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.
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Question 1 of 15
Which one of the following is an indication for dorsi-flexing osteotomy of the first metatarsal?CorrectIncorrect
Question 2 of 15
Which one of the following is true concerning patients before dorsiflexing osteotomy?CorrectIncorrect
Question 3 of 15
Which one of the following is true of the Coleman block test?CorrectIncorrect
Question 4 of 15
When performing dorsiflexing osteotomy in isolation, (not as part of a complex cavus correction) which one of the following is true of patient’s position on the operating table?CorrectIncorrect
Question 5 of 15
Which one of the following describes how the proximal end of the metatarsal be identified at the beginning of the operation?CorrectIncorrect
Question 6 of 15
Which one of the following describes the diameter of drill used to make the first drill hole – in the proximal metatarsal?CorrectIncorrect
Question 7 of 15
Which one of the following is true of the first bony cut made in dors-flexing osteotomy?CorrectIncorrect
Question 8 of 15
Which one of the following statements describes when the angle of the second cut, and therefore the size of the excised fragment, is estimated?CorrectIncorrect
Question 9 of 15
Which one of the following statements describes how the osteotomy is usually completed?CorrectIncorrect
Question 10 of 15
Which one of the following describes the correct action to take if the inferior cortex is inadvertently completely divided?CorrectIncorrect
Question 11 of 15
When using a 12mm interaxis staple to compress the osteotomy, which one of the following describes the interaxis setting that should be used on the drill guide?CorrectIncorrect
Question 12 of 15
Which one of the following is true regarding introduction of the staple?CorrectIncorrect
Question 13 of 15
Which one of the following is true about mobilising the patient after dorsi-flexing surgery?CorrectIncorrect
Question 14 of 15
Which one of the following is true about the results of Leeuwenstijn et al, reporting results of CMT correction?CorrectIncorrect
Question 15 of 15
Which one of the following describes the effect that Ward el al reported relating to smoking and outcome of surgery?CorrectIncorrect