Podcast
Questions and Answers
In the context of tailor's bunion etiology, which condition would most significantly confound pre-operative planning due to its impact on post-operative biomechanics and recurrence rates?
In the context of tailor's bunion etiology, which condition would most significantly confound pre-operative planning due to its impact on post-operative biomechanics and recurrence rates?
- Uncompensated rigid forefoot varus, compounded by a non-reducible rearfoot varus. (correct)
- Isolated enlargement of the fifth metatarsal head without angular deviation.
- A structurally flexible hypermobile fifth ray, exhibiting excessive sagittal plane excursion.
- Mild plantarflexion of the fifth ray with a declination angle of 12 degrees, measured on a weight-bearing lateral radiograph.
When evaluating radiographic parameters for a tailor's bunion, the Fallat and Buckholz method deviates from traditional intermetatarsal angle (IMA) measurement by:
When evaluating radiographic parameters for a tailor's bunion, the Fallat and Buckholz method deviates from traditional intermetatarsal angle (IMA) measurement by:
- Utilizing the medial aspect of the fifth metatarsal shaft to determine the IMA. (correct)
- Bisecting the shafts of both the fourth and fifth metatarsals instead of using their anatomical axes.
- Calculating a weighted average of the angular relationship between the fourth and fifth metatarsals.
- Ignoring the relationship between transverse plane deformity and sagittal plane positioning of the metatarsals.
During surgical planning for a tailor's bunion correction, what consideration should be given to the nutrient artery of the fifth metatarsal to minimize the risk of avascular necrosis?
During surgical planning for a tailor's bunion correction, what consideration should be given to the nutrient artery of the fifth metatarsal to minimize the risk of avascular necrosis?
- The surgical approach should be lateral to avoid any medial structures, thereby preventing arterial damage.
- Since it arises from the dorsalis pedis artery, the plantar approach poses the least risk to its integrity.
- The nutrient artery enters from the medial aspect; therefore, any midshaft osteotomy should be meticulously planned to avoid disrupting its trajectory. (correct)
- Preservation of periosteal attachments is irrelevant, as the primary blood supply is intramedullary.
A patient presents with a Coughlin type II tailor's bunion. What is the defining radiographic characteristic that differentiates this type from others, guiding appropriate surgical intervention?
A patient presents with a Coughlin type II tailor's bunion. What is the defining radiographic characteristic that differentiates this type from others, guiding appropriate surgical intervention?
In a patient presenting with a tailor's bunion and an associated adductovarus deformity of the fifth toe, which biomechanical factor would be MOST critical to address to prevent recurrence following surgical correction?
In a patient presenting with a tailor's bunion and an associated adductovarus deformity of the fifth toe, which biomechanical factor would be MOST critical to address to prevent recurrence following surgical correction?
Which surgical approach to a tailor's bunion addresses both the transverse plane deformity and sagittal plane malalignment, while also mitigating the risk of troughing, a potential complication?
Which surgical approach to a tailor's bunion addresses both the transverse plane deformity and sagittal plane malalignment, while also mitigating the risk of troughing, a potential complication?
In the surgical management of tailor's bunion, what is the primary rationale for performing a plantar lateral release of the fifth metatarsophalangeal joint capsule in conjunction with osseous correction?
In the surgical management of tailor's bunion, what is the primary rationale for performing a plantar lateral release of the fifth metatarsophalangeal joint capsule in conjunction with osseous correction?
What specific characteristic of a 'skew foot' distinguishes it from metatarsus adductus in the context of tailor's bunion management?
What specific characteristic of a 'skew foot' distinguishes it from metatarsus adductus in the context of tailor's bunion management?
Which of the following conservative treatments would be MOST appropriate for managing a tailor's bunion in a patient with significant hallux valgus and a flexible forefoot?
Which of the following conservative treatments would be MOST appropriate for managing a tailor's bunion in a patient with significant hallux valgus and a flexible forefoot?
Post-operatively, a patient who underwent a scarf osteotomy for a tailor's bunion presents with persistent pain at the osteotomy site six months after surgery. Imaging reveals a nonunion with dorsal angulation. Which factor most likely contributed to this complication?
Post-operatively, a patient who underwent a scarf osteotomy for a tailor's bunion presents with persistent pain at the osteotomy site six months after surgery. Imaging reveals a nonunion with dorsal angulation. Which factor most likely contributed to this complication?
What is the MOST critical consideration when performing a metatarsal head resection for a recalcitrant tailor's bunion to avoid iatrogenic complications?
What is the MOST critical consideration when performing a metatarsal head resection for a recalcitrant tailor's bunion to avoid iatrogenic complications?
In the context of adductovarus of the fifth toe, what is the primary pathomechanical consequence of the abductor digiti minimi muscle losing its abductory force due to eversion of the fifth metatarsal shaft?
In the context of adductovarus of the fifth toe, what is the primary pathomechanical consequence of the abductor digiti minimi muscle losing its abductory force due to eversion of the fifth metatarsal shaft?
A patient with a painful adductovarus fifth toe seeks conservative treatment. Which intervention directly targets the underlying biomechanical cause of the deformity, rather than solely addressing its symptoms?
A patient with a painful adductovarus fifth toe seeks conservative treatment. Which intervention directly targets the underlying biomechanical cause of the deformity, rather than solely addressing its symptoms?
Which statement accurately describes the typical surgical progression for addressing an adductovarus fifth toe, considering both soft tissue and osseous procedures?
Which statement accurately describes the typical surgical progression for addressing an adductovarus fifth toe, considering both soft tissue and osseous procedures?
What is the MOST important consideration when deciding between a skin plasty (Z or V-Y) and syndactyly for surgical correction of an adductovarus fifth toe?
What is the MOST important consideration when deciding between a skin plasty (Z or V-Y) and syndactyly for surgical correction of an adductovarus fifth toe?
Which complication is most likely to arise from an initial overcorrection during surgical management of a tailor's bunion, particularly when using an aggressive lateral condylectomy?
Which complication is most likely to arise from an initial overcorrection during surgical management of a tailor's bunion, particularly when using an aggressive lateral condylectomy?
What are the long-term consequences relating to sagittal plane malalignment following tailor's bunion correction, particularly indicated by a post-operative sagittal plane deviation angle exceeding 16 degrees?
What are the long-term consequences relating to sagittal plane malalignment following tailor's bunion correction, particularly indicated by a post-operative sagittal plane deviation angle exceeding 16 degrees?
When evaluating a patient for a tailor's bunion, what distinguishing clinical finding differentiates a structural etiology from a functional/biomechanical etiology?
When evaluating a patient for a tailor's bunion, what distinguishing clinical finding differentiates a structural etiology from a functional/biomechanical etiology?
What impact does the presence of metatarsus adductus have on surgical planning to alleviate a tailor's bunion?
What impact does the presence of metatarsus adductus have on surgical planning to alleviate a tailor's bunion?
In the classification system described by Coughlin for tailor's bunions, a Type III deformity is characterized primarily by:
In the classification system described by Coughlin for tailor's bunions, a Type III deformity is characterized primarily by:
According to the Fallat and Buckholz measurements for intermetatarsal angle in the context of tailor's bunions, what angular measurement is considered pathological?
According to the Fallat and Buckholz measurements for intermetatarsal angle in the context of tailor's bunions, what angular measurement is considered pathological?
According to the Fallat and Buckholz description of Lateral Bowing (Deviation) Angle, what measurement is considered normal?
According to the Fallat and Buckholz description of Lateral Bowing (Deviation) Angle, what measurement is considered normal?
What are the benefits and disadvantages of a Distal Metatarsal Osteotomy?
What are the benefits and disadvantages of a Distal Metatarsal Osteotomy?
What is the primary surgical goal when addressing adductovarus of the fifth toe via Z lengthening tenotomy?
What is the primary surgical goal when addressing adductovarus of the fifth toe via Z lengthening tenotomy?
Following a surgical correction for a tailor's bunion, a patient develops a transfer lesion. What caused this complication?
Following a surgical correction for a tailor's bunion, a patient develops a transfer lesion. What caused this complication?
What statements is correct regarding splay foot?
What statements is correct regarding splay foot?
While there are numerous surgical options to correct Tailor's Bunion Deformities, what critical step must a surgeon do to avoid a flail toe?
While there are numerous surgical options to correct Tailor's Bunion Deformities, what critical step must a surgeon do to avoid a flail toe?
What is the most specific etiologic factor that contributes to the development of a rigid adductovarus deformity of the fifth digit?
What is the most specific etiologic factor that contributes to the development of a rigid adductovarus deformity of the fifth digit?
You are planning surgical intervention for a tailor's bunion. Intraoperatively, you are approaching the metatarsal head and notice a laterally positioned nutrient artery branch. Which surgical step would MOST prudently minimize risk to this vital structure?
You are planning surgical intervention for a tailor's bunion. Intraoperatively, you are approaching the metatarsal head and notice a laterally positioned nutrient artery branch. Which surgical step would MOST prudently minimize risk to this vital structure?
In managing a patient with a tailor's bunion, alongside clinical and radiographic evaluation, which additional diagnostic modality would be MOST beneficial to assess for associated soft tissue pathologies (e.g., bursitis, nerve impingement)?
In managing a patient with a tailor's bunion, alongside clinical and radiographic evaluation, which additional diagnostic modality would be MOST beneficial to assess for associated soft tissue pathologies (e.g., bursitis, nerve impingement)?
What is an advantage of using a midshaft osteotomy to correct a tailor's bunion?
What is an advantage of using a midshaft osteotomy to correct a tailor's bunion?
In a long-term follow up situation, a patient has returned with a non-union after a surgical procedure was performed. What is the likely culprit for this complication?
In a long-term follow up situation, a patient has returned with a non-union after a surgical procedure was performed. What is the likely culprit for this complication?
What is the primary purpose of the Gerbert Closing Wedge osteotomy when surgically correcting a tailor's bunion?
What is the primary purpose of the Gerbert Closing Wedge osteotomy when surgically correcting a tailor's bunion?
When planning to surgically correct both a tailor's bunion and an adductovarus 5th toe, what outcome should the expert surgeon prioritize?
When planning to surgically correct both a tailor's bunion and an adductovarus 5th toe, what outcome should the expert surgeon prioritize?
What key anatomical structures have the greatest risk of injury in a midshaft/proximal metatarsal osteotomy?
What key anatomical structures have the greatest risk of injury in a midshaft/proximal metatarsal osteotomy?
In cases of severe adductovarus, syndactyly is considered as a surgical option instead of a skin plasty. Why is syndactyly a viable option?
In cases of severe adductovarus, syndactyly is considered as a surgical option instead of a skin plasty. Why is syndactyly a viable option?
After surgically correcting a severe case of tailor's bunion, the surgeon notes that the patient now has severe stress to the 4th metatarsal. What could have been a possible cause of this stress?
After surgically correcting a severe case of tailor's bunion, the surgeon notes that the patient now has severe stress to the 4th metatarsal. What could have been a possible cause of this stress?
While debridement of hyperkeratosis is not a definitive treatment of a tailor's bunion, why can it be a recommendation?
While debridement of hyperkeratosis is not a definitive treatment of a tailor's bunion, why can it be a recommendation?
In a patient with a tailor's bunion exhibiting a rigid plantarflexed fifth ray, which of the following pathomechanical adaptations is MOST likely to occur, exacerbating the deformity and complicating treatment?
In a patient with a tailor's bunion exhibiting a rigid plantarflexed fifth ray, which of the following pathomechanical adaptations is MOST likely to occur, exacerbating the deformity and complicating treatment?
A patient presents with a tailor's bunion and radiographic evidence of an abnormally high fifth metatarsal declination angle. Which of the following surgical interventions would be MOST appropriate for addressing the underlying pathomechanics?
A patient presents with a tailor's bunion and radiographic evidence of an abnormally high fifth metatarsal declination angle. Which of the following surgical interventions would be MOST appropriate for addressing the underlying pathomechanics?
In the surgical management of a tailor's bunion with a concomitant adductovarus deformity of the fifth toe, what biomechanical rationale supports performing an abductor digiti minimi release and transfer?
In the surgical management of a tailor's bunion with a concomitant adductovarus deformity of the fifth toe, what biomechanical rationale supports performing an abductor digiti minimi release and transfer?
When employing a scarf osteotomy for the correction of a tailor's bunion, what technical modification would be MOST critical in a patient presenting with significant lateral bowing of the fifth metatarsal shaft?
When employing a scarf osteotomy for the correction of a tailor's bunion, what technical modification would be MOST critical in a patient presenting with significant lateral bowing of the fifth metatarsal shaft?
A patient undergoing surgical correction of a tailor's bunion via distal metatarsal osteotomy postoperatively develops a symptomatic transfer lesion at the fourth metatarsal head. Which of the following intraoperative factors MOST likely contributed to this complication?
A patient undergoing surgical correction of a tailor's bunion via distal metatarsal osteotomy postoperatively develops a symptomatic transfer lesion at the fourth metatarsal head. Which of the following intraoperative factors MOST likely contributed to this complication?
In managing a tailor's bunion in the presence of a hypermobile fifth ray, which of the following surgical strategies would be MOST effective in providing long-term stability and preventing recurrence?
In managing a tailor's bunion in the presence of a hypermobile fifth ray, which of the following surgical strategies would be MOST effective in providing long-term stability and preventing recurrence?
What is the MOST critical biomechanical consideration in preventing flail toe following surgical correction of a Tailor's bunion?
What is the MOST critical biomechanical consideration in preventing flail toe following surgical correction of a Tailor's bunion?
When performing a proximal closing wedge osteotomy for a tailor's bunion, what degree of obliquity relative to the plantar aspect of the foot is considered MOST optimal for maintaining hinge integrity and minimizing the risk of avascular necrosis?
When performing a proximal closing wedge osteotomy for a tailor's bunion, what degree of obliquity relative to the plantar aspect of the foot is considered MOST optimal for maintaining hinge integrity and minimizing the risk of avascular necrosis?
What specific pathomechanical effect does a rigid forefoot varus deformity have on the fifth metatarsal ray that contributes to the development of a tailor's bunion?
What specific pathomechanical effect does a rigid forefoot varus deformity have on the fifth metatarsal ray that contributes to the development of a tailor's bunion?
A patient presents with a tailor's bunion and a flexible forefoot. What is the MOST appropriate initial conservative treatment?
A patient presents with a tailor's bunion and a flexible forefoot. What is the MOST appropriate initial conservative treatment?
Following surgical correction of a tailor's bunion using a midshaft osteotomy, a patient develops a nonunion with dorsal angulation. Which factor most likely contributed to this complication?
Following surgical correction of a tailor's bunion using a midshaft osteotomy, a patient develops a nonunion with dorsal angulation. Which factor most likely contributed to this complication?
What is the primary rationale for performing a plantar lateral release of the fifth metatarsophalangeal joint capsule in conjunction with osseous correction?
What is the primary rationale for performing a plantar lateral release of the fifth metatarsophalangeal joint capsule in conjunction with osseous correction?
When evaluating a patient for a tailor's bunion, what clinical finding differentiates a structural etiology from a functional etiology?
When evaluating a patient for a tailor's bunion, what clinical finding differentiates a structural etiology from a functional etiology?
In the classification system described by Coughlin for tailor's bunions, what characteristics define Type IV deformity?
In the classification system described by Coughlin for tailor's bunions, what characteristics define Type IV deformity?
Following a surgical correction for a tailor's bunion, a patient develops a transfer lesion. What is the most likely cause?
Following a surgical correction for a tailor's bunion, a patient develops a transfer lesion. What is the most likely cause?
In the surgical management of tailor's bunion, proximity to what anatomical structure is most concerning during a midshaft/proximal metatarsal osteotomy?
In the surgical management of tailor's bunion, proximity to what anatomical structure is most concerning during a midshaft/proximal metatarsal osteotomy?
How does metatarsus adductus affect surgical planning to alleviate a tailor's bunion?
How does metatarsus adductus affect surgical planning to alleviate a tailor's bunion?
In a scenario where syndactyly is considered as a surgical option to address severe adductovarus instead of a skin plasty, what is a reasonable explanation?
In a scenario where syndactyly is considered as a surgical option to address severe adductovarus instead of a skin plasty, what is a reasonable explanation?
After surgically correcting a severe case of tailor's bunion, the surgeon notes that the patient now has severe stress to the 4th metatarsal. A likely cause is:
After surgically correcting a severe case of tailor's bunion, the surgeon notes that the patient now has severe stress to the 4th metatarsal. A likely cause is:
When performing the Fallat and Buckholz method for tailor's bunion evaluation, which plane(s) of deformity are being measured?
When performing the Fallat and Buckholz method for tailor's bunion evaluation, which plane(s) of deformity are being measured?
What is another common name for a tailor's bunion?
What is another common name for a tailor's bunion?
Which of the following is a common clinical presentation of a tailor's bunion?
Which of the following is a common clinical presentation of a tailor's bunion?
Which of the following is considered a structural etiology of tailor's bunion?
Which of the following is considered a structural etiology of tailor's bunion?
A plantarflexed fifth ray is a structural deformity that may contribute to a tailor's bunion. What declination angle of the 5th metatarsal is considered pathological?
A plantarflexed fifth ray is a structural deformity that may contribute to a tailor's bunion. What declination angle of the 5th metatarsal is considered pathological?
What is the typical clinical finding associated with a tailor's bunion and adductovarus fifth toe?
What is the typical clinical finding associated with a tailor's bunion and adductovarus fifth toe?
Which of the following best describes a functional/biomechanical cause of tailor's bunion formation?
Which of the following best describes a functional/biomechanical cause of tailor's bunion formation?
According to the classification system described by Coughlin, which type of tailor's bunion is defined as an enlargement of the lateral surface of the fifth metatarsal head?
According to the classification system described by Coughlin, which type of tailor's bunion is defined as an enlargement of the lateral surface of the fifth metatarsal head?
According to the classification system described by Coughlin, which type of tailor's bunion is characterized by an increased 4-5 intermetatarsal angle?
According to the classification system described by Coughlin, which type of tailor's bunion is characterized by an increased 4-5 intermetatarsal angle?
What does the Fallat and Buckholz method use to determine the intermetatarsal angle (IMA)?
What does the Fallat and Buckholz method use to determine the intermetatarsal angle (IMA)?
According to the Fallat and Buckholz description of Lateral Bowing (Deviation) Angle, how is this measurement performed?
According to the Fallat and Buckholz description of Lateral Bowing (Deviation) Angle, how is this measurement performed?
What average measurement for Lateral Bowing (Deviation) Angle would insinuate a Tailor's Bunion?
What average measurement for Lateral Bowing (Deviation) Angle would insinuate a Tailor's Bunion?
What is the normal range for your Lateral Bowing (Deviation) Angle?
What is the normal range for your Lateral Bowing (Deviation) Angle?
Which of the following conservative measure would be MOST appropriate for a tailor's bunion?
Which of the following conservative measure would be MOST appropriate for a tailor's bunion?
Which of the following is NOT a surgical treatment option for tailor's bunion?
Which of the following is NOT a surgical treatment option for tailor's bunion?
What is the primary advantage of performing a distal metatarsal osteotomy for a tailor's bunion?
What is the primary advantage of performing a distal metatarsal osteotomy for a tailor's bunion?
What is a disadvantage of distal metatarsal osteotomy?
What is a disadvantage of distal metatarsal osteotomy?
When is a plantar lateral release of the fifth metatarsophalangeal joint capsule typically indicated
When is a plantar lateral release of the fifth metatarsophalangeal joint capsule typically indicated
Which of the following is a potential complication of metatarsal head resection for tailor’s bunion correction?
Which of the following is a potential complication of metatarsal head resection for tailor’s bunion correction?
What is a major disadvantage of a metatarsal head resection?
What is a major disadvantage of a metatarsal head resection?
What surgical procedure is described as a 'Bump and Run'?
What surgical procedure is described as a 'Bump and Run'?
What is one consideration to keep in mind regarding the nutrient supply during a Tailor's Bunion procedure?
What is one consideration to keep in mind regarding the nutrient supply during a Tailor's Bunion procedure?
What is the location of the nutrient artery location relative to the fifth metatarsal that should be kept in mind during surgical procedures?
What is the location of the nutrient artery location relative to the fifth metatarsal that should be kept in mind during surgical procedures?
Which tailor's bunion surgical treatment is more likely associated with troughing?
Which tailor's bunion surgical treatment is more likely associated with troughing?
Which of the following is a potential complication associated with a scarf osteotomy for tailor's bunion correction?
Which of the following is a potential complication associated with a scarf osteotomy for tailor's bunion correction?
What is the primary goal of Z-lengthening tenotomy?
What is the primary goal of Z-lengthening tenotomy?
What is a skew foot?
What is a skew foot?
What is the definition of splay foot?
What is the definition of splay foot?
Which complication is NOT listed as a tailor's bunion complication?
Which complication is NOT listed as a tailor's bunion complication?
Which of the following non-osseous pathologies frequently accompanies an adductovarus of the 5th digit?
Which of the following non-osseous pathologies frequently accompanies an adductovarus of the 5th digit?
What is a disadvantage to performing an exostectomy?
What is a disadvantage to performing an exostectomy?
What surgical procedure might one consider if there is a Lister corn?
What surgical procedure might one consider if there is a Lister corn?
What is a cause of Tailor's bunion in a setting of metatarsus adductus?
What is a cause of Tailor's bunion in a setting of metatarsus adductus?
What is the goal to correcting the bunion AND adductus reduce the distance between the first and fifth MT heads?
What is the goal to correcting the bunion AND adductus reduce the distance between the first and fifth MT heads?
Which radiographic measurement is most useful in differentiating between structural and functional etiologies of tailor's bunion?
Which radiographic measurement is most useful in differentiating between structural and functional etiologies of tailor's bunion?
What is the BEST advantage when performing a midshaft osteotomy to the fifth metatarsal?
What is the BEST advantage when performing a midshaft osteotomy to the fifth metatarsal?
What statement is correct regarding adductovarus 5th toe?
What statement is correct regarding adductovarus 5th toe?
What procedure would an expert surgeon choose for a severe adductovarus 5th toe?
What procedure would an expert surgeon choose for a severe adductovarus 5th toe?
Which patient presentation would require radiographic evaluation to rule out Tailor's bunion?
Which patient presentation would require radiographic evaluation to rule out Tailor's bunion?
You are about to perform an osteotomy, but you are unsure if you have transected the bone enough. What equipment should you have ready?
You are about to perform an osteotomy, but you are unsure if you have transected the bone enough. What equipment should you have ready?
What is something to note when prescribing orthotics as a method of conservative care to treat Tailor's bunion?
What is something to note when prescribing orthotics as a method of conservative care to treat Tailor's bunion?
A patient with a tailor's bunion also has a flexible forefoot. What initial treatment is appropriate?
A patient with a tailor's bunion also has a flexible forefoot. What initial treatment is appropriate?
In a long term follow up, a patient returns with a non union after a surgical procedure. What is the likely culprit?
In a long term follow up, a patient returns with a non union after a surgical procedure. What is the likely culprit?
A patient presents with a painful prominence on the lateral aspect of their fifth metatarsal head. During the physical exam you note a reddened bursal sac. Which condition is most likely?
A patient presents with a painful prominence on the lateral aspect of their fifth metatarsal head. During the physical exam you note a reddened bursal sac. Which condition is most likely?
Which of the following is considered a functional/biomechanical etiology of a tailor's bunion?
Which of the following is considered a functional/biomechanical etiology of a tailor's bunion?
A patient with a tailor's bunion also exhibits an uncompensated forefoot varus. How does this contribute to the development of the bunion?
A patient with a tailor's bunion also exhibits an uncompensated forefoot varus. How does this contribute to the development of the bunion?
According to the McGlamry classification, an increased 4-5 intermetatarsal angle with divergence of the 4th and 5th metatarsals characterizes which type of tailor's bunion?
According to the McGlamry classification, an increased 4-5 intermetatarsal angle with divergence of the 4th and 5th metatarsals characterizes which type of tailor's bunion?
The Fallat and Buckholz method differs from the traditional intermetatarsal angle (IMA) measurement by:
The Fallat and Buckholz method differs from the traditional intermetatarsal angle (IMA) measurement by:
What is the normal range for the Lateral Bowing (Deviation) Angle, according to Fallat and Buckholz?
What is the normal range for the Lateral Bowing (Deviation) Angle, according to Fallat and Buckholz?
Which of the following conservative treatments is MOST appropriate for managing a tailor's bunion?
Which of the following conservative treatments is MOST appropriate for managing a tailor's bunion?
Which surgical treatment is considered a 'Bump and Run' procedure?
Which surgical treatment is considered a 'Bump and Run' procedure?
During a surgical procedure to correct a tailor's bunion, what anatomical consideration is MOST important to prevent avascular necrosis?
During a surgical procedure to correct a tailor's bunion, what anatomical consideration is MOST important to prevent avascular necrosis?
Troughing is a potential complication associated with which surgical procedure for tailor's bunion correction?
Troughing is a potential complication associated with which surgical procedure for tailor's bunion correction?
Which post-operative complication is MOST likely to result from shortening the 5th metatarsal during tailor's bunion surgery?
Which post-operative complication is MOST likely to result from shortening the 5th metatarsal during tailor's bunion surgery?
A tailor's bunion is present alongside an adductovarus deformity of the fifth toe. What other name might be used to describe an adductovarus deformity?
A tailor's bunion is present alongside an adductovarus deformity of the fifth toe. What other name might be used to describe an adductovarus deformity?
A Lister corn is MOST likely to develop in which location in a patient with adductovarus of the 5th toe?
A Lister corn is MOST likely to develop in which location in a patient with adductovarus of the 5th toe?
What is a primary goal when correcting a tailor's bunion and associated adductus?
What is a primary goal when correcting a tailor's bunion and associated adductus?
You are planning surgical intervention for a tailor's bunion. What radiographic findings would preclude performing a simple exostectomy alone?
You are planning surgical intervention for a tailor's bunion. What radiographic findings would preclude performing a simple exostectomy alone?
What is the expected outcome of performing a Z-lengthening tenotomy when surgically correcting adductovarus of the fifth toe?
What is the expected outcome of performing a Z-lengthening tenotomy when surgically correcting adductovarus of the fifth toe?
Which of the following best describes a skew foot?
Which of the following best describes a skew foot?
What are the angular parameters that define a splay foot deformity?
What are the angular parameters that define a splay foot deformity?
After performing a tailor's bunion correction, a surgeon observes significant stress concentrated on the 4th metatarsal head. What intraoperative factor MOST likely contributed to this outcome?
After performing a tailor's bunion correction, a surgeon observes significant stress concentrated on the 4th metatarsal head. What intraoperative factor MOST likely contributed to this outcome?
Which of the following is NOT typically included in the conservative managment plan for adductovarus of the 5th toe?
Which of the following is NOT typically included in the conservative managment plan for adductovarus of the 5th toe?
In the classification system described by Fallat and Buckholz, which of the following is not included as a classification of tailor's bunion?
In the classification system described by Fallat and Buckholz, which of the following is not included as a classification of tailor's bunion?
While considering treatment options for Tailor's Bunion Deformities, what critical step must a surgeon do to avoid a flail toe?
While considering treatment options for Tailor's Bunion Deformities, what critical step must a surgeon do to avoid a flail toe?
While reviewing post-operative records of a distal osteotomy, you see the patient has returned with a non-union. What most likely would have prevented this complication?
While reviewing post-operative records of a distal osteotomy, you see the patient has returned with a non-union. What most likely would have prevented this complication?
In a patient presenting with both a tailor's bunion and a rigid plantarflexed fifth ray, which pathomechanical adaptation is most likely to occur, exacerbating the deformity and complicating treatment?
In a patient presenting with both a tailor's bunion and a rigid plantarflexed fifth ray, which pathomechanical adaptation is most likely to occur, exacerbating the deformity and complicating treatment?
Which statement best describes the primary surgical goal when performing a plantar lateral release of the fifth metatarsophalangeal joint capsule in conjunction with osseous correction?
Which statement best describes the primary surgical goal when performing a plantar lateral release of the fifth metatarsophalangeal joint capsule in conjunction with osseous correction?
What is the primary risk associated with a proximal closing wedge osteotomy?
What is the primary risk associated with a proximal closing wedge osteotomy?
During a surgical correction of a tailor's bunion, the surgeon notes that the patient now has severe stress to the 4th metatarsal. What could have been a possible cause of this stress?
During a surgical correction of a tailor's bunion, the surgeon notes that the patient now has severe stress to the 4th metatarsal. What could have been a possible cause of this stress?
If an expert surgeon is planning to surgically correct a Tailor's Bunion, what outcome regarding the foot should be prioritized?
If an expert surgeon is planning to surgically correct a Tailor's Bunion, what outcome regarding the foot should be prioritized?
A patient sits cross-legged for extended periods. How does this contribute to the formation of a tailor's bunion?
A patient sits cross-legged for extended periods. How does this contribute to the formation of a tailor's bunion?
What is another term for a tailor's bunion?
What is another term for a tailor's bunion?
A tailor's bunion is the same as hallux valgus.
A tailor's bunion is the same as hallux valgus.
What is the typical location of a tailor's bunion?
What is the typical location of a tailor's bunion?
An increased 4-5 ______ angle is a structural etiology of tailor's bunion.
An increased 4-5 ______ angle is a structural etiology of tailor's bunion.
Match the following structural deformities with their descriptions:
Match the following structural deformities with their descriptions:
Which of the following best describes a functional/biomechanical etiology of tailor's bunion?
Which of the following best describes a functional/biomechanical etiology of tailor's bunion?
A normal 5th metatarsal declination angle is greater than 10 degrees.
A normal 5th metatarsal declination angle is greater than 10 degrees.
What is a common symptom associated with tailor's bunion, worsened by shoe gear?
What is a common symptom associated with tailor's bunion, worsened by shoe gear?
A rigid rearfoot deformity with forefoot compensation is an example of a ______/biomechanical etiology of a tailor's bunion.
A rigid rearfoot deformity with forefoot compensation is an example of a ______/biomechanical etiology of a tailor's bunion.
Match the following functional/biomechanical etiologies of tailor's bunion with their descriptions:
Match the following functional/biomechanical etiologies of tailor's bunion with their descriptions:
According to Coughlin's classification, what characterizes a Type I tailor's bunion?
According to Coughlin's classification, what characterizes a Type I tailor's bunion?
In Fallat and Buckholz's classification, a normal 4/5 intermetatarsal angle is greater than 8 degrees.
In Fallat and Buckholz's classification, a normal 4/5 intermetatarsal angle is greater than 8 degrees.
According to Fallat and Buckholz, what anatomical landmark is used to determine the measurement of the IM angle for a tailor's bunion?
According to Fallat and Buckholz, what anatomical landmark is used to determine the measurement of the IM angle for a tailor's bunion?
According to the Fallat and Buckholz classification, a lateral deviation angle greater than ______ degrees is associated with a symptomatic tailor's bunion.
According to the Fallat and Buckholz classification, a lateral deviation angle greater than ______ degrees is associated with a symptomatic tailor's bunion.
Match the following Tailor's Bunion classifications with their defining characteristics:
Match the following Tailor's Bunion classifications with their defining characteristics:
Which of the following is typically included in the conservative treatment of a tailor's bunion?
Which of the following is typically included in the conservative treatment of a tailor's bunion?
Exostectomy is a conservative treatment option for tailor's bunions.
Exostectomy is a conservative treatment option for tailor's bunions.
Besides padding, name one conservative treatment option for tailor's bunions.
Besides padding, name one conservative treatment option for tailor's bunions.
In addition to padding and shoe modification, oral or topical ______ are also a conservative treatment for tailor's bunion.
In addition to padding and shoe modification, oral or topical ______ are also a conservative treatment for tailor's bunion.
Match the following non-surgical treatments with their role in managing tailor's bunions:
Match the following non-surgical treatments with their role in managing tailor's bunions:
Which surgical procedure involves the removal of the bony prominence on the fifth metatarsal head?
Which surgical procedure involves the removal of the bony prominence on the fifth metatarsal head?
A metatarsal head resection increases the length of the 5th ray.
A metatarsal head resection increases the length of the 5th ray.
Name one surgical treatment option for tailor's bunion that involves cutting and realigning the bone.
Name one surgical treatment option for tailor's bunion that involves cutting and realigning the bone.
The nutrient artery to the fifth metatarsal enters from the ______ aspect.
The nutrient artery to the fifth metatarsal enters from the ______ aspect.
Match these Tailor's bunion surgical treatments to their descriptions:
Match these Tailor's bunion surgical treatments to their descriptions:
A potential post-operative complication following a tailor's bunion surgery is:
A potential post-operative complication following a tailor's bunion surgery is:
Nonunion is not a potential complication following tailor's bunion surgery.
Nonunion is not a potential complication following tailor's bunion surgery.
Name one potential complication associated with metatarsal head resection.
Name one potential complication associated with metatarsal head resection.
Sagittal plane malunion with a deviation angle greater than 16 degrees post-operatively is predictive of ______ lesion.
Sagittal plane malunion with a deviation angle greater than 16 degrees post-operatively is predictive of ______ lesion.
Match the following surgical complications of tailor's bunion surgery with their descriptions:
Match the following surgical complications of tailor's bunion surgery with their descriptions:
What is the term for a fifth toe that has greater adduction than abduction, moving towards a varus position?
What is the term for a fifth toe that has greater adduction than abduction, moving towards a varus position?
Adductovarus of the 5th toe is not associated with Tailor's bunion.
Adductovarus of the 5th toe is not associated with Tailor's bunion.
What type of lesion is the by product of adductovarus?
What type of lesion is the by product of adductovarus?
Where the shaft of the 5th matatarsal everts, the abductor digiti quinti moves more ______ essentially losing its abductory strength.
Where the shaft of the 5th matatarsal everts, the abductor digiti quinti moves more ______ essentially losing its abductory strength.
Match Conservative/Surgical treatments to indication:
Match Conservative/Surgical treatments to indication:
De-rotational arthroplasty for adductovarus is ellipse. Ellipse is:
De-rotational arthroplasty for adductovarus is ellipse. Ellipse is:
Fifth digit hammertoe surgery should be commonly completed as ARTHRODESIS.
Fifth digit hammertoe surgery should be commonly completed as ARTHRODESIS.
Skin plasty has surgical options, List one.
Skin plasty has surgical options, List one.
Can you also perform a ______ which is the cutting and sewing toes together
Can you also perform a ______ which is the cutting and sewing toes together
Match the following words for treatment of adductovarus:
Match the following words for treatment of adductovarus:
Select the word that is a rare type of flatfoot described as a “Z” foot or serpentine foot. It is characterized by forefoot adduction and hindfoot valgus:
Select the word that is a rare type of flatfoot described as a “Z” foot or serpentine foot. It is characterized by forefoot adduction and hindfoot valgus:
A bunionette is the same as a tailor's bunion.
A bunionette is the same as a tailor's bunion.
Which of the following best describes the typical location of a tailor's bunion?
Which of the following best describes the typical location of a tailor's bunion?
Which of the following activities is most associated with the development of Tailor's bunions?
Which of the following activities is most associated with the development of Tailor's bunions?
A tailor's bunion is characterized by prominence of the ______ metatarsal head.
A tailor's bunion is characterized by prominence of the ______ metatarsal head.
Which of the following clinical presentations is commonly associated with a Tailor's bunion?
Which of the following clinical presentations is commonly associated with a Tailor's bunion?
Shoe gear pressure can worsen the pain of a tailor's bunion.
Shoe gear pressure can worsen the pain of a tailor's bunion.
Which of the following deformities is often associated with a tailor's bunion?
Which of the following deformities is often associated with a tailor's bunion?
What is an adventitial bursa?
What is an adventitial bursa?
Which of the following structural etiologies contributes to the formation of a tailor's bunion?
Which of the following structural etiologies contributes to the formation of a tailor's bunion?
Which of the following is a functional/biomechanical cause of tailor's bunion?
Which of the following is a functional/biomechanical cause of tailor's bunion?
Match each type of Coughlin's classification of tailor's bunion with its description:
Match each type of Coughlin's classification of tailor's bunion with its description:
According to Fallat and Buckholz, an intermetatarsal angle greater than which measurement is associated with a Tailor's bunion?
According to Fallat and Buckholz, an intermetatarsal angle greater than which measurement is associated with a Tailor's bunion?
What is the average lateral bowing angle found in a foot with a Tailor's bunion?
What is the average lateral bowing angle found in a foot with a Tailor's bunion?
Which of the following is a surgical treatment option for a tailor's bunion?
Which of the following is a surgical treatment option for a tailor's bunion?
Which surgical procedure involves cutting and realigning the metatarsal bone?
Which surgical procedure involves cutting and realigning the metatarsal bone?
An exostectomy is a curative surgical procedure for tailor's bunions.
An exostectomy is a curative surgical procedure for tailor's bunions.
Which statement best describes the nutrient artery's location?
Which statement best describes the nutrient artery's location?
Which of the following is a potential complication associated with surgical intervention for a tailor's bunion?
Which of the following is a potential complication associated with surgical intervention for a tailor's bunion?
What is a sagittal plane malunion?
What is a sagittal plane malunion?
What is the most common complication associated with a Z or scarf (scarfette) osteotomy?
What is the most common complication associated with a Z or scarf (scarfette) osteotomy?
In the context of tailor's bunion surgery, what does 'troughing' refer to?
In the context of tailor's bunion surgery, what does 'troughing' refer to?
The terms Z lengthening and tenotomy describe the same surgical procedure:
The terms Z lengthening and tenotomy describe the same surgical procedure:
De-rotational arthroplasty is also known as what?
De-rotational arthroplasty is also known as what?
Which of the following is a characteristic of skew foot?
Which of the following is a characteristic of skew foot?
What is an adductovarus fifth toe otherwise known as?
What is an adductovarus fifth toe otherwise known as?
Which of the following is a potential surgical treatment for adductovarus of the 5th toe?
Which of the following is a potential surgical treatment for adductovarus of the 5th toe?
Increased bowing of the 5th metatarsal is always present in metatarsus adductus.
Increased bowing of the 5th metatarsal is always present in metatarsus adductus.
In splay foot deformity, the 1-2 intermetatarsal angle is typically greater than ______ degrees.
In splay foot deformity, the 1-2 intermetatarsal angle is typically greater than ______ degrees.
What defines when a tailor's bunion is also classified as a splay foot.
What defines when a tailor's bunion is also classified as a splay foot.
What is the typical 4-5 IM normal range in degrees?
What is the typical 4-5 IM normal range in degrees?
What is the best surgical management for a very healthy 70 y/o + patient who presents with a tailor's bunion and no 5th toe PIPJ dysfunction?
What is the best surgical management for a very healthy 70 y/o + patient who presents with a tailor's bunion and no 5th toe PIPJ dysfunction?
Flashcards
Tailor's Bunion
Tailor's Bunion
A bony prominence at the lateral aspect of the fifth metatarsal head.
Tailor's Bunion Type I
Tailor's Bunion Type I
Enlargement of the lateral surface of the fifth metatarsal head.
Tailor's Bunion Type II
Tailor's Bunion Type II
Abnormal lateral bowing of the distal fifth metatarsal.
Tailor's Bunion Type III
Tailor's Bunion Type III
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Fallat and Buckholz Method
Fallat and Buckholz Method
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Lateral Bowing (Deviation) Angle
Lateral Bowing (Deviation) Angle
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Conservative Tailor's Bunion Treatments
Conservative Tailor's Bunion Treatments
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Surgical Tailor's Bunion Treatments
Surgical Tailor's Bunion Treatments
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Transfer Lesion (Surgical Complication)
Transfer Lesion (Surgical Complication)
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Nonunion (Surgical Complication)
Nonunion (Surgical Complication)
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Troughing
Troughing
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Dislocation (Surgical Complication)
Dislocation (Surgical Complication)
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Shortening and Flail Toe (Surgical Complication)
Shortening and Flail Toe (Surgical Complication)
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Adductovarus 5th Toe
Adductovarus 5th Toe
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Conservative Adductovarus Treatments
Conservative Adductovarus Treatments
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Surgical Adductovarus Treatments
Surgical Adductovarus Treatments
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Splay Foot Deformity
Splay Foot Deformity
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Metatarsus Adductus
Metatarsus Adductus
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Skew Foot Deformity
Skew Foot Deformity
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Bunionette
Bunionette
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Clinical Presentation of Tailor's Bunion
Clinical Presentation of Tailor's Bunion
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Structural Causes of Tailor's Bunion
Structural Causes of Tailor's Bunion
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Functional Causes of Tailor's Bunion
Functional Causes of Tailor's Bunion
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Coughlin's Tailor's Bunion Classification
Coughlin's Tailor's Bunion Classification
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Lateral Bowing Measurement
Lateral Bowing Measurement
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Exostectomy
Exostectomy
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Distal Metatarsal Osteotomy
Distal Metatarsal Osteotomy
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Tenotomy
Tenotomy
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Arthrodesis
Arthrodesis
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4-5 Intermetatarsal Angle
4-5 Intermetatarsal Angle
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Lateral Bowing of the 5th Metatarsal
Lateral Bowing of the 5th Metatarsal
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Skin Plasty (Adductovarus)
Skin Plasty (Adductovarus)
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Syndactyly
Syndactyly
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Adventitial Bursa
Adventitial Bursa
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Unstable 5th Metatarsal
Unstable 5th Metatarsal
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Hypermobile 5th Ray
Hypermobile 5th Ray
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Traditional IM Angle
Traditional IM Angle
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Conservative Care
Conservative Care
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Midshaft Osteotomy Risk
Midshaft Osteotomy Risk
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Adductovarus Repair
Adductovarus Repair
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Skew Foot
Skew Foot
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Capsular Release
Capsular Release
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Sagittal Plane Malunion
Sagittal Plane Malunion
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Study Notes
Overview
- Tailor's bunion, also known as a bunionette, and associated adductovarus is the area of focus
- Main resources are textbooks on foot and ankle surgery, foot and ankle radiology, and master techniques in podiatric surgery
Learning Objectives
- Recognize radiographic findings of tailor's bunions
- Demonstrate knowledge of biomechanical causes
- Understand etiology of adductovarus of the 5th toe
- Identify conservative and surgical treatments for tailor's bunions and associated adductovarus of the 5th toe
- Recognize complications from surgical intervention
- Understand clinical and radiographic findings related to tailor's bunions such as splay foot, skew foot, and metatarsus adductus
Tailor's Bunion Explanation
- Tailors are known to sit cross-legged, placing pressure on the lateral foot, especially at the 5th metatarsal head
- A bunionette is a smaller version of a bunion
- The 5th metatarsophalangeal (MTP) joint is smaller than the first MTP joint
Clinical Presentation
- Clinical signs include prominence of the 5th metatarsal head
- Includes dorsal, dorsolateral, lateral, and plantar lateral
- Adductovarus of the fifth toe, or "curly toe" is often also present
- Shoe gear pressure can worsen pain and cause redness
- An adventitial bursa, a fluid-filled sac, may develop due to repeated trauma or shearing
Etiology
Structural Causes
- Increased 4-5 intermetatarsal (IM) angle
- Shape of the fifth metatarsal head and shaft
- Plantarflexed 5th ray
Functional/Biomechanical Causes
- Uncompensated or rigid forefoot deformity
- Rigid rearfoot deformity with forefoot compensation
- Hypermobile 5th ray
Structural 5th Ray Deformities
- Can result in an enlarged 5th metatarsal head
- Increased 4/5 intermetatarsal angle
- Increased fifth metatarsal lateral deviation angle (lateral bowing)
- Plantarflexed 5th metatarsal
Plantarflexed 5th Metatarsal
- Leads to prominence of the 5th metatarsal head, either lateral or plantar-lateral
- Very unstable 5th metatarsal when pronating
- Normal 5th metatarsal declination angle is 10°
- Plantarflexed 5th metatarsal pathology has a declination angle > 10°
Functional/Biomechanical Pathology
- Uncompensated or rigid forefoot deformity
- Rigid rearfoot deformity with forefoot compensation
- Hypermobile 5th ray
Hypermobile 5th Ray
- Second and third metatarsals are more stable compared to the 5th and 1st metatarsals
- Total excursion can be compared to the 2nd and 3rd rays
- Allows the foot to remain pronated longer
- Stabilize the central metatarsals, then grasp the 5th metatarsal head, not toe
- Normal is less than 3 mm total excursion
Bunion Classifications
- MJ Coughlin, MD
- Fallat and Buckholz
Fallat and Buckholz Classification
- Article developed a method to accurately measure the 4/5 intermetatarsal angle and the lateral deviation angle
- Fallat LM, Buckholz J. An analysis of the tailor's bunion by radiographic and anatomical display (J Am Podiatry Assoc. 1980 Dec;70(12):597-603)
Intermetatarsal Angle Measurements
- Traditional = Angle ABD by bisecting the shafts of the respective metatarsals
- Fallat et al. Method = Angle ABC using the MEDIAL shaft of the 5th metatarsal
Lateral Bowing Deviation Angle Measurements
- The traditional method involves the angle created by the intersection of the bisection of articular surface of fifth metatarsal head/neck and the line drawn along the medial margin of the 5th metatarsal
- Normal: Average 2.64°, Range 0° to 7°
- Tailor's Bunion: Average 8.05°
- Lateral deviation angle of Fallat and Buckholz measures bisection a line drawn along the Distal fifth metatarsal (head and neck) and a line drawn along the PROXIMAL medial margin of the 5th metatarsal
- A measurement >8° is associated with a symptomatic tailor's bunion
Treatment
Conservative
- Padding and strapping
- Shoe modification
- Orthotics
- Activity modification
- Debridement of hyperkeratosis
- NSAIDs
- Steroid injection into overlying bursa
- Physical therapy
Surgical
- Exostectomy/condylectomy
- Distal metatarsal osteotomies
- Midshaft metatarsal osteotomies
- Proximal metatarsal osteotomies
- Metatarsal head resection
Surgical Treatment
Exostectomy
- Includes condylectomy, bumpectomy, and a "bump and run"
- Can include partial resection of the metatarsal head
- Easy to perform with typically no fixation required
- rarely curative and needs address most deformities, removing too much bone during the procedure can lead to subluxation or dislocation
Distal Metatarsal Osteotomies
- Intraoperative image of planned bone cut at the distal 5th metatarsal
- Post-operative x-ray with fixation of distal 5th metatarsal osteotomy
- Z or scarf osteotomy
Reverse Hohmann
- A transverse osteotomy is performed at the metatarsal neck
- X-ray images show this osteotomy with and without fixation
- Distal procedures have fewer complications than proximal osteotomies, fixation is not always required
- Unable to address larger deformities
Reverse Wilson Osteotomy
- Distal lateral to proximal medial osteotomy
- Distal procedures avoid complications associated with proximal osteotomies
- Risk for over-shortening, fixation is required
Reverse or mini-Austin (Chevron)
- A transverse osteotomy at the metatarsal neck
- Make long dorsal or plantar arm for screw placement
- More stable, less likely to elevate
- Two bone cuts are technically more difficult to create and do not address larger deformities, one screw can lead to rotation
Distal(ish)
- A distal L with long arm plantar approach
- Inherently stable, easy to place two screws
- Technically more difficult, moving into midshaft range causes more periosteal disruption
Midshaft
- Scarfette, reverse scarf, or Z osteotomy is performed at the midshaft to proximal 5th metatarsal
Proximal
- Can be long oblique
- Greater risk of delayed union/nonunion because more dissection is required closer to the nutrient artery
Wedge
- Hinge maintenance is high maintenance
- Ideal fixation is perpendicular to osteotomy, obliquity is important
- The more proximal, the more angular correction
- The more proximal, the more risk to the nutrient artery
Metatarsal Head Resection
- Technically easier and more curative for tailor's bunion
- Shortens the 5th ray which increases the risk of transfer lesion and flail toe
Surgical Complications
- Transfer lesions
- Transverse or sagittal plane malunion
- Nonunion
- Troughing
- Joint dislocation
- Flail toe
- Over correction
- Shortening
Surgical Complications: Transfer Lesions
- Elevated and/or shortened 5th metatarsal to relieve pressure now creates new plantar pressure points
- Maintenance of the metatarsal parabola is important
Surgical Complications: Plane Malunion
- A sagittal plane deviation angle of > 16° postoperatively is predictive of transfer lesions
Surgical Complications: Troughing
- Associated with the Z or scarf (scarfette) osteotomy
- Can lead to nonunion or malunion
Surgical Complications: Dislocation
- Can be the product of an over-resection of the lateral prominence
- Due to excessive soft tissue dissection
- Caused by incomplete closure techniques
Surgical Complications: Shortening and Flail Toe
- Often Go Together
- Associated with 5th metatarsal head resection or over-shortening
- Treatment through skin plasty or syndactyly
Adductovarus Toe
- Known as a curly toe
- Often co-occurs with tailor's bunion
- The lateral margin of the toenail may develop a Lister corn
- Heloma molle in the 4th interspace with ulceration can develop
- The abductor digiti quinti moves more plantar to the fifth metatarsal, losing its abductory force
- The 5th toe with greater adduction than abduction moves into a varus position
Adductovarus Treatments
Conservative
- Padding and strapping
- Shoe modification
- Orthotics
- Activity modification
- Debridement of hyperkeratosis
- NSAIDs
- Steroid injection into an overlying bursa
- Physical therapy
Surgical
- Exostectomy/condylectomy
- Tenotomy
- Arthroplasty
- Skin plasty
- Syndactyly
- Amputation
Surgical Treatments
De-Rotational Arthroplasty (Ellipse)
- Distal medial to proximal lateral technique
- Also known as two semi-elliptical or lenticular
Skin Plasty Options
- Z or V-Y
Syndactyly
- Joining of digits
Amputation
- Partial or complete
Deformities
Splay Foot
- Combination of hallux valgus and tailor's bunion
- Includes increased 1-2 intermetatarsal angle
- Includes increased 4-5 intermetatarsal angle
- 1-2 IM angle is typically greater than 12°
- 4-5 IM angle is greater than 8°
Metatarsus Adductus
- Is an adduction deformity of the metatarsals
- Medial deviation at the forefoot, associated with the tarsometatarsal joints
Skew Foot
- A rare flatfoot type/serpentine foot
- Characterized by forefoot adduction and hindfoot valgus
Tailor's Bunion with Metatarsus Adductus
- 4/5 IM angle is not necessarily increased, bowing of the 5th metatarsal is not always present
- Distance between the medial first metatarsal head and lateral 5th metatarsal head is increased
- Pressure increases on the first and fifth met heads in shoe gear, causing soft tissue swelling, bursitis and/or bony hypertrophy of the 5th metatarsal head
- Correcting the bunion and adductus can reduce this distance by 10.5 mm (~1cm) possibly changing shoe size by a half size
Additional Notes
- EBM week 4 focuses on tailor's bunion and adductovarus toe
- 15-point assessment quiz at the end of week
- Review session associated with clinic days at Noon
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