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BACKGROUND: The purpose of the study was to evaluate the increased correction possible with a mid shaft rotational osteotomy with the stability and ease of fixation associated with a scarf osteotomy.
MATERIALS AND METHODS: Between September 1999 and September 2006, 63 patients underwent operative repair of 77 Tailor's bunion deformities. Twenty eight patients (36 feet) were available for a final review (nine males and 19 females). A further seven patients (nine feet) completed a questionnaire. The mean followup period for the 28 patients reviewed in clinic was 6.5 years, (79.5 months; SD, 22).
RESULTS: Eighty-six percent were completely satisfied, 11.4% were satisfied with reservations and 3% were dissatisfied. Ninety-one percent considered themselves better than before their surgery while 8.6% felt they were no better. Ninety-one percent of patients said they would undergo surgery under the same conditions again. Preoperatively, the mean 4-5 intermetatarsal angle measured on weightbearing X-rays was 9.9 degrees (SD, 2.2), the mean postoperative intermetatarsal angle was 5.7 degrees (SD, 2.0). The mean preoperative AOFAS score was 44.1 (SD, 14.5) and the mean postoperative score at 6-month review was 91.8 (SD, 20.2). The AOFAS score at final review was 88.1 (SD, 11.6).
CONCLUSION: The rotational scarf osteotomy was a reliable procedure for the correction of Tailor's bunion deformities. The osteotomy allowed for early mobilization and had few associated complications. The rotational scarf osteotomy facilitated correction of the intermetatarsal angle while maintaining excellent sagittal and transverse plane stability.
PURPOSE OF THE STUDY To present the results of shortening scarf osteotomy of the fifth metatarsal as an option for the treatment of forefoot deformities with calluses and associated pain around the fifth metatarsal head.
MATERIAL In nine patients, 12 osteotomies were performed between 2004 and 2007.The results were evaluated at the end of 2009. One patient had one-stage bilateral surgery two had two-stage bilateral surgery.
METHODS Surgical treatment was indicated in patients in whom conservative treatment had failed, and after the evaluation of load radiographs of the forefoot. The operation (sec. Barouk) is standardly performed from a longitudinal incision and involves the excision of two bone blocks, 3 to 4 mm in width, from both fifth metatarsal fragments after the osteotomy. Fixation is achieved with two Poldi screws from mini-instrumentation.The procedure can be combined with surgery on the other meta- tarsals. The lower extremity is then immobilised in a cast for 3 weeks. Partial weight-bearing on the heel is allowed from the second post-operative day and full weight-bearing is permitted after X-ray examination at 6 weeks. The average hos- pital stay is four days.
RESULTS Nine patients (12 feet) underwent surgery. The average follow-up was 3.8 years (2 to 5). The average inter-metatarsal angle was 13 degrees before surgery and 4 degrees after it. The average valgus angle of the fifth metatarso-phalangeal joint was 25 degrees pre-operatively and 5 degrees post-operatively. The average metatarsal shortening was 6.5 mm.
DISCUSSION Shortening shaft osteotomy allows for maximal medial translation of the fifth metatarsal and maximal correction of the angle between the fourth and fifth metatarsals. At one stage it permits metatarsal head medialisation, as does chevron osteotomy, as well as proximal translation of the head achieved by Weil osteotomy. The results of shortening scarf osteo- tomy have been better than those of an isolated Weil procedure, chevron osteotomy or bunionectomy. Percutaneous Kram- mer's method, BRT, shaft and proximal osteotomies are still discussed.
CONCLUSIONS Shortening scarf osteotomy of the fifth metatarsal is indicated when conservative treatment is unsuccessful in mana- gement of calluses and fifth metatarsal head deformities, particularly in flat-footedness. It can also be used in salvage pro- cedures following failed surgery or in digitus quintus supraductus in adults. It requires experience with first metatarsal osteo- tomy and a precise operative technique. Key words: scarf osteotomy, pes planus, varus deformity of the fifth metatarsal.
BACKGROUND: Bunionette deformity is a painful osseous prominence on the lateral aspect of the head of the fifth metatarsal. The purpose of this study is to evaluate the results of a fifth metatarsal sliding osteotomy for the treatment of this deformity in patients under 18 years of age.
METHODS: We retrospectively evaluated 13 feet in 11 consecutive patients with bunionette deformity treated from January 2003 to January 2008 at 2 referral centers. Mean age was 14.8 years (95% confidence limit, SD 1.5 y); mean follow-up was 32.2 months (95% confidence limit, SD 11.7 mo); and clinical evaluation was made according to the modified American Orthopaedic Foot and Ankle Society (AOFAS) score and the Coughlin score. The IV-V intermetatarsal angle ( IV-V IMA), the width of the forefoot (WF), lateral deviation angle (LDA), and fifth metatarsophalangeal angle (5 MPA) were also measured preoperatively and postoperatively.
RESULTS: The average postoperative AOFAS score was 91±4.1 points. Seven patients (8 feet) had an excellent outcome and 4 patients (5 feet) a good outcome according to the Coughlin scoring rate. The IV-V IMA averaged 12.29 degrees±1.5 degrees preoperatively, while postoperatively it was 6.18 degrees±1.4 degrees (P<0.0001). The LDA improved from 7.74 degrees±1.7 degrees preoperatively to 4.25 degrees±1 degree after surgery (P<0.0001). The WF decreased from 8.01±1.3 mm to 7.05±1.3 mm (P<0.0001). The mean 5 MPA decreased from 21.7 degrees±4.1 degrees preoperatively to 7.63 degrees±3.4 degrees at final follow-up (P<0.0001). One patient developed a superficial infection around a K-wire.
CONCLUSIONS: Metatarsal sliding osteotomy is a safe and effective method for the correction of symptomatic bunionette in patients below 18 years of age. Further research is required to compare this approach with other treatment methods in this specific age group.
PURPOSE OF THE STUDY: To present the results of shortening scarf osteotomy of the fifth metatarsal as an option for the treatment of forefoot deformities with calluses and associated pain around the fifth metatarsal head.
MATERIAL: In nine patients, 12 osteotomies were performed between 2004 and 2007.The results were evaluated at the end of 2009. One patient had one-stage bilateral surgery two had two-stage bilateral surgery.
METHODS: Surgical treatment was indicated in patients in whom conservative treatment had failed, and after the evaluation of load radiographs of the forefoot. The operation (sec. Barouk) is standardly performed from a longitudinal incision and involves the excision of two bone blocks, 3 to 4 mm in width, from both fifth metatarsal fragments after the osteotomy. Fixation is achieved with two Poldi screws from mini-instrumentation.The procedure can be combined with surgery on the other metatarsals. The lower extremity is then immobilised in a cast for 3 weeks. Partial weight-bearing on the heel is allowed from the second post-operative day and full weight-bearing is permitted after X-ray examination at 6 weeks. The average hospital stay is four days.
RESULTS: Nine patients (12 feet) underwent surgery. The average follow-up was 3.8 years (2 to 5). The average inter-metatarsal angle was 13 degrees before surgery and 4 degrees after it. The average valgus angle of the fifth metatarsophalangeal joint was 25 degrees pre-operatively and 5 degrees post-operatively. The average metatarsal shortening was 6.5 mm.
DISCUSSION: Shortening shaft osteotomy allows for maximal medial translation of the fifth metatarsal and maximal correction of the angle between the fourth and fifth metatarsals. At one stage it permits metatarsal head medialisation, as does chevron osteotomy, as well as proximal translation of the head achieved by Weil osteotomy. The results of shortening scarf osteotomy have been better than those of an isolated Weil procedure, chevron osteotomy or bunionectomy. Percutaneous Krammer's method, BRT, shaft and proximal osteotomies are still discussed.
CONCLUSIONS: Shortening scarf osteotomy of the fifth metatarsal is indicated when conservative treatment is unsuccessful in management of calluses and fifth metatarsal head deformities, particularly in flat-footedness. It can also be used in salvage procedures following failed surgery or in digitus quintus supraductus in adults. It requires experience with first metatarsal osteotomy and a precise operative technique.
Minimally Invasive Osteotomy for Symptomatic Bunionette Deformity Is Not Advisable for Severe Deformities: A Critical Retrospective Analysis of the Results.
Waizy H, Olender G, Mansouri F, Floerkemeier T, Stukenborg-Colsman C. Foot Ankle Spec. 2012 Jan 31.
Quote:
Bunionette, or tailor's bunion, is a painful protrusion on the plantar and/or lateral aspect of the fifth metatarsal head. Until recently, there have been very good results reported in literature when minimally invasive therapy is used to treat this deformity. In this study, the authors critically review the outcome of patients operated by the minimal invasive technique. A total of 31 feet were retrospectively reviewed with a mean follow-up of 52 months (range 14-106 months). The results were related to the preoperative severity of the bunionette deformity. The mean intermetatarsal angle IV/V was reduced from 12° to 7.5° postoperatively. The American Orthopaedic Foot and Ankle Society score showed good and excellent values (80-100 points) at follow-up in 16 (12 type I, 4 type III) feet. Fourteen (2 type I, 5 type II, 7 type III) feet were rated as satisfactory (60-80 points) and one (type III) foot with fair (56 points). Nine patients (5 type II and 4 type III) indicated that they would not undergo the operative procedure again. Our results show inclusive evidence that minimal invasive osteotomies have a good clinical outcome in the treatment of high-grade deformities. The best future option is to consider the classification of the deformity before a minimally invasive operation is to take place.
'Reverse' scarf osteotomy for bunionette correction: Initial results of a new surgical technique.
Guha AR, Mukhopadhyay S, Thomas RH. Foot Ankle Surg. 2012 Mar;18(1):50-4
Quote:
BACKGROUND:
The bunionette or tailor's bunion is a lateral prominence of the fifth metatarsal head. It is usually characterised by a wide intermetatarsal angle (IMA) between the 4th and 5th metatarsals, varus of the metatarsophalangeal (MTP) joint, pain and callus formation. Various distal, shaft and basal osteotomies have been described in the literature. We have described a reverse scarf osteotomy for bunionette correction.
PATIENTS AND METHODS:
We have used a 'reverse' scarf osteotomy in 12 cases (10F: 2M) with a mean follow-up of 12 months (range 5-22 months) with radiographs and clinical scoring.
RESULTS:
Post operatively, mean IMA improved from 13.1° to 7.27° (range 2.0-11.5°); mean 5th MTP angle improved from 19.9° to 6.36° (range 2.8-9.0°) and postoperative mean AOFAS improved from 54.25 to 89.58 (range 70-100).
CONCLUSION:
'Reverse' scarf osteotomy in the correction of bunionette deformity offers promising results in the short term.
Minimally Invasive Osteotomy for Symptomatic Bunionette Deformity Is Not Advisable for Severe Deformities; A Critical Retrospective Analysis of the Results
Hazibullah Waizy, Gavin Olender, Farhad Mansouri, Thilo Floerkemeier, Christina Stukenborg-Colsman Foot Ankle Spec April 2012 vol. 5 no. 2 91-96
Quote:
Bunionette, or tailor’s bunion, is a painful protrusion on the plantar and/or lateral aspect of the fifth metatarsal head. Until recently, there have been very good results reported in literature when minimally invasive therapy is used to treat this deformity. In this study, the authors critically review the outcome of patients operated by the minimal invasive technique. A total of 31 feet were retrospectively reviewed with a mean follow-up of 52 months (range 14-106 months). The results were related to the preoperative severity of the bunionette deformity. The mean intermetatarsal angle IV/V was reduced from 12° to 7.5° postoperatively. The American Orthopaedic Foot and Ankle Society score showed good and excellent values (80-100 points) at follow-up in 16 (12 type I, 4 type III) feet. Fourteen (2 type I, 5 type II, 7 type III) feet were rated as satisfactory (60-80 points) and one (type III) foot with fair (56 points). Nine patients (5 type II and 4 type III) indicated that they would not undergo the operative procedure again. Our results show inclusive evidence that minimal invasive osteotomies have a good clinical outcome in the treatment of high-grade deformities. The best future option is to consider the classification of the deformity before a minimally invasive operation is to take place.
Subcaptial Oblique Fifth Metatarsal Osteotomy Versus Distal Chevron Osteotomy for Correction of Bunionette Deformity: A Cadaveric Study
Minton Truitt Cooper, Michaael J. Coughlin Foot Ankle Spec June 19, 2012 1938640012451315
Quote:
The aim of this study was to compare a distal subcapital oblique fifth metatarsal with a distal chevron osteotomy for correction of bunionette deformity. Materials and methods. Twenty cadaveric feet were randomly assigned to undergo either a subcapital oblique or chevron osteotomy of the distal fifth metatarsal. Radiographic measurements, including 4–5 intermetatarsal angle (IMA), fifth metatarsophalangeal angle (5-MPA) and foot width, were compared between the 2 groups. Results. Foot width and 5-MPA was significantly decreased in both groups with no difference between the groups. The 4–5 IMA was not significantly altered in either group. Conclusion. Decrease in foot width and 5-MPA was similarly achieved with either distal chevron or subcapital oblique osteotomy of the fifth metatarsal in normal cadaveric specimens. No significant difference was found between the 2 techniques in any of the radiographic parameters measured.
Background
Treatment of tailor's bunion is largely conservative. For severe or refractory cases surgical intervention is necessary. The aim of this study is to evaluate a percutaneous technique for correcting such bunionette deformities.
Methods
Twenty-one procedures were performed on 20 patients using a percutaneous technique. Patients were scored using the American Orthopaedic Foot & Ankle Society (AOFAS) Lesser Toe Metatarsophalangeal–Interphalangeal Scale.
Results
No wound healing problems, infections, non-unions or mal-unions occurred. Functional assessments revealed very good results. Radiographic evaluation confirmed good average correction of the fourth–fifth intermetatarsal angle and metatarsophalangeal angle.
Conclusions
This percutaneous technique is a reliable and effective approach for the treatment of bunionette deformity. The results obtained were comparable to those reported using traditional open techniques, but major complications due to soft tissue damage were averted. This technique can be adapted depending on the type of deformity, and does not require internal fixation.
I like scarf for tailor's bunion deformity, but have not tried shortening technique. I am reqeusting above article, but would like to hear pros/cons from other who have done shortening scarf.
I like scarf for tailor's bunion deformity, but have not tried shortening technique. I am reqeusting above article, but would like to hear pros/cons from other who have done shortening scarf.
Hi,
The rotation scarf for 5th metatarsals as described in Maher & Kilmartin's article (above) is my primary procedure for tailor's bunions (apart from cheilectomy in isolated hypertrophic lateral condyles). I have yet to perform a shortening scarf as described in the other abstract below, but I have yet to see a foot that I believe would need one. I have altered the orientation of my longitudinal cut to alter the relative plantar/dorsiflexion of the 5th metatarsal head relative to the 4th in cases with 5th MTPJ plantar callus with good results. My worry with shortening is transfer lesions to the 4th which I do not seem to see with the standard rotation. I can not seem to access the full article so I also would be interested if you report back on their findings.
This is one of the popular MIS procedures that were frequently performed. I performed quite a few osteotomies at the level of the anatomical neck of the 5th metatarsal using a shannon #44 burr. I loved this MIS procedure and they healed great.
Subcaptial Oblique Fifth Metatarsal Osteotomy Versus Distal Chevron Osteotomy for Correction of Bunionette Deformity; A Cadaveric Study
Minton Truitt Cooper, Michael J. Coughlin Foot Ankle Spec October 2012 vol. 5 no. 5 313-317
Quote:
The aim of this study was to compare a distal subcapital oblique fifth metatarsal with a distal chevron osteotomy for correction of bunionette deformity. Materials and methods. Twenty cadaveric feet were randomly assigned to undergo either a subcapital oblique or chevron osteotomy of the distal fifth metatarsal. Radiographic measurements, including 4–5 intermetatarsal angle (IMA), fifth metatarsophalangeal angle (5-MPA) and foot width, were compared between the 2 groups. Results. Foot width and 5-MPA was significantly decreased in both groups with no difference between the groups. The 4–5 IMA was not significantly altered in either group. Conclusion. Decrease in foot width and 5-MPA was similarly achieved with either distal chevron or subcapital oblique osteotomy of the fifth metatarsal in normal cadaveric specimens. No significant difference was found between the 2 techniques in any of the radiographic parameters measured.
A paucity of data is available on the mechanical strength of fifth metatarsal osteotomies. The present study was designed to provide that information. Five osteotomies were mechanically tested to failure using a materials testing machine and compared with an intact fifth metatarsal using a hollow saw bone model with a sample size of 10 for each construct. The osteotomies tested were the distal reverse chevron fixated with a Kirschner wire, the long plantar reverse chevron osteotomy fixated with 2 screws, a mid-diaphyseal sagittal plane osteotomy fixated with 2 screws, the mid-diaphyseal sagittal plane osteotomy fixated with 2 screws, and an additional cerclage wire and a transverse closing wedge osteotomy fixated with a box wire technique. Analysis of variance was performed, resulting in a statistically significant difference among the data at p <.0001. The Tukey-Kramer honestly significant difference with least significant differences was performed post hoc to separate out the pairs at a minimum α of 0.05. The chevron was statistically the strongest construct at 130 N, followed by the long plantar osteotomy at 78 N. The chevron compared well with the control at 114 N, and they both fractured at the proximal model to fixture interface. The other osteotomies were statistically and significantly weaker than both the chevron and the long plantar constructs, with no statistically significant difference among them at 36, 39, and 48 N. In conclusion, the chevron osteotomy was superior in strength to the sagittal and transverse plane osteotomies and similar in strength and failure to the intact model.
BACKGROUND:
Treatment of tailor's bunion is largely conservative. For severe or refractory cases surgical intervention is necessary. The aim of this study is to evaluate a percutaneous technique for correcting such bunionette deformities.
METHODS:
Twenty-one procedures were performed on 20 patients using a percutaneous technique. Patients were scored using the American Orthopaedic Foot & Ankle Society (AOFAS) Lesser Toe Metatarsophalangeal-Interphalangeal Scale.
RESULTS:
No wound healing problems, infections, non-unions or mal-unions occurred. Functional assessments revealed very good results. Radiographic evaluation confirmed good average correction of the fourth-fifth intermetatarsal angle and metatarsophalangeal angle.
CONCLUSIONS:
This percutaneous technique is a reliable and effective approach for the treatment of bunionette deformity. The results obtained were comparable to those reported using traditional open techniques, but major complications due to soft tissue damage were averted. This technique can be adapted depending on the type of deformity, and does not require internal fixation.
Tailors Bunion Surgery
Linear Mode
