Caldiño-Lozada I, Gallegos-de la Torre O, Esperón-Hernández R

Language: Spanish
References: 13
Page: 86-90
PDF size: 332.79 Kb.

ABSTRACT

Brachymetatarsia (shortening of the metatarsal) directly affects the transversal arch of the foot causing severe deformities, such as hallux valgus, divergent toes, overlapping toes, metatarsalgia, all of these alter the biomechanics of the foot and gait. Treatment consists of two main techniques, one-stage lengthening with bone graft or elongation through callotaxis with external fixator; there are variants of both techniques used to minimize the disadvantages of each. The objective of treatment must be to return the structural harmony to the forefoot, improving the biomechanics, resulting in a satisfactory outcome for the patients. This article presents a surgical treatment for feet with closed physis to obtain the appropriate metatarsal formula and to reestablish aesthetics and function. This case was treated by means of one-stage lengthening with bone graft to the affected metatarsal; shortening of the adjacent metatarsals; hallux valgus alignment through the necessary osteotomies and the treatment of deformities of the lesser toes as needed. This surgical technique has as one of its advantages the correction of the entire forefoot at one time, without the need of an external fixator and its required postoperative care. Its main disadvantages are its dependence on structural bone graft and the need of postoperative dressing until healing of the bone has taken place. Satisfactory clinical and radiographical outcomes were obtained in treated patient.

REFERENCES

1. Martín-Urrialde JA, Mesa-Jiménez J: Cadena cinética abierta… cadena cinética cerrada… una discusión abierta. Archivos de Medicina del Deporte. 2007; 24(119): 205-9.

2. Viladot-Voegeli A, Viladot-Pericé A: Síndrome de insuficiencia del primer radio. En: Núñez-Samper Pizzarroso M, Llanos-Alcázar LF: Biomecánica, medicina y cirugía del pie. 2a ed. España: Masson; 2006: 235-48.

3. Lee WC, Yoo JH, Moon JS: Lengthening of fourth brachymetatarsia by three different surgical techniques. J Bone Joint Surg Br. 2009; 91(11): 1472-7.

4. Montero-Quijano M, Mora-Ríos FG, Mejía-Rohenes C, López-Marmolejo A, Tamayo-Pacho F, Antonio-Romero CE: Estudio comparativo de manejo de braquimetatarsia congénita mediante elongación por callotaxis. Acta Ortop Mex. 2015; 29(2): 77-81.

5. Jones MD, Pinegar DM, Rincker SA: Callus distraction versus single-stage lengthening with bone graft for treatment of brachymetatarsia: a systematic review. J Foot Ankle Surg. 2015; 54(5): 927-31.

6. Scher DM, Blyakher A, Krantzow M: A modified surgical technique for lengthening of a metatarsal using an external fixator. HSS J. 2010; 6(2): 235-9.

7. Maestro M, Besse JL, Ragusa M, Berthonnaud E: Forefoot morphotype study and planning method for forefoot osteotomy. Foot Ankle Clin. 2003; 8(4): 695-710.

8. Baek GH, Chung MS: The treatment of congenital brachymetatarsia by one-stage lengthening. J Bone Joint Surg Br. 1998; 80(6): 1040-4.

9. Kim JS, Baek GH, Chung MS, Yoon PW: Multiple congenital brachymetatarsia. A one-stage combined shortening and lengthening procedure without iliac bone graft. J Bone Joint Surg Br. 2004; 86(7): 1013-5.

10. Khazen G, Khazen C, Belandria U, Bonmatti F: Alargamiento en un tiempo quirúrgico con interposición de aloinjerto y fijación con placa. Tobillo y Pie. 2016; 8(1): 14-9.

11. Parra-Téllez P, Lezama-Peniche MJ, López-Gavito EG, Vázuez-Escamilla J: Evaluación funcional posterior al tratamiento de la braquimetatarsia mediante elongación por callotaxis a un año de seguimiento en pacientes adultos. Tobillo y Pie. 2016; 8(1): 20-3.

12. Kim HT, Lee SH, Yoo CI, Kang JH, Suh JT: The management of brachymetatarsia. J Bone Joint Surg Br. 2003; 85(5): 683-90.

13. Alter SA, Feinman B, Rosen RG: Chevron bone graft procedure for the correction of brachymetatarsia. J Foot Ankle Surg. 1995; 34(2): 200-5.