Forefoot morphotype study and planning method for forefoot osteotomy
Section snippets
The architecture of the normal forefoot
First of all, the question is: What is a normal forefoot?
Clinically, the forefoot presents no pathology and “no calluses under the heads”, as Martorrel-Martorrel [3] wrote; structurally, however, no rule of bone architecture construction has been defined.
At the beginning of our study in 1995 [2], working from a dorso-plantar X ray, we drew the M2 axis on its straight medial border and then a perpendicular line from the center of the lateral sesamoid bone. This line passed through the central
Metatarsal morphotypes
There seems to exist two levels of harmony in the forefoot: one between the lateral sesamoid bone and the fourth metatarsal head, and another between the length of the lesser rays.
For the previous study, the M2 axis was chosen as the axis of reference for measurements and reconstruction planning. Proximally, it travels through the central part of the talus body on the lateral view and through the midpoint of the backfoot on the dorsoplantar view in the majority of cases; in so doing, it merges
Surgical applications
The relative metatarsal length disorders are a major factor of metatarsalgia, and we can now correct a disharmony in these lengths with more accuracy.
Ageing, microtraumatism, inflammation, surgery, and other outside factors generally cause a soft tissue retraction that causes articular chain instability and deformity; consequently, bone shortening is necessary in almost every case to replace and stabilize the joint and to preserve mobility. The main effect of the bone shortening is a
Summary
In the reconstruction of the hip, knee, or any other joint, preoperative planning is necessary for avoiding mistakes during surgery. Since 1995, the authors have been doing this before forefoot surgery to increase the accuracy of the surgery. As much as possible, they try to correct only the lesion and to avoid preventive or extensive surgery on adjacent rays, except if the correction leads to a modified dysharmonious new morphotype with high risk of transfer lesion. The tolerance length seems
Acknowledgements
The authors would like to acknowledge the Pied Innovation Group: M. Benichou, MD, M. Augoyard, MD, J. Peyrot, MD, T. Lemrijs, MD, B. Valtin, MD, L.S. Barouk, MD, F. Langlois MD, A. Meloni MD, M. Bouharoua MD, B. Moyen MD, J. Dimnet, PhD .
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