsalgia
Chapter 13: Management of the Bunionette
Section III: SURGERY FOR THE NEUROPATHIC FOOT AND ANKLE
Chapter 14: Surgery for Neuropathic Foot and Ankle
Section IV: CORRECTION OF THE CAVUS FOOT
Chapter 15: Cavus Foot Correction
Section V: CORRECTION OF PARALYTIC DEFORMITY
Chapter 16: Tendon Transfers for Management of Paralytic Deformity
Section VI: FLATFOOT DEFORMITY CORRECTION
Chapter 17: Correction of Flatfoot Deformity in the Child
Chapter 18: Correction of Flatfoot Deformity in the Adult
Chapter 19: Complications of Treatment of Flatfoot
Section VII: TARSAL TUNNEL SYNDROME
Chapter 20: Management of Tarsal Tunnel Syndrome
Chapter 21: Management of Nerve Entrapment Syndromes
Section VIII: MANAGEMENT OF ANKLE ARTHRITIS
Chapter 22: The Use of Bulk Fresh Allografts in Ankle Reconstruction
Chapter 23: Reconstruction of Malunited Ankle Fractures
Chapter 24: Total Ankle Replacement
Chapter 25: Revision Total Ankle Replacement
Chapter 26: Osteotomy of the Tibia and Fibula
Section IX: TENDON REPAIR AND RECONSTRUCTION
Chapter 27: Disorders of the Achilles Tendon
Chapter 28: Rupture of the Anterior Tibial Tendon
Chapter 29: Peroneal Tendon Injury and Repair
Section X: ANKLE INSTABILITY AND ARTHRODESIS
Chapter 30: Tarsal Coalition
Chapter 31: Ankle Instability and Impingement Syndromes
Chapter 32: Management of Osteochondral Lesions of the Talus
Chapter 33: Arthrodesis of the Hallux Metatarsophalangeal and Interphalangeal Joints
Chapter 34: Arthrodesis of the Tarsometatarsal Joint
Chapter 35: Subtalar Arthrodesis
Chapter 36: Triple Arthrodesis
Chapter 37: Ankle Arthrodesis
Chapter 38: Tibiotalocalcaneal and Pan-Talar Arthrodesis
Section XI: RHEUMATOID FOOT AND ANKLE SURGERY
Chapter 39: The Rheumatoid Foot and Ankle
Index
Section I
THE HALLUX AND SESAMOIDS
CHAPTER 1 Chevron Osteotomy

INDICATIONS
Chevron osteotomy is a procedure performed for correction of hallux valgus that is associated with a mild to moderate increase in the intermetatarsal angle. Recent years have seen an increased interest in “pushing” the procedure for correction of more severe deformity. Indeed, with a release of the adductor, a moderate deformity of an intermetatarsal angle between 14 and 17 degrees may be corrected with a more aggressive version of chevron osteotomy. Correction of severe deformity does require moving the metatarsal head laterally by at least 50%, thereby increasing the risk for malunion resulting from poor bone contact. After all, the chevron osteotomy is really just a short version of the scarf osteotomy and, with modifications, can correct multiplanar deformity. In my experience, an adductor release is important for an optimal result, and if any doubt exists regarding the adequacy of the chevron osteotomy for correction, it is preferable to perform a distal soft tissue release. This additional step is even more important in patients who are found to have a greater degree of hallux valgus than that expected on the basis of the radiographic intermetatarsal angle, for whom the soft tissue release is very useful.
The incidence of avascular necrosis of the metatarsal head does not increase when a soft tissue release is performed simultaneously with the osteotomy. Avascular necrosis of the metatarsal head typically results when excessive periosteal stripping is performed along the dorsal lateral metatarsal neck, which really does not need to be exposed. The osteotomy can be performed in conjunction with a closing wedge osteotomy of the hallux proximal phalanx (Akin osteotomy) for patients in whom the distal metatarsal articular angle