Misc, Etiology, Clinical
Tailor’s bunion derived from
Tailors sitting cross-legged
Average IM angle between the 4th and 5th metatarsals
6.4 to 9.1 degrees
Where is the incision?
Dorsolateral
Which common osteotomy of the 1st met can be applied to the 5th met?
Chevron
Complications that are common to metatarsal surgery
Delayed/nonunion, arthritis, transfer lesion/metatarsalgia, infection
Name 1 of the 2 mentioned structural causes
Increased IM angle between the 4th & 5th metatarsal
Shape of the 5th metatarsal head
Average IM angle between the 4th and 5th metatarsals in symptomatic bunionettes
8.7 to 10.8 degrees
You make your incision from skin to subcutaneous tissue first. Why shouldn’t you make your dorsolateral incision from skin straight to bone?
To locate and retract the tendon.
Which type of osteotomy allows medial displacement and shortening of the 5th met?
Wilson
Which condylectomy weakens the metatarsal head?
A plantar lateral one
What is a Lister’s corn?
Hyperkeratotic lesion in the nail border. (Commonly lateral, commonly 5th digit)
Coughlin reported that his average 5th MTPJ angle was ___ degrees and reduced ___ degrees postoperatively
16 degrees
reduced 0.5 degrees postoperatively
Where should you begin freeing the periosteum & why?
At the metatarsal shaft where it is the least adhered to bone
Which osteotomy is a simple transverse osteotomy paired with medial displacement?
Hohmann
Joint subluxation can occur when ___ and can be minimized by securing ___
Lateral eminence is resected in excess; securing the lateral capsule
Plantar grade displacement of which muscle leads to adductovarus of the 5th digit?
Abductor digiti minimi
Who determined how to measure apex of deformity in 5th metatarsal?
Crawford
What can happen if you resect too much of the lateral prominence of the 5th met head?
5th MTPJ subluxation
The distal fragment should be shifted no more than ___ to prevent instability.
½ of the width of the metatarsal head
How do you determine the amount of bone to resect in condylectomy?
Load the MTPJ! Resect the exposed met head not covered by the base of the proximal phalanx.
What was said to cause rotation of the 5th metatarsal which results in lateral bowing?
Pronation of the foot.
Lateral bowing angle is normally ___ degrees, with a range of ___ degrees, and in deformity is on average ___ degrees.
2.64 degrees
0 to 7 degrees
8.05 degrees
What procedure is indicated for a patient only complaining of bump pain with or without increased IM angle?
Condylectomy, possibly with lateral prominence resection.
Where do you perform distal osteotomies for tailor’s bunion? Why?
At the metaphyseal-diaphyseal junction due to the cancellous bone composition, thus increased blood supply, thus decreased non healing
Most common complication of met head resection is ___ and can be avoided by ___
Dorsal floating toe; lengthening/tenotomizing extensor tendon or aggressively bandaging toe in plantarflexed position for weeks postoperatively.