Forefoot Reconstruction by Louis-Samuel Barouk

By Louis-Samuel Barouk

For a very long time, forefoot surgical procedure had many risks together with a painful postoperative interval and recurrence of deformities. New options – particularly shawl, the 1st metatarsal osteotomy and the Weil osteotomy of the lesser metatarsal – offer an important development within the remedy of static forefoot issues. the nice toe osteotomy has additionally been enormously more advantageous. due to the fact that 1991, the writer has brought those thoughts in lots of international locations, whereas constructing and learning the corresponding implants and the postoperative interval. He has additionally constructed surgical administration concepts that bridge those various osteotomies. greater than a thousand surgeons all over the world are utilizing those options, that are now greatly taught. during this moment version of the publication the final presentation is clearer and extra friendly and lots of images were changed. numerous subject matters are emphasised, particularly the good toe proximal phalanx osteotomy, the joint preservative surgical procedure in critical forefoot problems, together with revision after failed bunionectomy and rheumatoid forefoot following the "ms” aspect for a correct and potent metatarsal shortening. finally, new techniques are uncovered, relatively in Claw toe and hammer with the PIP plantar unlock and the surgical procedure of the center phalanx and likewise the Weil osteotomy of the 1st metatarsal in hallux limitus.

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Shortening without lowering may result in 2nd ray transfer m etatarsalgia (scarf early experience). 3. a: The longitudinal cut does not follow the axis of the 1st metatarsal, so that the 1st metatarsal shortening by scarf does not provide elevation. b: Thanks to the plantar obliquity of the longitudinal cut, M1 lowering by scarf is automatically combined with the lateral shift. 4. This lowering should compensate the shortening but does not cancel the necessity to harmonize the metatarsal parabola.

5. Media/location of the distal screw, to maintain the DMAA correction. 6. DMAA correction combined with M l shortening. 7. Sometimes, there is an intraoperative excess of DMAA correction: In this case, the Load Simulation Test is useful, but the real assessment is made by X-ray (or fluoroscopy) (8). At this stage, the correction is easy (9). 45 46 Forefoot Reconstruction Fig. 07b7. DMAA correction: indications and results. 1. In usual case. 2. In juvenile hallux valgus. 3. In iatrogenic deformity.

07cl 0. In a supinated forefoot or an hypermobile 1st ray, does the scarf replace the Lapidus procedure? 1, 2. We observed that each time we have a sufficient Ml lowering (large intermetatarsal angle), this lowering is sufficient to ensure both the long-lasting hallux valgus correction (3, 4) and to significantly improve the hindfoot valgus (5, 6). All these pictures are from the same patient with 2 years follow-up, left foot. When there is too much foot valgus, additional rearfoot procedures have to be performed (see Fig.

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