November 2013

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A recent study in the Journal of Foot and Ankle Surgery concludes that the proximal opening wedge osteotomy is an effective surgery to correct high-level hallux valgus deformities.

   The study authors looked at 41 patients with moderate and severe hallux valgus who underwent proximal opening wedge osteotomies between 2005 and 2009. In the study, surgeons also utilized biplanar Chevron and/or Akin osteotomy procedures adjunctively according to the magnitude of distal angles. Additionally, the researchers used either the Darco BOW (Wright Medical Technologies) or the LPS plate (Arthrex) to obtain fixation. Researchers noted that following the procedure, patients’ American Orthopaedic Foot and Ankle Society (AOFAS) scores improved from a mean of 50 to 82 and the sesamoid position improved in 79 percent of the feet.

   Patrick DeHeer, DPM, FACFAS, utilizes proximal opening wedge osteotomies in less than 2 to 3 percent of his cases. His first choice is to treat the “apex of the deformity” or the first metatarsocuneiform joint in severe hallux valgus cases. He notes that arthrodesis of the first metatarsocuneiform joint is his procedure of choice in these cases with a few exceptions.

   Dr. DeHeer will often opt for a first metatarsophalangeal joint (MPJ) arthrodesis alone if there are adaptive changes of the MPJ. This plantarflexes the first ray and stabilizes the medial column while correcting the MPJ deformity, he adds.

   “If the patient is a pediatric patient with open growth plates and a severe hallux valgus deformity, then this is where I choose the proximal opening wedge (osteotomy),” explains Dr. DeHeer, a Diplomate of the American Board of Podiatric Surgery.

   When Dr. DeHeer performs proximal opening wedge osteotomies, he always uses opening wedge locking plates in combination with either an allograft or autograft. To minimize the risk of complication, Dr. DeHeer ensures the patient has three to four weeks of non-weightbearing followed by two to four weeks of partial weightbearing and finally four weeks of assisted weightbearing.

   Regardless of the procedure, Dr. DeHeer maintains that there are key considerations one must keep in mind when treating and assessing patients with severe hallux valgus. “You must correct all levels of deformity to fully correct the severe hallux valgus. This may mean a gastroc recession, a first metatarsocuneiform joint arthrodesis, MPJ procedures and an Akin osteotomy,” he explains. “When each level of deformity is corrected, results are more consistent and predictable.”

How Effective Are Autologous Conditioned Plasma And ESWT For Plantar Fasciitis?

By Brian McCurdy, Senior Editor

Autologous conditioned plasma and extracorporeal shockwave therapy (ESWT) are two of many treatment options for plantar fasciitis and a recent randomized trial in Physical Medicine and Rehabilitation says both can be effective in relieving heel pain.

   The study focused on 54 patients with unilateral plantar fasciitis for more than four months. Nineteen received autologous conditioned plasma and conventional treatment, 19 had ESWT and conventional treatment, and 16 had conventional treatment alone. Conventional treatment included stretching exercises and orthotics if indicated.

   The Visual Analogue Scale (VAS), the AOFAS ankle-hindfoot scale, and plantar fascia thickness improved in all groups at one, three and six months, according to the study. However, the authors noted that the autologous conditioned plasma and ESWT groups experienced significant improvements in pain on VAS scores in comparison to the group that only got conventional treatment.

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