Dorsi-flexing osteotomy of first metatarsal surgical technique
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Dorsiflexion osteotomy of the first ray may be performed in isolation to relieve excess pressure through an overlong or overloaded first ray, to relieve pressure through an overloaded and painful sesamoid bone , or to correct a plantar flexed first ray in a cavus foot.
In cavus foot, the plantar flexed first ray strikes first on loading the forefoot, and causes the foot to roll into varus.
Correction of the first ray in cavus is occassionally performed in isolation, but more commonly is performed in association with other procedures such as lateral displacement calcaneal osteotomy, midfoot correction or triple fusion – with or without corrective tendon transfers.
The operation is simplified by the use of a staple to hold the osteotomy, which allows the osteotomy to be performed within 1 cm of the proximal end of the metatarsal, and with correct technique will provide enough stability for the patient to bear weight and mobilise early. The decision as to how much to dorsiflex the first ray is clinical and cannot be calculated accurately pre-operatively . It is judged clinically during the operation.
Because of this, orthotics shoud always be trialled prior to surgery, and the patients should be aware that orthotics are also often needed to get good results after surgery. The osteotomy will adjust the major deformity, but orthotics are usuall needed to achieve fine adjustment and optimal function.
Author: Mr Paul Cooke FRCS
Institution: The Nuffield Orthopaedic Centre ,Oxford ,UK.
- Each operation and the questions associated become a named course in the CPD section
- The operative technique itself is read as a lesson as is any company implant information if this is being assessed.
- You’ll need to tick the box to confirm this has been done and can do this immediately if you have already read the op tech.
- The vast majority of operations have a 10-15 MCQ quiz covering all aspects of the decision making and the technique
- There are four possible answers of which one is correct (or on occasion more correct) than the others.
- There are additional quiz modules on the surgical steps, the implants and problem cases being added continually
- The course is completed once all the lessons are read and quizzes submitted and passed.
- On successful completion of each quiz you will receive validated CPD points that add to the certificate in your CPD folder.
- Your dashboard also will contain a record of the time you have spent logged onto and using the site.
- The timer suspends after 5 minutes though if there is no activity.
- When you restart you will resume at the same point in the module.
- Once you have completed each quiz you will need to feedback on the module first then click “submit” and your paper will be marked.
The pass mark is 75%.
- If you fall below this level you will be directed back to re-read the slides where you’ve tripped up.
- Once these have been read you can re-do just the questions you failed on.
- Once you have passed the quiz you can return at a future stage & resit .
- Operation Quiz – 1 CPD point
- Surgical steps Quiz – 1/4 CPD point
- Implants Quiz – 1/4 CPD point
- Problem case Quiz – 1/2 CPD point
One CPD point equates to one hour of academic activity
Welcome to the Professional Development question section. The objective of taking these tests is to demonstrate that you have understood all aspects of the assessment and management of patients requiring surgical intevention. On successful completion you will receive a certificate accredited by both the Royal College of Surgeons of both England and Edinburgh as well as the British Orthopaedic Association.
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