González-Rincón JA, Valle-de Lascurain G, Oribio-Gallegos JA

Language: Spanish
References: 18
Page: 103-108
PDF size: 76.84 Kb.

ABSTRACT

The most frequent foot and ankle anatomical alterations in the pediatric population are found in the little toes. Several treatments are proposed for these conditions, ranging from total phalangeal resections, phalangeal osteotomies, osteosynthesis, and soft tissue management. We propose a surgical technique based on the diaphysectomy of the proximal phalanx and the release of soft tissues that are under tension. The purpose is to assess the functional foot results after surgical treatment consisting of proximal phalanx diaphysectomy and soft tissue release using the functional AOFAS scale in pediatric patients. A prospective, longitudinal, descriptive, non-comparative clinical study was conducted from March 2008 to December 2010, with a follow-up of up to six months. Twenty patients (35 toes) were included; 15 females and five males, with a mean age of 14.65 years. Fifteen (30 toes) had bilateral involvement; 88.56% had greater involvement of the fifth toe. The surgical indication was determined based on the degree of functional disability for gait and the type of footwear. The functional assessment was conducted using the AOFAS criteria and a subjective assessment scale with a total score of 100 to assess the metatarsophalangeal and the interphalangeal joints of the smallest toes. Scores were as follows: < 50 points, poor; 51-70 points, fair; 71- 90, good, and > 91, excellent. The assessment was done preoperatively and at postoperative month six. The mean preoperative score was 73.55 and the mean postoperative score was 85.75, with a 12.2 point difference (p > 0.5). Results were: 11 excellent, seven good and two fair. There were four relapses, so a salvage procedure was performed with the Ruiz-Mora technique; excellent results were obtained in all four. One case had soft tissue infection. Proximal phalanx diaphysectomy and soft tissue release provides appropriate alignment of the affected toes and relief of soft tissues under tension, thus avoiding broad resections leading to both esthetic and functional alterations. This is a simple and effective technique for the treatment of little toe deformities as it improves function and alignment.

REFERENCES

1. Staheli LT: Ortopedia Pediátrica. Madrid: Ed Marban; 2003: 97.

2. Nicasio RJ, Díaz CF, Sotelo BF, Melchor MM: Prevalencia de alteraciones músculo-esqueléticas en jóvenes preparatorianos. Acta Ortop Mex 2003; 17(2): 68-73.

3. Viladot A: Quince lecciones sobre patología del antepié. 2da ed. Barcelona: Editorial Masson; 2000: 26-26, 151-57.

4. Kelikian H: Hallux valgus allied deformities of the forefoot and metatarsalgia. Philadelphia: W. B. Saunders Company; 1965: 169-175.

5. Cockin J: Butler´s operation for an over-riding fi fth toe. JBJS 1968: (50B): 78-81.

6. Janecki CJ: Results of phalangectomy of the fi fth toe for hammertoe. The Ruiz Mora Procedure. JBJS Am 1976; 58(7): 1005-72.

7. Black GB, Grogan DP, Babechko WP: Butler Arthroplasty for correction of the adducted fi fth toe: a retrospective study of 36 operations between 1968 and 1982. J Pediatr Orthop 1985; 5(4): 439-41.

8. Rao GS, James JH: Artifi cial syndactilization for congenital crossed toes. Br J Plast Surg 1987; 40(5): 502-4.

9. Paton RW: V-Y plasty for correction of varus in the fi fth toe. J Pediatr Orthop 1990; 10(2): 248-9.

10. Taiwil Hj, Piliard D, Taussig G: V-Y plasty in the correction of the varus of the fi fth toe. Chir Orthop Reparatrice App Mot 1992; 78(2): 107-11.

11. Kitaoka HB: Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int 1994; 15(7): 349-53.

12. Dyal CM, Davis WH, Thompson FM: Clinical evaluation of the Ruiz- Mora procedure: long-term follow-up. Foot Ankle Int 1997; 18(2): 94-7.

13. De Palma L, Zanoli G: Zanoli´s procedure for overlapping fi fth toe: retrospective study of 18 cases followed for 4-17 years. Acta Orthop Scand 1998; 69(5): 505.

14. Derhy Y: Congenital quintus varus supraductus: surgical procedure. Ann Chir Plast Esther 2004; 49(4): 373-7.

15. López GE, Parra TP, Vázquez EJ, Alberto GA: Tratamiento quirúrgico del quinto dedo supraducto del pie. Técnica original. Acta Ortop Mex 2005; 19(6): 255-58.

16. Pastrana GF, Olivares GJ, Bárcenas JL, Fuentes NM: Tratamiento de la deformidad en garra de los dedos menores del pie: Acta Ortop Mex 2008; 22(3): 189-194.

17. Velázquez PV, López MA, Isunza RA, Cortes GJ, Félix MR, Mora MI: Efi cacia de la cirugía mínimamente invasiva en el antepié en niños. Acta Ortop Mex 2008; 22(1): 19-25.

18. López GE, Parra TP, Burgos PR, Vázquez EJ; Evolución clínica de la ostetomía del quinto dedo supraducto del pie en pacientes postoperados con la técnica quirúrgica LP-INR. Acta Ortop Mex 2010; 24(4): 235-41.